NHB review of Dunedin Hospital

In August 2011, the National Health Board in New Zealand released its report in a review of Dunedin Hospital. This review was conducted in alliance with Southern District Health Board.

In short the review was less than positive about the activities of management in Dunedin Hospital, while recognising that at the same time, despite the many barriers created, the sheer enthusisasm of staff, both clinical and nonclinical ensured patients needs were met in most instances.

The reports states, a lack of alignment or shared vision between the Board and clinical staff, a lack of cohesive and visible vision, lack of confidence by clinical staff in the executive management team, poor definition of roles of board, committee members and management, blurred lines of responsibility between governance and management, managers not being aware of what is expected of them, reactive and ad hoc decision making, lack of leadership contributing to poor planning processes, organisational duplication and waste, culture of disempowerment, minimal standards of quality and patient safety and poorly designed operational practices.

Okay, on the surface, it’s not looking good. But let’s look at the strengths. This is a well established hospital with good clinicians and administrative staff. It is a key regional hospital with a good reputation in the community. Many of the issues are systemic in nature. This means they are fixable.

In recent years the hospital has been focused on achieving financial stablity and reducing deficits and this strategy appears to have impacted upon other areas of the hospital. Its not an excuse, it simply illustrates the importance of everyone in the hospital having an understanding of the relationships, connections and interdependencies that make up the hospital. Nothing happens in isolation.

Creating a new culture in a hospital is not an easy task. Hospitals are like big ships, they take a long time to change direction. Culture begins at the top with the Board, the CEO and the executive management team. They are responsible for setting mission, direction, goals and ensuring alignment through holding people accountable. This group is also responsible for ensuring that every action or activity being undertaken in the hospital is directly contributing to acheiving mission and strategic outcomes. The executive management team must become role models and be seen to be consistently practicing the type of culture they want Dunedin Hospital to be. Every other staff member models their behaviour upon that they observe by the management group.

Management capacity can be developed and built upon. Very few people are natural managers, for most it is about developing an understanding of the strategies and competencies, putting them into practice, reflecting upon them, learning from their experiences, sharing and learning from their peers and changing those practices that fail to contribute to achieving stratgic goals or mission outcomes. Managers at all levels should conduct an analysis of professional development needs and put in place strategies to building their personal management capacity.

Trust must be earned by managers at every level being seen to do the things that they said they would do. When people feel let down by their managers then they have no reason to have confidence in them. When there is a lack of confidence every management proposal has to be sold to staff. Trust develops through managers building respectful relationships.

Operational issues can take a little longer to resolve. They require a mixture of appropriate funding, the right mix of people and job design that is effective. The best way to make sure things happen in the most effective manner is to engage staff at all levels in the process of designing work flow and workplace practices. Before this can be done, trust must be in place. Similarly, for Lean Practices to be implemented and remain sustainable requires high levels of collaboration, cooperation, shared conversations, shared knowledge and cross functional teamwork. These are not possible without a respectful and trusting workplace. It all begins with managers at every level taking a long, hard look at themselves and then taking personal responsibility for the things that are important.

When this occurs, Dunedin Hospital will emerge from this period, stronger and a better place to work in, for everyone, staff and patients.

Those are my thoughts for the day.
John Coxon


About John Coxon

Principal consultant for John Coxon & Associates, a management consultancy working with boards and management teams in healthcare, aged care and not for profit organisations to develop effective strategic planning processes and social enterprise business plans
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