Inadequate progress on clinical engagement in hospitals

Published: Fri 2 Oct 2015 12:11 PM
2 October 2015
ASMS survey highlights inadequate progress on clinical engagement in hospitals
A survey of ASMS members employed in district health boards this year highlights the lack of progress being made on genuinely incorporating distributive clinical leadership within the country’s public hospitals, says Ian Powell, Executive Director of the Association of Salaried Medical Specialists (ASMS).
The survey asked senior doctors and dentists whether their district health boards (DHBs), chief executives and senior management teams were genuinely committed to distributive clinical leadership. As with the previous survey carried out in 2013, the results were mixed.
“Once again we’ve seen that a few DHBs and chief executives are doing quite well, but most need to improve their performance in this area,” says Mr Powell. “Like 2013, these latest results show that the Government’s policy on clinical leadership – and the good intentions expressed for more engagement – have not materialised in public hospitals in a sufficiently meaningful way. If anything, it is deteriorating.
“It’s worth reiterating that distributive clinical leadership is not just something that’s nice to have. It’s about drawing on the experience and many years of training of clinical staff – in this case, senior doctors and dentists – to drive decisions about delivering the best possible health care for New Zealanders.”
Distributive clinical leadership ensures that hospital specialists are able to lead decision-making at many levels of the system which improves quality of care, patient safety and financial performance. This type of leadership is distributed throughout the specialist workforce and is quite different to formal clinical leadership positions held by individuals. More information can be found at
A total of 1182 ASMS members answered this year’s survey (32% of those approached). The overall results were:
• 29% believed their DHB was genuinely committed to distributive clinical leadership (down from 30% in 2013)
• 27% believed the culture of their DHB encourages distributive clinical leadership (down from 28% in 2013)
• 56% had a partially or largely favourable rating of their chief executives’ support for distributive clinical leadership (down from 58%) in 2013, while slightly more rated their chief executives’ work in this area negatively (21%, up from 18% in 2013)
• 58% had a partially or largely favourable rating of their senior managers, up from 53% in 2013.
“These results show us that there has been very little movement in the past couple of years,” says Mr Powell. “We’ve seen a few rises and falls, but overall it’s nothing to write home about.”
How the DHBs performed:
• Pretty good – Northland, Hawke’s Bay, West Coast, Canterbury (2013 results: Lakes Canterbury, West Coast)
• Could do better but showing promise – Waitemata, Auckland, Counties Manukau, Lakes, MidCentral, Nelson Marlborough (2013 results: Northland, Waitemata, Counties Manukau, Waikato, Tairawhiti, Hawke’s Bay, Taranaki, MidCentral, Nelson Marlborough, South Canterbury)
• Need to really lift their game – Bay of Plenty, Taranaki, Whanganui, South Canterbury (2013 results: Bay of Plenty, Whanganui, Capital & Coast)
• In serious difficulties – Waikato, Tairawhiti, Wairarapa, Hutt Valley, Capital & Coast, Southern (2013 results: Auckland, Wairarapa, Hutt Valley, Southern).
“There’s a strong message here to the people running New Zealand’s public hospitals – you need to make more effort to involve senior doctors and other clinical staff in your DHB’s decision-making, and to encourage them to have input from the very start of evaluating, designing, organising and delivering health services. To do otherwise will ultimately compromise the quality of patient care and worsen financial performance.”
The survey results are available in more detail in the latest issue of the ASMS magazine, The Specialist, which is available at

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