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What’s missing in the health reform push? Quite a bit, actually

Changing the governance of the health system will not necessarily translate into better health. Nor will it lead to meaningful reforms without a far more sophisticated understanding of how to achieve change in the health sector.

So cautions health services management expert, Associate Professor Godfrey Isouard. Below is an edited version of his article that appears in the latest Asia Pacific Journal of Health Management. He writes:

“The proposed National Health Reforms involve substantial structural change to the current health and economic systems in order to provide the required financing and governance foundations.

The expectation is that changes to funding arrangements, together with the strategic introduction of locally controlled networks, activity based funding, and national governance functions, will drive the change processes. These measures are seen as important drivers towards greater efficiencies, increased transparency and accountability, and sustainability into the future.

There is an unsubstantiated assumption by the Australian Government that restructuring to obtain systems improvement directly leads to better health.

Despite growing evidence that a structural view of health reform is largely ineffective, health reform based on such foundation continues to be introduced.

There is a growing view that a structural approach to change needs to be appropriately accompanied by due consideration to the key organisational aspects – political, cultural, behavioural and professional factors. Such factors provide invaluable insight into strategically planning for the implementation of systems change.

Over the last decade there has also been growing interest in the importance and contribution that leadership and management can play in the health service delivery and health reform process. Leadership has emerged as a key strategy to address the unique challenges in health care.

Despite leadership being central to implementing reform, the current National Health Reform strategies refer more to leadership from an Australian Government perspective rather than at the important health care and health services level.

The recently developed Society for Health Administration Programs in Education (SHAPE) Declaration provides a number of guiding principles that define the health service manager’s position on reform in terms of policy focus, systems enhancement, service delivery and governance. The importance of health service managers and the need for government commitment to their education and development are viewed as critical aspects for successful change.

This present review of the current National Health Reform Plan has revealed that if implemented, two striking weaknesses would exist.

The Plan fails to account for the political, cultural, behavioural and professional aspects of change, and also does not position leadership and health management as central to the implementation process. The complexity of significant structural change is such that evidence has shown major health reform strategies need to incorporate proper assessment of organizational behaviour aspects within a system which values the central roles of leadership and health management.

The study has also confirmed the growing evidence of the importance and contribution of leadership and management in the health reform process, and as promulgated in the SHAPE Declaration. The health management workforce requires managers to be appropriately qualified and trained, and skilled in engaging at various levels of health care delivery within complex health service organisations.

The limitations found with the current reform plans led to this author’s development of a new leadership model for introducing health reform. In its simplest framework, the new model for change takes due consideration of key organizational and leadership factors.”