Senior doctors press hospital bosses for more leadership in health services – ASMS

The union for senior doctors and dentists working in public hospitals is calling on district health board bosses to let doctors behind the wheel of the health system.

“Hospital managers need to put senior doctors in the driving seat when it comes to changes in service design, configuration and delivery that are going to affect their clinical practice,” says Ian Powell, Executive Director of the Association of Salaried Medical Specialists (ASMS).

“Instead, they’re increasingly being left to pump air into the bald tyres, which is a waste of their expertise and is also contrary to the brave new era of clinical leadership that the Government and DHBs have previously promised to usher in.”

Writing in the latest issue of the ASMS magazine, The Specialist, he says several strategic documents published since 2008 had created an expectation that health services would be clinically-led. These documents include the Health Sector Relationship Agreement between DHBs and health unions, the Time for Quality Agreement between DHBs and ASMS, and the Government’s policy statement on clinical leadership, In Good Hands.

Since the increased financial pressures on DHBs, however, Mr Powell says DHBs have lapsed into the frustrating habit of excluding the wider senior medical workforce from strategic planning in hospitals, even when their expertise is directly relevant.

“It’s very disappointing, and results in changes to health services that are not well supported by the wider senior medical workforce. Essentially we’re seeing the derailing of these earlier strategic policy documents, which were themselves the result of much discussion and negotiation.”

He attributes this to an artificial division between the people carrying out the planning functions of DHBs and the health professionals, including senior doctors and dentists, who provide front line patient care.

“This split appears to be a leftover from the failed dogma of the 1990s market-driven era, which, unfortunately, still exists in some DHBs,” he says.

Lack of adequate funding for New Zealand’s public hospitals wasn’t helping the situation, with hospital managers opting for short-term solutions rather than long-term answers.

“Short-term solutions are about reacting to the environment the DHBs find themselves in but what New Zealanders need is a more considered approach that leads to sustainable improvements in health care.

“We think that an important part of that approach is to let senior doctors and dentists do what they’ve been trained to – weigh the evidence, work out what’s needed, and then guide the development of clinical services for the benefit of New Zealanders.”