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King Speech: Professionalism In The Health System

17 April 2002 Speech Notes

Professionalism: Its Nature And Role In The Health System

Firstly, I would like to welcome everyone to this important conference, and to congratulate the Association of Salaried Medical Specialists and the Ministry of Health for jointly sponsoring the event.

I feel honoured that I have been asked to co-chair the conference, along with Dr Peter Roberts, and I will spend as much time here today as I can.

The list of people attending and participating in this conference represents a strong who’s who of the medical profession. If this group cannot come up with solutions and ideas about ways in which we should be applying the principles and values of professionalism, particularly in our District Health Boards, then I doubt if any group in this country would be capable of doing so.

Very shortly we will be starting on the main business of the day with the address by Professor John Luce, from the University of California. Like everyone else here, I am looking forward to hearing what he has to say, but one perk of being a co-chair is that before the professor speaks, I have the chance to pass on a few thoughts of my own.

The first of those thoughts is that it is essential to acknowledge the complexity of some of the issues with which you will be grappling. The words health and complexity tend to go together, in fact. Because we all have different jobs, we all tend to view the complexities or the problems slightly differently. That makes it even more important to try to find balanced solutions.

Professionalism in health is about ensuring people are adequately trained and equipped to appreciate and respond to the complex issues and problems that arise in their daily work.

The reason for that is straightforward, even if it is sometimes forgotten. Health professionals, and the wider health workforce, are the crucial ingredients in providing safe and effective services.

Hospital walls and the equipment within them do not protect patients. The people who work within those walls and use the equipment do that.

To return to the word balance that I just mentioned. For this event to be successful today, people here have to acknowledge that achieving balance while still maintaining the highest professional standards is not an easy or straightforward task. Everyone has a contribution to make. No individual or group, no matter how senior, has an exclusive insight into professionalism.

It is no bad thing that we have four themes today to help focus our thinking.

Those themes deserve reiterating through the day. They are:

- How professionalism can improve the effectiveness of the system?

- Why is it important to empower health professionals?

- What is the role of management in working with health professionals?

- Andƒnwhat is the role and importance of culture in DHBs?

I think it is important to point out that a desire to improve things doesn’t mean things are not working well. Things are working well. The vast majority of New Zealanders continue to receive high quality, professional care from our public health system. We should not lose sight of this fact. What we want is to do better still.

It is interesting, to try to put our health service in some sort of perspective, to reflect on a new report, released this week, from the Commonwealth Fund. It reveals that more than one of five Americans, or some 8.1 million households, report that they or a family member have experienced a medical or prescription drug error that turned out to be a serious problem.

We should remind ourselves that major mistakes that give rise to questions about the professionalism of the system here are rare, despite the publicity they almost invariably attract. Yet it remains vitally important to try to learn from mistakes when they do occur.

As Commonwealth Fund senior vice-president Stephen Schoenbaum says: “A good relationship between doctor and patient characterised by open and trusting communication is a critical component of high quality health care.”

We should not feel threatened by the public’s determination to talk more openly about the performance of medical professionals and safety in health. It is a matter of finding a balance between patients’ rights and ensuring they receive the quality care they justifiably expect, and safeguarding the interests of medical professionals who need to be able to work without fear of harassment.

Safety is only one aspect of achieving professionalism. Maintaining professionalism across the whole system is a far more complex and challenging task.

I believe there are four key components to doing this: balance, trust, reliability and effective relationships. B, T, R. and E. Add another “e” and a “t”, and you have what we are aiming for, something “BETTER”.

As I mentioned in my opening remarks, balance is essential because health is a complex area. The tension of managing within resource constraints and providing the treatment options we want will always exist regardless of policies or the economic and political environment. We cannot deal with these elements in isolation from each other.

The crucial issue is identifying processes and structures, and cultures that allow us to negotiate a path through the tensions. The policy setting of the past decade was not always good at doing this.

This Government has instituted a number of changes that should make the difficult task of achieving balance somewhat easier. These changes are based on admitting that imposing change is not good enough. There has to be cultural change if new structures are to work.

The admission that central government no longer has all the answers is central to this process. So is every opportunity to allow groups like medical professionals, who have extensive expertise to contribute, to have a role in decision-making. I know some DHBs are exploring ways in which they can help this happen.

The three-year funding package and long-term commitment to the District Health Board structure are particularly important in this regard.

Both are designed to provide certainty to assist decision-making, a greater sense of partnership with communities, and to build on the good working relationships that already exist between the different groups making up the health workforce. In some cases, these groups may need to prove to each other that they have a constructive contribution to make to this process.

Doing things better will also require re-establishing the sense of trust that many feel has been eroded in recent years. The challenge is to facilitate the development of good relationships, and for health professionals the ambit of relationships is wide indeed.

It stretches from the patient-doctor relationship to a relationship with other health professionals to a relationship with the public, and how the latter relates to public expectations about how professionals perform.

Relationships are tenuous in nature. In the past decade or so there was an emphasis on contractual relationships, probably to our cost. It is necessary to return to a more basic, if also more complex, interpretation of the nature of relationships.

These are only brief thoughts, but I hope they reflect some of the ways you have been thinking about the issues we are here to discuss.

During the day I certainly look forward to learning more about what you are thinking. And what better way will there be to start that process than by listening to Professor Luce.


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