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Taking on the biggest job in health

Margie Apa

Elizabeth Brown | Senior Communications Advisor

Fepulea’i Margie Apa was involved in setting up the country’s District Health Boards more than 20 years ago. Now she is heading up the single organisation replacing them.

Margie has been appointed as the interim Chief Executive of Health New Zealand. She started the job early this year and will lead Health NZ when it officially comes into being on 1 July. Health NZ will merge the functions of the existing DHBs and lead the day-today operational running of the health system. Significantly it will become the country’s largest employer with a workforce of about 80,000. Raised in south Auckland and proudly Samoan (Fepulea’i is a chief title from her family village on the island of Savai’i), Margie has held many senior positions in the health sector over the past 24 years. Most recently she was Chief Executive of Counties Manukau DHB.

Motivation

The opportunity to “really get traction on improving health equity” is what pushed her to want to take on such a large and challenging role. “We know there are pockets of our communities - Ma -ori, Pacific, low income, rural – and we need to support a diversity of models that will reach out to those communities more easily and that’s what really motivated me to apply.” Simplifying and taking out what she calls “unwanted variation” in patient care, added motivation. “I think one of the advantages of being one organisation is that we can simplify funding arrangements. We can make decisions and move more quickly to implement them and try to get the balance right in developing enough flexibility locally, but also assure New Zealanders that they are getting consistency and quality of care or access, although it may look different for their local area.”

With the clock ticking down on July 1, exactly what Health New Zealand will look like and how it will run, is still unclear.

There is no national leadership team for the organisation yet, but Margie says she is not frightened by the tight deadline. She says her immediate focus is to lay out a clear plan and timelines to give people working in the system some certainty. “I want people to understand that actually large parts of the system aren’t going to change. The new bits are really shaping up national and regional functions, but for most people who work in a hospital, their boss won’t change come July 1.”

I want people to understand that actually large parts of the system aren’t going to change.

Clinical networks

Working with SMOs to strengthen clinical networks is something she wants to happen quickly, supported by better data and digital resources. “Imagine in a clinical network being able to see how we are delivering and offering care to people, not only in their own hospital or setting, but being able to see that regionally and nationally – that’s quite exciting to me.” Margie says these networks will be critical in identifying what is needed, especially where there are vulnerable national services.

Clinically led decision making

In terms of the future of local and clinically led decision making there is no intention “to grow a monolith in one place that’s going to make decisions for the country,” according to Margie. “I think it’s important that clinical leaders are well placed in our system to be part of decision making because they have a professional obligation to tell us if we are doing things to put patient safety at risk and I value that input absolutely.” ASMS members regularly express frustration with top-down management or poor management culture. In terms of shifting that culture, Margie intends to build on what she believes was her successful work at Counties Manukau - embedding clinical and managerial partnerships and giving clinical leaders clear roles in setting strategic development for their services. “We’re going to be really transparent about how we make decisions because it’s not about trading off clinical issues for managerial priorities – they should really be the same. We’re all aiming for the same outcomes and the same improvements in clinical care.”

We’re going to be really transparent about how we make decisions because it’s not about trading off clinical issues for managerial priorities – they should really be the same.

Workforce planning

With what are now entrenched staffing shortages in hospitals, combined with the woeful lack of workforce planning, Margie says she’s heard the views of ASMS on the need for urgent action on a centralised, co-ordinated approach to workforce planning and supply. She says work is already underway to prioritise the issue. “It’s not something we can do on our own – we need all the players at the table. Tertiary and training institutions need to have a look at their pathways, the colleges need to be part of the conversation, and the Ministry. If there are regulatory settings getting in the way, we need to get them out.” “We need to be active. We can’t spend three months planning. We need some interventions to collectively take on. Unions are central to this,” she says. Margie is careful to avoid comment on the current ASMS-DHB MECA negotiations, except to say that “it’s a challenging point in time.” However, she acknowledges the need to retain talent, skills, and experience, and for more resources and support at the frontline. “We need to support the capacity so people can take the time out and we can roster and schedule people to really be supported in their wellbeing. I know there’s variation in practice and support and we want to make that a more consistent experience for your members.”

Unwelcome distraction?

There has been criticism that transitioning to Health NZ during a global pandemic, is an unwelcome distraction. There is also concern that with such high workloads, SMO/SDOs simply do not have time to engage in clinical planning and change process. Margie’s response is that Covid has exposed the realities of workforce shortages and infrastructure investment and the reasons why “we need to push on.” She promises she is not tone deaf to the pressures of the frontline. “We have to be careful and mindful as Health NZ that we are inviting our clinical leaders who are trusted and respected in their field by their peers and that we free up and support their capacity to be able to contribute.”

We have to be careful and mindful as Health NZ that we are inviting our clinical leaders who are trusted and respected in their field by their peers and that we free up and support their capacity to be able to contribute.

“What I’m hearing is that we need to be mindful of the pressures, but I’m not hearing anyone say stop, because the pressures we’re seeing were there before Covid.”

As Health NZ Chief Executive, Margie will remain Auckland-based but with a lot of time spent in Wellington. She is currently organising visits to DHBs and has accepted an invitation to speak to the ASMS National Executive in June.

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