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King To Royal Australasian College Of Surgeons

28 August 2002
Hon Annette King
Speech Notes

Royal Australasian College Of Surgeons Joint Meeting


Thank you very much for inviting me to open this important meeting today. This is my second formal speech in my second term as Minister of Health, and, coincidentally, the first was also in this very building in Christchurch, last Friday at the annual meeting of the Psychological Society.

Mind you, if the city has not changed, the timing certainly has. The psychologists opened their conference in the middle of the afternoon. I was up at 5am today to ensure I made it to this event.

And, I should add, I was up that early more than happily. I feel privileged to be part of this Australasian event, so privileged, in fact, that I will not even mention salary caps or Tri-Nations trophies during my address.

I also feel privileged to be serving a second term as Minister of Health. It is most unusual for a minister to serve two terms in this portfolio, but I think it is particularly important to do so as a signal that the health sector will benefit from a period of stability and continuity. That is what I hope to ensure occurs over this term of government.

I would like to welcome our Australian visitors particularly today. I hope many of you have been able to bring your families and that you will all enjoy your stay in New Zealand and get the opportunity to visit some of the wonderful spots we have here, including the local ski fields.

This conference is an excellent opportunity to share information and knowledge and to network, and I know you will all take advantage of this. I am sure that the conference convenor, Ross Roberts, and the organising committee will have done much to ensure your stay is memorable.

I understand that one of the topics for discussion at this meeting will be the future surgery environment. Over the past 50 years, there has been a significant increase in the number of surgical procedures available. Amazing advances in technology and research have allowed more people to have the surgery they need efficiently and safely.

I expect technological and research advances will continue rapidly and I am excited about this prospect.

As well as improvements in technology and research, I believe another key area of development for surgery in the future, and the health and disability sector as a whole, is an improvement in quality.

Although we cannot predict with absolute certainty what the future surgery environment will be like, I am sure we can all agree that we would like it to be an environment that supports quality improvement.

Quality is the degree to which the services we provide to people increase the likelihood of them getting the best health outcomes possible. This Government has a vision of a quality health system that is people-centred and system-focused.

This means we focus on the people receiving the services we provide, we focus on how our systems function (particularly where the system might be weak), and we use evidence to inform our decision-making.

Before I talk more about quality improvement, I want to refer to a culture of ‘name, blame and shame’ that has been bred, not always inadvertently, in our health sector.

In that respect, I was dismayed in the past week or so by the hysteria that surrounded a case in Canterbury in which a 72-year-old man was allegedly forced to amputate his own gangrenous fingers because the health system apparently was not there for him.

The facts of the case have now been revealed, particularly the reality that this heavily-smoking patient, with a history of severe heart disease, renal failure, bowel disorder and diabetes, has been seen by hospitals no fewer than 18 times in the past 19 months, and actually admitted to hospital on five of those occasions. In Christchurch Hospital alone, he has received more than $65,000 worth of treatment.

I am appalled at the cynical way in which some of the media and some politicians decided to exploit this man’s case.

Clinicians not only performed life-enhancing surgery on the patient, but also have probably managed, through conservative treatment, to save his toes and one good hand. Yet where the recognition of their skill and compassion?

This is a classic case of the culture of name, blame and shame, a culture that leads to a cycle of fear, which distracts us from what we really need to do.

The Government is committed to changing this culture into one that supports a quality improvement ethos and practice.

Last year, I announced that the Ministry of Health was leading the development of a New Zealand Health Sector Quality Improvement Strategy.

This Strategy is now well advanced. The Ministry has given it priority, and an early draft of the Strategy has been shared with the New Zealand Medical Association and the Council of Medical Colleges in New Zealand. I am hoping they will support its direction.

This is not just another Strategy. The Ministry is taking the opportunity to provide comprehensive high-level direction, building on the work of the National Health Committee to develop a culture that supports quality improvement. When it becomes available I hope you all put it on the top of your pile of bedtime reading material.

Changing the current culture will not be easy. It will require commitment from all members of the health sector. It will require a change of public opinion and media attitudes, and less grandstanding by politicians.

We all must take responsibility for and provide leadership in implementing the Strategy’s people-centred and system-focussed philosophy. The Strategy provides direction for developing key quality improvement and monitoring tools, but they will not work if the context in which they are used does not support them.
So let me describe the vision for the kind of culture that will provide a supportive context for quality improvement.

It is one in which health professionals are clearly aware of their own and their team member’s roles in the systems that they work in.

It is a culture in which openness and communication is shared, so the strengths and weaknesses of the system, not individuals, are highlighted. Strengths can be built on and weaknesses remedied to benefit the whole system.

There will need to be a sense of a shared purpose and collaboration, with all health professionals working towards improving quality and continuing to make improvements as and when required.

To support the fruition of this culture, quality improvement principles will need to be recognised as a topic in education and skill development training programmes at the undergraduate level. But new quality improvement approaches will also need to be learnt as we go. They cannot simply be taught in a one-off course.

We need to know how to convert these principles into methods and tools in our working environments. What will work in some areas of medicine, in some hospitals and for some teams, may not work in others.

In the health sector we deal with all kinds of people, who present in unique circumstances and situations, with unique problems.

As surgeons, you constantly have to adapt your approach to each individual, but within the financial, administrative and policy boundaries. I know that this can be difficult and I am certain I can speak on behalf of both the New Zealand and Australian Governments when I say that we appreciate the work you do in situations that are often difficult.

I know some health professionals may be worried about more demands being placed on them, but we cannot afford not to implement quality improvements. We are not talking about substantial ‘changes’, because, after all, so much does work so well in our health systems already.

We are talking about small incremental gains. We are talking about gains we want to hold by maintaining our quality assurance programmes and improving on them. But most importantly, we can hold these gains by supporting them with our culture.

I invite all of you to contribute to the development of the culture I have described. This conference is a prime opportunity to develop this culture further by sharing your ideas and knowledge.

I would like to finish by referring to research that Radio New Zealand health reporter Rae Lamb carried out on her recent tenure of a Harkness Fellowship in the United States.

I mentioned earlier that moving away from the name, blame and shame culture toward a quality improvement culture requires openness and good communication. That is clearly the case too even in the more litigious environment of the United States.


Rae’s literature review, carried out as part of her research, revealed a number of studies which suggest honesty and transparency with patients, especially about medical error, is good not only for patients, but also for physicians and/or hospitals.

One well-known study in the US was of the Veterans Affairs Hospital in Lexington, Kentucky. It instituted a very proactive policy of finding mistakes and errors and telling the patients. The hospital found its overall costs of medical malpractice cases went down!

Other studies include a survey of patients, which found they said they were less likely to sue their doctor if they had been dealt with honestly and openly from the start.

And, as two institutions told Rae directly, apart from honesty not costing them any more, it was also “the right thing to do”. I could not agree more.

Again, I thank you all for having me here today. I appreciate your attention, and wish you the best for the remainder of your conference.

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