Preparing leaders and managers for health reform: The NHS Experience

David Rankin is General Manager Healthwise in ACC where he has worked since 1998. This position has responsibility for purchasing health services for treatment of the 1.5 million claims by New Zealanders for injuries each year. David holds a Master’s in Health Administration and a Master’s in Public Health, both from Loma Linda University in California. He gained a Diploma in Obstetrics from the University of Auckland in 1985 and an MBChB from the University of Otago in 1982. David is a Fellow of the ACHSE.

The Canterbury Branch meeting in the Botanic Gardens Cafe attracted about 30 locals, a few first timers attracted by the topic and the presenter. Numbers were further boosted by 25 participants in the Health Leadership Programme (RH Penny Ltd in conjunction with the NZIHM) running in Christchurch at the same time. A buffet meal was provided and then all settled in for the presentation. (Slides attached). We also took the opportunity to present Pauline Barnett with her certificate of admission to the ACHSE as an Associate Fellow.

Dr David Rankin, GM Healthwise - ACC delivered a lively presentation entitled "Helicopters, Consultation and Sacred Cows - When Best Practice Conflicts with Public Opinion". He characterised sacred cows as being firmly held community beliefs, the community contributes to service, failure of service is perceived to jeopardise community health, supported by prominent community leaders (although self interest may not be declared), arguments are emotive, not rational and they are often contrary to best practice.

The withdrawal of the review of rescue helicopters was the starting point and a good illustration of the issues with sacred cows. David presented data (Slide 12) showing NZ has 38 rescue helicopters (plus 23 fixed wing aircraft) compared to 3 helicopters in Victoria, 3 in Scotland and 9 in NSW.

He went on to compare the consultation process around this issue with that of the consolidation of the emergency Communication Centres from 8 poorly equipped centres to 3 well resourced and technologically up to date centre undertaken earlier and with little public concern. Key lessons from the process were:

Never plan into a vacuum - always have a picture of the desired situation.
Don't assume even distribution of knowledge Beware of pictures - the visual medium is very powerful and many react to what they think the picture tells them rather than the explanations that come with it.
Be aware of community fears Don't assume silence implies no change
Consult before you consult - peers, interested parties Don't consult on technical issues
and most importantly - Never go on holiday after releasing a major strategy!

David went on to examine some other sacred cows and myths. He looked at "Specialist opinion is always correct" which crumbled under graphs of massive variability of claims by region, intervention rates per 100,00 of population and use of MRI in diagnosis. "The doctor knows best" was next in line with a fascinating graph (Slide 24) of the average number of days of time off work after the initial 7-day stand down period given by GPs with the vast majority giving less than 35 days but a group of about 60 GPs who on average give over 99 days. "Pricing is simple" received similar treatment and a scatter plot (Slide 31) of price responses to a tender is so diverse as to beggar belief.

Of great concern to the ACC is the gap between Maori and non-Maori. On a comparable basis, the number of Maori claims to ACC are about 72% of those of non-Maori (Slide 27). The age group makes a huge difference with the claim rates for the 20-54 year olds being on a par with non-Maori but the young and old groups having major disparities (Slide 28). David's concern, particularly with the younger age group, is that injuries are going untreated and will lead on to continued problems throughout life.

Other sacred cows to be exposed were:

Rural Hospitals are Necessary
Rural Surgery is better than nothing
Waiting Lists are always bad
Magic Rubs work
Expensive Equipment is desirable
Doctors make the best Health Leaders
Only Anaesthetists are Safe
Stretch before exercising.

Another excellent presentation with some very focused questions and comments from members of the audience.

Many thanks to Eurest (NZ) Ltd for their continued support of the NZIHM through both venue and refreshments. A special thanks to Bruce White who has been a behind-the-scenes organiser of logistics for the Canterbury Branch since its revival - Bruce is moving to a new role with Capital and Coast DHB and will be sorely missed.

Next meeting: TBA

Michael Aitken FCHSE
National Vice-President
NZIHM/ACHSE

This event was made possible by the generous support of