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Senior Doctors Seek More Influence

Thursday 20 January 2005

“Senior doctors seek more influence and clinical democracy in dhbs; more involvement in engine-room”

“Senior doctors are seeking more influence in district health board decision-making and greater clinical democracy,” said Mr Ian Powell, Executive Director of the Association of Salaried Medical Specialists, today.

Mr Powell was commenting on the recent settlement of the senior doctors’ new national collective agreement which calls for greater senior doctor involvement in decision-making based on clinical democracy.

“While the government is putting more money into district health boards, we question how effectively it is being spent. There is massive expertise and experience among senior doctors, nurses and other health professionals but their influence on decision-making is largely around the margins.”

“Senior doctors need to be in the engine-room of decision-making if the government is to be confident that the most effective use is being made of its increased funding and that it is getting value for money, something close to the heart of Finance Minister Michael Cullen.”

“The current practice of involving senior doctors in decision-making is often well meaning but is variable between and within DHBs. While there are some promising developments, generally they are limited to reacting to decisions and proposals already made rather than developing them. Too much time and effort is wasted on ineffective decision-making because senior doctors are not involved enough.”

“Every DHB should have a clinical board responsible for proactively developing recommendations in health service organisation and delivery. These clinical boards should be based on democratic representation from doctors, nurses and other health professionals. Although many DHBs have clinical boards, generally the members of them are hand-picked by management, don’t have enough influence, and sometimes are not representative of what their colleagues think.”

“Clinical leaders and directors should also be selected on the basis of having a mandate from their fellow clinical staff. While this often happens at a head of department level, it is less likely to happen further up the DHB hierarchy where they are often hand-picked by management.”

“Health Minister Annette King has given DHBs written instructions to increase the involvement of health professionals in their decision-making. But this is likely to be largely ignored unless we and others push hard for it.”

“If our DHBs are to make more effective, better quality decisions and are to be more fiscally responsible, then we need more clinical democracy in our DHBs so that their in-house expertise and experience can be used rather than sidelined,” concluded Mr Powell.


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