Transcript Document

HEALTH LEADERSHIP: THE CONTEXT
CDAMS EXECUTIVE LEADERSHIP
PROGRAM
February 2005
Robert Wells
OBSERVATION
‘There is something fascinating about science. One gets
such wholesale returns of conjecture out of such a
trifling investment of fact.’
(George Orwell)
OVERVIEW








Globalisation
Economics
The disappearing workforce
The changing health care scene
Policy
Australia: health & education
Leadership
Some challenges
GLOBALISATION
 Trade:
 Free trade agreements
 Goods & services
 International conventions:
 Human rights
 Workforce
 Mobility
 Shortages
ECONOMICS
 Microeconomic reform: National Competition Policy
 Balanced budgets & economic rationalists
 Costs:
 increasing % GDP on health
 ‘out of control’ items- PBS
 Intergenerational issues
 Increasing ‘dependency’
THE DISAPPEARING WORKFORCE





Shorter working hours by choice & decree
Longer training time for specialties
Increasing specialisation vs generalists
The 2020 problem
Driver for policy & practice changes
THE CHANGING HEALTH CARE
SCENE
More complex care & treatment needs
More treatment modalities
Teamwork
Patients are better educated & have access to much
more information about their conditions
 Patients invest enormous amounts of their own
money in alternative & complementary therapies




AUSTRALIA- HEALTH








Multiple jurisdictions
Multiple funding buckets within jurisdictions
Obsession with hospitals & waiting lists
Private & public
Centralisation of control: ‘central agencies’
Reform = reorganise
Policy = $
ALP looking for a health policy?
POLICY PRELUDE
 A philosophical diversion:
 Plato & the shadows
 Bishop Berkley & the disappearing quadrangle
POLICY






Evidence-based
Rational process
Balancing of interests
Long term perspective
Open & accountable
Objectively evaluated






Reactive
Ad hoc
Highly targeted
Short term horizon
Secretive
Spin
AUSTRALIA- EDUCATION









Higher education reforms:
Local market in medical school places
Greater accountability & control
Redefinition of a university
Medical education changes
PBL
Graduate/ mature entry
Clinical focus
Rural Clinical Schools/ UDRHs
AUSTRALIA-RESEARCH




NHMRC & ARC funding peaks
Matching $
Commercial returns
All adds up to intense internal competition within &
between universities
LEADERSHIP





Art rather than science
Great leaders rarely talk about it
Creativity & innovation vs caution & propriety?
Harder to say ‘yes’
Lack of time
LEADERSHIP - ESSENTIALS
 Know the business
 Know the ‘rules’
 Know your team
… and remember
‘And when we think we lead, we are most led’ (Byron)
‘Don’t panic’ (Dad’s Army)
SOME CHALLENGES








Redesign medical education & research:
Learn in teams to work in teams
Takes too long to train
Research to make a difference
Redesign workplaces and tasks in health system
Leaders not just in medical education & research but also:
Shaping health policy
Shaping education policy