DHBs fail clinical leadership tests

“District health boards are too busy telling their Minister what they think he wants to hear and are failing to provide the leadership New Zealand’s health system needs,” said Mr Ian Powell, Executive Director of the Association of Salaried Medical Specialists (ASMS), today.

“We’ve surveyed our members working in public hospitals two times now, and both times we’ve found that not enough is being done to provide senior doctors and dentists with opportunities for clinical leadership,” he says. “A few DHBs and chief executives are doing well, and they’re to be commended, but most are really failing.

“Frankly, they’re missing the point of clinical leadership. It’s not a luxury or a nice-to-have but an essential part of a safe modern health system. It’s a no-brainer to involve a highly skilled professional and committed workforce in leadership decisions about the services they then have to deliver.”

The first ASMS survey was done in August and September 2013, and found that most hospital specialists (63%) simply did not have enough time to take part in clinical leadership activities.

The second survey carried out at the end of last year, and reported in the latest issue of the ASMS magazine The Specialist, aimed to better understand the performance of individual DHBs, chief executives and hospital managers on the issue of clinical leadership.

“The findings make for grim reading,” says Mr Powell. “There’s significant variation between the DHBs and chief executives performing well and those at the bottom of the class, who really need to be sent to the principal’s office for some remedial homework.”

He says the failure to engage with hospital specialists and involve them more fully in decision-making is not just an issue for the people managing New Zealand’s hospitals; it can also be sheeted home to the Government.

“The broader political failure to invest in the specialist workforce has resulted in entrenched shortages which have become the norm in the health sector. One of the consequences of this is an increased workload for senior doctors and less time to get involved in anything else. Improving clinical leadership was once a flagship government policy. Now it is a policy failure.”

Mr Powell says DHBs have been saying all of the right things about clinical engagement for several years now but the two membership surveys show the reality is somewhat different.

“DHBs need to lift their game in this area as it has flow-on effects for patients, specialists and health care delivery. It’s not enough for them to tell the Government what it wants to hear about clinical engagement – they need to provide some real leadership for the sector,” concluded Mr Powell.

The latest survey results, just published, found:

DHB ratings - 30% of members surveyed thought their DHB was genuinely committed to distributive clinical leadership, 47% felt their DHB was not, and the remaining 23% were not sure. Just two DHBs scored higher than 50% - Canterbury (62%) and Lakes (56%). The worst results were recorded for Wairarapa, Hutt Valley, Southern, Bay of Plenty, and Auckland DHBs.
Chief executive ratings – members rated their chief executive’s commitment to enabling effective distributive clinical leadership in their DHB’s decision-making. Overall, 12% thought their chief executive was working to a great extent to do this, 46% believed to some extent, 18% to no extent, and 24% said they didn’t know. Canterbury/West Coast DHBs’ Chief Executive David Meates was the standout performer while 12 other chief executives received the lowest ratings.

DHB senior managers – by and large these people were rated lower than the chief executives they report to. Just 8% were thought to be enabling clinical leadership in decision-making to a great extent, 45% to some extent, 25% to no extent, and 22% of members were not sure. When the ‘great extent’ and ‘some extent’ categories are combined, the top performing senior managers appear to be in Hawke’s Bay, Canterbury, Lakes, Nelson Marlborough and Taranaki DHBs. The poorest performers are South Canterbury, Bay of Plenty, Southern, Wairarapa and the Hutt Valley DHBs.

DHB middle managers – these rated even lower, with just 7% of members saying they enable effective distributive clinical leadership to a great extent, 43% to some extent, 32% to no extent, and 18% saying they do not know.

Human resource managers – these performed worst in the survey, with a national average rating of just 2% for ‘great extent’ 19% for some extent, and 40% considered not to be enabling distributive clinical leadership at all. Another 39% of members said they did not know if their HR manager was enabling clinical leadership.

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