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