Before we get carried away with the usual internal bunfights, let’s all take a deep breath and have a look at how to help turn the Government’s plans for health reform in to something useful and workable.
That seems to be the suggestion from Dr David Briggs, editor of the Asia Pacific Journal of Health Management, who has some evidence to share about what health management academics think will be useful.
He writes:
“The Croakey blogs are already demonstrating that the perceptions of contributors about health reform are dominated by self interest, ‘strife’s of interest’ (Sax), ‘Vipers nests’ (Leeder) and, not surprisingly, by personal negative experiences of the health system.
Michelle Grattan at the National Press Club presentation by the Prime Minister asked him did he have a plan B and C, in case plan A did not get up. Remember plan A came out of a significant national health reform consultation and report.
Research by this author of what health managers think of the health system is informing. They saw the health system as one of constant, complex change in a particularly non adaptive system. A system that they say is overly controlled by bureaucratic and political interests and one in which managers are no longer central to and responsible for the change.
Remember, in this research we spoke to health managers, not health bureaucrats and, they are different and should have different roles. However, the confusion of these roles is another story, but nonetheless part of the problem with the management of the current system.
If we want to build on the merits of Plan A and not end up with a hybrid Plan Z, or worse, the status quo, we need to examine the reforms on merit not self interest.
To assist that approach requires a rational framework for our reasoning. The following framework was developed out of the considerations of health management academics across Australia and subsequently adopted by the Society of Health Administration in Education Programs (SHAPE) and published in the Asia Pacific Journal of Health Management (2008;3:2, 10-13)Â .
The following extract from that paper is published here in the interest of promoting rational, if not informed debate. It might reduce the wasted effort in belting up of health economists, health professionals and, even doctors etc. The rest might still be considered fair game.
Principles
- Public policy should focus on improving health outcomes and not be prescriptive but provide frameworks of responsibility and cooperation at the program delivery level.
- Reform should focus on the needs of communities and populations and structural arrangements should be determined in the light of that focus.
- If Government and public policy focuses on principles and guidance [35] then providers should be structured to meet the diversity of need and demonstrate good governance and management through proper engagement of structural interests.
- Effective models of community engagement need to be incorporated into public policy and the governance of health services.
- Health managers should be appropriately qualified, skilled and adept in managing complex health service organisations
Parameters
Successful implementation of reform is more likely to occur within the following parameters of organisational arrangements:
- health services structures should reflect the diversity of need and differences in geographic location of populations, culture and, healthcare needs.
- health services at the service delivery level need to have the capacity to achieve inter-sectoral collaboration.
- governance should take into account how adequate levels of accountability, trust and stewardship can be restored to the health system. [23]
- debate about the degree of centralisation and decentralisation should consider the issue of how far those responsible for delivering care should be situated from those who receive care [23] and that to be effective managers need to be able to manage out and down to staff and communities and other stakeholders as well as up to central authorities.
- the relationship between providers and recipients of care requires that health service managers need to be accessible to multi-disciplinary clinical teams and be capable of developing environments, cultures and systems to support the delivery of safe quality care.
(The numbers in the text are the article references, details of which can be accessed from the full article.)
The intriguing and most positive aspect of Plan A is that the proposed networks are of similar scale to the main primary health care organisational arrangement, Divisions of General Practice and, of many not for profit aged and community care providers and, close to geographic communities of interest.
This alignment of scale would provide opportunities through future financial incentives for these groups to align and cooperate in service delivery, provide integrated care and to form partnerships. In fact, new additional funding should be dependent on innovation at that level. State health bureaucrats could relax and focus on how to deliver, where required, state wide services, investment in capital infrastructure and continue to pursue the holy grail of the very best form of electronic record. Something they used to do reasonably well and more than enough challenges to keep everyone busy!
These days, health managers are limited by professional responsibility and public policy direction from their political and bureaucratic masters in their ability to commit to public debate about important and, much needed health reform.
They will in most but not all cases remain silent in this debate and await the outcome, when in past eras of reform they would have been vocal and active. They publicly supported the earlier moves to area and network structures that were similar in scale to the proposed Plan A networks. They will need to be highly skilled and supported to implement plan A, but may continue to be disappointed by Plan Z being the eventual outcome.
It would be good to see debate focus on how plan A or B might work and be implemented and let it be given time to work. Besides, the independent funding authority determining fair efficient prices, I think we might need an Health Innovation Council to see that any new additional funds are actually targeted at needed health interventions and actually do make a difference.
As a rural dweller I suspect we might need a Rural and Remote Health Council that supports rural networks in their endeavours to get adequate resources to do their job and to ensure they are not finessed by the more ‘sophisticated and sometimes paternalistic’ lobbying of major urban city health interests who have ready access and influence in State health bureaucracies.
In entering the debate I would be interested to hear on what rational basis you might be stating your case and how that might advance this much needed reform. Your contribution might just lift us out of the current sceptical and negative paradigm that affects how well our health system could and might work.”
