Business desk has published an excellent article by Ian Powell yesterday on the health reforms. Under the headline Why it’s risky to get rid of DHBs the article included:
There are two ways to make sustainable, transformational changes in universal public health systems – structural change or changing the culture. Structural change lends itself to blue-sky thinking by whiteboard warriors. Unless it arises out of cultural change, it’s likely to be simplistic and fail. Cultural change, including at a leadership level, takes longer but it’s more likely to be sustainable. To be effective, it needs to recognise that the experience and expertise in health systems rests first with its workforce of health professionals.
To best use this impressive intellectual human capital, leadership needs to be spread throughout this workforce. Universal health systems are complex, dynamic, interdependent and workforce dependent. This means cultural change must be the main driver. Health professionals, especially medical specialists, are experts in complexity. It makes sense to use this attribute to continually improve the systems’ complex processes.
The more widely distributed this culture is, the more likely it is that outcomes will make both good clinical and financial sense. This is the recipe for sustainable transformational change. But cultural change has a problem. It requires paragraphs to explain it, while structural change can be explained in soundbites.
Nevertheless, until minister of health Andrew Little announced his surprise decision in April to abolish district health boards by July 1, 2022, the expression ‘cultural change trumps structural change’ was a mantra in our health system. However, these approaches don’t have to be opposite alternatives. Structural change can be justified when it reinforces cultural change. But structural change alone won’t lead to sustainable improvement in systems.
There are high risks in simplistic structural change designed by business consultants, including unintended consequences. One immediate casualty will be the loss of decision-making by those who know their populations well; decision-making will be further away from populations and workforces than it is now.
The cabinet-approved decision was very much last minute and knowledge of it was confined to a limited number of people. The prime minister’s transition unit set up to implement the Simpson review is effectively run by business consultants, primarily EY. Its head isn’t even an employee of the prime minister’s department; instead EY is contracted to provide its senior partner Stephen McKernan.
The experience and expertise to advise government is primarily in the health system, not in this tight transition unit.
Here’s a link to this article: https://businessdesk.co.nz/article/opinion/why-its-risky-to-get-rid-of-dhbs
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