Health boards cannot borrow credibility

‘Credibility is a leader’s currency. With it, he or she is solvent; without it, he or she is bankrupt.’ — John C. Maxwell

In Manitoba health care, credibility manifests on the balance sheet. It shows up when a board asks executives to endure change, patients to trust a plan and the government to fund another deficit. Lose credibility and every decision eventually carries interest.

Dr. Alan H. Menkis, in the Free Press, recently asked: “For the patient, where does the buck stop?”

His concern was a health system with many layers: government, Shared Health, regional authorities, hospitals, boards, agreements, legal counsel and executives. Each layer can be lawful. The patient can still disappear between them.

For CEO appointments, the buck should stop at the board table.

A governance board does not run daily operations. Its work is direction, policy, financial oversight, risk, quality, safety and CEO accountability. Hiring and evaluating that chief executive is where governance spends or earns credibility.

Shared Health shows how quickly that currency can be depleted. Since its inception in 2018, Shared Health has had five CEOs. My back-of-the-napkin calculation shows that the average tenure of a Shared Health CEO is just over a year and a half; roughly 20 months. The only public office that makes that look durable these days is the revolving door at 10 Downing St.

Health care does not run on 20-month timelines. A five-year clinical plan, capital project, workforce strategy or culture-change mandate cannot be credibly delivered if the person accountable for execution is replaced every year or two.

On the health organization board I serve on, we recently made that choice. After executive turnover, senior management turnover and public scrutiny, an interim executive director helped stabilize the organization. Policies were strengthened and a new strategic plan was completed.

An extension would have been convenient. It promised continuity and an open competition risked being misread as a vote of no confidence. We posted anyway. The current executive director could apply. The successful candidate would be chosen through competition.

That was not a knock against the interim leader. It was a decision to protect the credibility of the organization.

An interim appointment is often necessary during a crisis. A permanent appointment is different. When a board quietly converts an interim role without competition, questions become inevitable: Who else was considered? What criteria were used? Was this the best candidate or simply the most convenient one?

A fair process protects the organization, the board and the successful candidate.

Manitoba’s health system is now facing the same test on a larger scale.

In February 2025, the CEOs of Shared Health and the Winnipeg Regional Health Authority were dismissed by their respective government-appointed boards and replaced with interim CEOs. The public explanation was fiscal and organizational: independent audits found regular overspending, governance problems and budgeting weaknesses.

If leadership change was justified by financial discipline, the next leadership decision should be judged by financial discipline too. Credibility requires the ledger to be transparent.

The numbers do not show a clean fiscal turnaround. Manitoba Health, Seniors and Long-Term Care spent $9 billion in 2024-25, up from $8.6 billion the previous year.

Manitoba’s 2025-26 budget shows WRHA receiving a $322.1-million funding increase over the 2024-25 budget. Shared Health is receiving a $128.7-million increase. Those increases may be justified. If deficits shrink, can we attribute it to improved management or did the government just cut a larger cheque?

Credibility is the difference between a turnaround and a bailout.

Frequent turnover does not mean boards should keep a chief executive when performance fails. Accountability requires consequences. Stability cannot mean anointing an interim leader without scrutiny. Credibility cannot be retrofitted after the announcement.

If the current interim CEOs are the best candidates, an open competition should strengthen them. If boards choose not to post, they owe the public a clear explanation of the process and evidence that the failures which led to the last leadership change have been corrected.

Have budgets improved because fiscal discipline is stronger or because appropriations are larger? Are deficits shrinking because management has improved or because the draw from government has increased?

Menkis asked where the buck stops for the patient. For CEO appointments, the buck stops with the board.

Credibility is a leader’s currency. It should not be borrowed against or spent casually. It certainly cannot be earned through a press release. Patients, staff and taxpayers deserve boards that give CEOs a clean mandate and the public a clear account.

Dr. Rafiq Andani is a physician and health policy expert who has practised across rural, remote and urban Manitoba, including work in First Nations and Inuit communities. He previously served as the associate chief medical officer for Shared Health.