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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