Political rhetoric that stresses the value of “frontline” health professionals (while threatening to cut the non-frontline workers) doesn’t acknowledge the important work that goes on behind the scenes.
In the article below, a senior public health leader from WA, Professor Tarun Weeramanthri, draws a useful analogy with football teams, arguing that their performance on the field relies on the work of many others who may not be so visible.
Thanks to Medical Forum WA for allowing republication of this article.
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The health system is more than the frontline
Dr Tarun Weeramanthri writes:
As a university student, I occasionally worked at Subiaco Oval on the gates for football matches, collecting money and opening the turnstiles. Not as glamorous as playing, perhaps, but I was happy (they paid me) and so presumably were my employers (I handed over the takings).
When discussion about ‘frontline services’ in government comes up, I often think about football teams.
Eighteen players plus the interchange bench are all that get on the field but behind them stands a diverse group of ‘backroom staff’, who are often recognised for their essential contribution to the success of the 18. Coach, trainers, physios, ground staff, administration and marketing – the list goes on.
In sport, you don’t disparage those who don’t play as somehow not contributing to the success of the team. Everyone’s contribution is valued. It’s a team on the field, and a wider team off the field.
Of course, management always considers how many backroom staff are needed to fulfil tasks but that’s no different in concept from managing your team list.
I believe the same should be true in health. Anyone who works inside a hospital knows it is a team effort. Yes, the doctors and nurses have most contact with patients but others have critical frontline roles (e.g. allied health workers), and others have critical backroom roles (e.g. records staff, laboratory staff, radiology technicians, pharmacy, information technology, catering, cleaning, administration, payroll etc.).
And a whole health system is more than hospitals. In public health our clients are the public, and our services include managing disease outbreaks, mitigating an A-Z of environmental risks (from asbestos in the home to zoonotic diseases), organising screening programs (for breast, cervical and bowel cancer), and working in partnership to promote good health and prevent chronic disease.
All these could and should be considered frontline services, but think what lies behind each of them.
Take immunisation services as one example. The physical injection is the end point of a complex process. Maintaining the cold chain, ordering the vaccines, training providers, monitoring for adverse events, compiling evidence for effectiveness, securing funding, and creating strategies to target high-risk groups all takes dedication and expertise from backroom staff at every step.
Working inside the Department of Health in East Perth, I get to see a slightly different group of backroom staff, working in the best traditions of the public service on a range of essential tasks, from legislation, to finance, to performance, to activity-based management – ensuring value for money, public accountability and transparency.
So, yes, always consider whether we have the right balance of staff to serve the public but in so doing, don’t equate frontline with essential and assume backroom is somehow non-essential.
Without the person at the gate to collect the money, the football team could not survive.
• Professor Tarun Weeramanthri is Chief Health Officer|Executive Director, Public Health and Clinical Services Division in the Department of Health, WA. Follow him on Twitter at: @tarunw
• This article was first published by Medical Forum WA
