Leading into the future

Sarah Dalton | Executive Director

As we inch towards Health New Zealand and a Ma -ori Health Authority, it’s important to keep talking about the critically important role of clinical leadership across our health system. In hospitals, this starts with the CMO and streams through to other formal leadership roles (CDs, HoDs, clinical leads), but actually includes all senior doctors and dentists. You are all clinical leaders in your services and your chosen field.

We notice when we work with groups of SMOs on service sizing, rosters, call arrangements and the like that where the CMO has a strong clinical voice, we tend to get better outcomes. Having senior clinical leaders role-modelling the primacy of clinically led decision-making is key to a successful health system. This is something we will continue to strongly speak up for.

“If Health New Zealand is to succeed it will need to recognise and promote clinically led decisionmaking at every level of our health system.”

As we’ve previously noted in The Role of the Clinical Director: A practical guide (which is available on our website), clinical leadership is critical in setting the tone and culture of our health services:

“The [clinical leader] has a pivotal role in determining departmental culture. This includes transparency, decision-making, inclusiveness, and equity. ASMS research has shown high levels of burnout and bullying among New Zealand SMOs, which needs to be addressed urgently. There is often heavy pressure on [clinical leaders] to achieve patient-turnover targets for their department, but this should not be at the expense of staff well-being, and in fact employment legislation prohibits this. The ASMS MECA recommends 30% non-clinical time as part of SMOs’ job-size. Advocating for adequate non-clinical time, documented and appropriate recovery time, regular service sizing and succession planning are key aspects of [the] role.” If Health New Zealand is to succeed it will need to recognise and promote clinically led decision-making at every level of our health system.

A nasty hangover

One of the key weaknesses of the current system is an over-reliance on bean-counting as the driver of planning and funding decisions. This is a nasty hangover from the neoliberal approach that pretended hospitals were businesses. They are not. Hospitals are critical public institutions, and only by placing people rather than balance sheets at the centre will we start to build a system that provides safe, sustainable work for its staff, and best care for all patients. This pseudo-business approach to running our health system has also fuelled a race to the bottom in terms of funding that sets DHB against DHB in a race for scarce resources. As Otago University’s Professor Robin Gauld recently observed in a Newsroom article, “The DHBs are providing more services than they’re funded for, so they wind up in this situation of being underfunded or having a so-called deficit".

“One of the key weaknesses of the current system is an over-reliance on beancounting as the driver of planning and funding decisions.”

Strategic and systematic underfunding of staffing and infrastructure has directly contributed to the DHBs’ preference for slight understaffing of services over a more considered, forward-looking approach, which would support good workforce datagathering, proactive succession-planning, and use of staff wellbeing data as key metrics to determine clinical and support staffing FTE. We need Health NZ to be able to flex with surge and demand. It must provide a structure that gets ahead of future growth, and which builds in significantly enhanced workforce modelling, development, and investment functions. That means starting from zero, as few if any of these things are currently in place.

Building on good practice

There are a few existing pockets of good practice that will help us. A handful of DHBs have recognised the work individual SMOs are doing to develop better workplace practices around staff wellbeing. This work recognises that wellbeing is an organisational concern, requiring whole-of-system responses. It’s not asking staff to be resilient, drink kale smoothies and attend lunchtime yoga. We need to build on this isolated good practice and lobby for funded (and backfilled) SMO roles to develop and lead this work. ASMS is keen to establish a network of wellbeing champions to connect, support and nurture the research and implementation work they’re doing. I’ll be talking to the Transition Unit about the vital importance of roles like these. I hope you will too. Staff from the Transition Unit have committed to attending several of our JCC pre-meetings over the coming months. It will provide an opportunity to speak directly with some of the people tasked with putting together the Health NZ Charter, which they tell us will underpin the whole healthcare workforce. I warmly encourage you to attend your next JCC. And finally, a big thank you to all of you who attended the recent stopworks. We know how precious your time is, so it was great to see so many of you actively participating. Nga - mihi