16 Garfield Street 16, rue Garfield

PO Box 2000, Charlottetown C.P. 2000, Charlottetown

Prince Edward Island Île-du-Prince-Édouard
Canada C1A 7N8 Canada C1A 7N8

April 25, 2023

The Honorable Diane Griffin
Chair of the Board of Directors,
Health PEI

Dear Diane:

This letter is to provide notice that I plan to leave the position of CEO of Health PEI on
October 31, 2023. I am, however, open to the possibility of staying on in the role until
the end of the calendar year if it would help provide some overlap with the incoming
CEO. I have stayed on the Island longer than I anticipated, having originally committed
to a 6-month contract in 2020, and will be returning home to Ontario to be closer to
family and to pursue other projects.

Given our small size and geography, I have always felt that PEI has the potential to
have an efficient and nimble healthcare system. I also believe, though, that Health PEI
was set up for failure from the time of its creation, with inconsistent and unclear
responsibilities and accountabilities, lack of a global budget, and enduring historical
decisions that left the health authority relatively powerless to do the work it needed to
do. Health PEI’s former Board Chair, Mr. Derek Key, has spoken about many of these
issues. Indeed, many of the challenges we face were decades in the making and it will
take several years more to achieve stability in the healthcare system.

This all being said, I believe that we have seen progress in addressing some of these
issues, all while facing unprecedented health human resource challenges following the
COVID-19 pandemic.

Some examples of successes include:

• Health PEI weathered the large Omicron wave of COVID-19 with minimal
service disruptions, despite having a significantly understaffed system. This
contrasts with most other Canadian jurisdictions;

• The impact of COVID-19 on our surgical waitlists was minimal, less than in any
other province, due to the close and careful management of resources and
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patient flow;

• Islanders were prescribed many-fold more Paxlovid per capita than any other
province;

• Significant advancements in creating provincial programs rather than hospital or

region-based programs, which has broken down silos and allowed us to use our
resources more efficiently. Health PEI is now finally living the tagline of “One
Island Health Authority”;

• Minimal service disruptions due to Hurricane Fiona;

• Changes to Treasury Board policy to allow Health PEI more budget flexibility
and lessen bureaucracy. I believe that lack of budget flexibility was one of the
decisions in 2010 that significantly hampered the newly formed Health PEI;

• Creation of a people strategy to begin tackling the longstanding staff retention

issues at Health PEI. The strategy is guided by feedback from staff in all service
areas through the first Employee Engagement Survey for Health PEI;

• Recruitment of a solid senior team of Chiefs and Executive Directors who are
transforming our system;

• Repatriation of communications from government and expansion of the program

so that we can better communicate operational issues with Islanders;

• Creation of a patient relations unit—while still in the development stage, this unit
will transform how Islanders interact with the healthcare system and
dramatically improve communication and support;

• Health PEI is a founding member of the Atlantic Clinical Trials Network which
will have an important role in bringing research to the Island when Health PEI is
ready to do so;

• The faster-than-anticipated rollout of Patient Medical Homes across the

province. This is the future of primary care in North America;

• The creation of Health PEI-led clinics for unaffiliated islanders to have access to
in-person primary care when required;

• Collaboration with the provincial government to create the Pharmacy Plus

program, enabling Islanders to receive expanded services from their community
pharmacists;

• Successfully passing Accreditation during the pandemic;

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• Collaboration with the College of Physicians and Surgeons and government to

work towards making it easier to license physicians to practise on the Island.

I am proud of these successes, which have been achieved through the dedication of
our leadership team, government partners and, of course, our Health PEI staff at all
levels. Yet, we have much more to do and it needs to be done quickly.

• First and foremost, the province has not yet solved its crippling
healthcare worker shortages. As I stated at Standing Committee on Health a
few months ago, most of our problems relate to short staffing, a situation that
has only gotten worse. Staff shortages are at the root of many of our retention
issues. At the same time, our province is the fastest growing in the country, and
our system has not kept up with immigration. There is no one cause for our
inability to recruit enough healthcare workers into our system; rather there are
multiple causes and there is no simple solution. This challenge requires
significant attention.

• Our current system of classification, hiring and recruitment is not working for
Health PEI and I am pleased that we are starting to make changes in this area,
but they are slow relative to our current situation. This is not a slight on the
hard-working people in those roles. Our current model has Health PEI holding
all of the accountability for short staffing with historically little authority to
address the issue, which is both demoralizing and exhausting;

• The impact of the UPEI Medical School on Health PEI doctors will be profound.
Work is underway to understand just how profound, but we will need to rethink
our entire physician recruitment, work, and payment models. How we will recruit
the necessary number of physicians remains to be seen;

• Our hospitals are not being used to their full potential, with our community
hospitals not being able to provide enough services to their regions because of
short staffing and because, the majority of inpatient beds are occupied with
patients who would be better cared for outside of the hospital system;

• Lack of staffing has put our smaller Emergency Departments at perpetual risk of
closing—in the absence of recruits, we will have to rethink how the regions
served by these EDs will obtain access to quality emergency services;

• The policy of physician complement, i.e. a cap on physician hiring, remains in

place and is regressive and detrimental to recruitment efforts. Those who lobby
to keep complement in order to ensure recruitment to smaller communities do
not understand that in today’s health human resources market, doctors cannot
be forced to work anywhere they don’t want to work;

• We must continue our drive to create provincial services to stop the historic
healthcare competition between different regions. PEI is far too small to support
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specialty program duplication, which has led us to a cycle of crisis as the

number of physicians in smaller programs is very unstable – one or two
physicians leave, and the system nears collapse;

• We need to reopen the Master Agreement with MSPEI, to ensure, amongst

other things, that Family physicians are appropriately remunerated for the
central role they have in our healthcare system;

• The rollout of the ambulatory care Electronic Health Record has been
challenged by a product that still requires a fair bit of improvement; however, as
these issues are fixed, the rollout to the community must continue;

• Health PEI is the only provincial health system without a learning management
system or an intranet, which has made communication and fostering a sense of
teamwork very difficult. Work is being done to remedy this, but it is slow.

Thus, there is much more work to be done; however, we are now in a better place to
tackle these issues, with most stakeholders understanding why changes need to be
made. I remain hopeful that Health PEI in 2024 will be in a different state from when I
first came to the Island in 2020, provided we continue to push onwards.

Despite some political rhetoric during the election period to the contrary, there are no
quick fixes to the status quo: this has been proven to be wrong time and time again in
every province. Canada has a long history of applying band-aids to our system and I
believe that band-aids are no longer enough. What is required is a significant
rethinking of how our provincial healthcare system functions, the services it can
provide, and bold, rapid actions to make the necessary changes. I cannot stress
enough that speed is of the essence as all aspects of our system are severely
strained. Our healthcare workers at all levels of our organization have deep insight
into the changes that need to be made. I believe we need to trust their expertise and
empower them to make these changes.

When this letter inevitably makes its way into the public, I want it to be known that this
is not a “resignation in protest”, something I have had to experience far too often in this
role. Being Health PEI’s CEO is not an easy job, especially during a long and tiring
pandemic. Like many of our healthcare workers, I am exhausted and need a change
for my personal well-being. My leaving should not be seen as a slight on either the
Board or the government. We have developed a good working relationship over my
more than two years as CEO, which I hope my successor will be able to build upon.

I believe we are in a better position than at any point in Health PEI’s history to push
through with significant improvements. I look forward to continuing to make positive
changes through the end of my tenure.

I have loved living on the Island and have truly enjoyed working with Islanders to help
make our healthcare system better. The team I work with every day at Health PEI is
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truly second to none, and if anything has kept me in this role, it is their inspirational
dedication to their work under very difficult conditions.

Sincerely,

Dr. Michael Gardam

CEO, Health PEI

Cc: Dan Campbell, Secretary of Executive Council

Pamela Williams, Chief of Staff, Premier’s Office
The Honourable Mark McLane, Minister of Health and Wellness
Lisa Thibeau, Deputy Minister of Health and Wellness