The Australian Health Ministers Advisory Council has commissioned Health Workforce Australia to develop a Rural and Remote Health Workforce Innovation and Reform Strategy.
The strategy aims to “provide national guidance on future needs, reforms and initiatives to improve the health care services of those in rural and remote communities”.
The article below is based upon the Australasian College of Health Service Management’s submission to HWA, which argues strongly that systematic efforts are needed to improve the quality of health service management.
The submission relates to rural and remote health services, but presumably these are also concerns for the wider health system…
We need to invest in improving health service leadership
Daryl Sadgrove writes:
High quality leadership, management and governance are pre-requisites for a health system that delivers high quality services to the community, as well as the best possible deal to taxpayers.
The work of Rural and Remote Health Service Managers is also particularly important in maintaining the social fabric of rural communities. Rural Health Managers are not only engaged in ensuring essential healthcare services are available, but they typically assume roles as community leaders and volunteers who drive social capital and community development throughout rural Australia.
We believe that the health sector has never needed a focus on leadership more so than now.
We are in the midst of great change, unprecedented challenges, and diminishing resource availability.
The Australasian College of Health Service Management (ACHSM) has been focused on developing leadership capacity in the health sector for more than 65 years, and we are particularly pleased to see an increased focus on this issue of late, including by Health Workforce Australia (HWA).
Workforce issues are frequently cited as the most significant challenge for Rural Health Managers.
The serious maldistribution of health professionals has been a major driver of poorer health outcomes in rural and remote communities, particularly in Aboriginal and Torres Strait Islander people.
We believe that to address this complex issue, leadership will be required at all levels within health, education, the private sector, and within rural and remote communities themselves.
However, implementing the major changes required to reform the national health system will require investment in the capacity of people to lead this change.
As such, we strongly endorse the HWA’s goal to improve leadership for the sustainability of the health system.
As the peak professional body for health managers and executives, ACHSM have developed a wealth of knowledge, experience and research in leadership and management development over many years. In fact we currently offer over 185 products and services for this specific purpose. Most of these services are currently available, some have the potential to be expanded (both geographically and in the wider health community), while others are nearing completion. We encourage HWA to take advantage of the considerable expertise and infrastructure that the ACHSM has available.
The three primary target groups that we believe have the greatest potential to inspire and drive leadership in the health sector, are clinical leaders, operational health managers and senior health leaders.
We believe that each of these groups has a distinct but important role to play in innovation and reform. For the remainder of the document I will refer to these three groups collectively as ‘Health Managers’.
We are concerned that the capacity of Health Managers to respond in this ‘hour of need’ may be compromised by over two decades of neglect in the professional development of this group.
Despite the key role of health managers in enabling change and innovation, the profession has experienced a progressive denigration of professional standards by healthcare employers, regulators and accreditation bodies.
Although at odds with all other major industries, healthcare has progressively removed minimum training requirements for managers, as well as the requirement that health managers should undertake ongoing professional development.
Despite these trends, the ACHSM has adopted a lead role in maintaining national professional standards in the health management profession, although we acknowledge we cannot achieve this in isolation. It requires a collaborative approach between employers, education providers, governments, and professional bodies such as ours.
The current starting point for developing leadership and management capacity in the health industry is less than ideal.
The health management industry is poorly defined, there are no nationally accepted competency standards, the industry is predominantly unregulated (with the exception of 3000 or so health managers who are members of the ACHSM), and essentially the profession is being driven almost entirely by market forces.
These issues may not seem to be relevant until organisations, such as HWA, seek to develop management and leadership capacity in the health sector, and finds that the industry lacks the fundamental building blocks to facilitate this.
For example it is not known how many health managers there are, where they are, and what qualifications they have; in fact many health managers do not even identify themselves as health managers.
There is now evidence to suggest that this lack of workforce data, standards and professional identity in health managers is having a dire effect on the attraction and retention of quality health managers.
This has led to a culture where management is not valued in health. In turn, this has damaged the morale of health service managers, is causing a growing disconnect between clinicians and managers, and has resulted in a considerable downward trend in management competence.
Although we do not believe that onerous professional regulation strategies are required in the health management industry, we do feel that some basic national standards are necessary.
We see a need to conduct a workforce study of health management to better understand the profile, demographics and needs of health managers, with a specific focus on rural and remote health service managers.
We support the development of a national set of management and leadership competencies, and minimum standards for entry into health management, as well as a requirement to undertake continuing professional development.
It is our view that these are basic requirements for any workforce where there is an expectation that professionals are competent, and keep up to date.
To support these standards, we also believe that there is a need to grow and expand the availability of professional development for health managers.
In relation to Rural and Remote Health Service Managers, we recommend there be a specific focus on addressing access issues and ensuring that management and leadership development initiatives are context-specific, relevant to rural and remote managers, and delivered using modalities that are accessible to all parts of the remote and rural workforce.
We contend that the best return on investment will not be achieved by delivering short-term leadership programs, but instead in strategies that establish professional standards and strengthen industry development in the health management profession.
Our two primary strategic recommendations to improve leadership for the sustainability of the health system are;
1) To introduce professional standards for health managers. This might include activities such as developing a national set of management and leadership competencies, developing minimum standards for entry into health management, and introducing a requirement for health managers to undertake continuing professional development.
2) To increase access to professional development for health managers. This might include the development of a Certification Program for Health Managers, access to a national clinical leadership program, the provision of a national e-learning knowledge hub for health leadership, expanding access to mentoring, the development of Aboriginal health leaders, board governance training for health boards, and much more.
As we outline in this submission, all of these initiatives are either currently available, nearing completion, or have potential to be expanded.
To this end ACHSM proposes that HWA/ COAG support the ACHSM, (through a partnership with its Institute for Health Leadership), to fast-track the implementation of a range of initiatives to improve management and leadership development at all levels, and across all disciplines in the health sector.
• Daryl Sadgrove is Chief Executive Officer of the Australasian College of Health Service Management