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Health boards past their use-by date

An article* published this month in the Journal of Health Organization and Management raises questions over the way health board members are elected and whether the boards are even needed.

Co-author Dr Greg Clydesdale, of Lincoln University, said health boards have had a poor run recently, and that may be due to how their members are appointed.

“Health management and governance have become highly specialised but, every three years, voters with no knowledge of healthcare decide who should be on the board,” he said.

“It is an exceptionally poor way to appoint people to such a specialised activity.”

The analysis also raised questions about whether a board was even necessary. Their research revealed that 99% of all motions presented to the board were accepted.

“This rubber stamping of management proposals raises questions whether the boards are adding value to the decision-making process.”

“Often the board are not given any options, in which case, we need to ask, why are they needed.”

Their research also studied the minutes and agendas of health board meetings at the Canterbury District Health Board. It found that there were no public presentations to the board in the period studied.

This suggested that the current structure is not the best way to facilitate public participation.

The intention of the electoral process is to ensure public participation in health care, but Dr Clydesdale questioned whether board level was the appropriate level to engage with the public.

“The current electoral model reflects our passion for democracy but, it may not be the best process for a health sector given its specialised nature. The public simply don’t have the necessary knowledge to make an informed decision.

“Most people do not know what boards do. Let alone Health Boards.”

He said, not surprising, voting on electoral health boards has experienced decline. In 2001, the voter turnout was 47%. By 2013, it had declined to 43%. Not only does this suggest reduced public participation, but that elections might not provide a board that truly represents the public.

“It is also failing to provide efficiency.”

He said in 2015, the Southland District Health Board was sacked and replaced by a commissioner. This year, the Waikato District Health Board suffered the same fate. At Canterbury, a crown monitor has been appointed to help guide the board.

One of the Waikato board members claimed that “democracy lost”, but Dr Clydesdale suggested that we may not be using democracy efficiently. “For other departments, like transport and social welfare, we elect the government who appoints ministers, but in health we have two layers of democracy – is that necessary?”

“The failings are now so common that we must question the structure and method of appointing talent.”

Dr Clydesdale co-authored the article with colleague Dr Gillis MacLean and John Sheard. He is a senior lecturer in the Faculty of Agribusiness and Commerce, who has authored a number of books on business and prosperity, and has expertise in creativity, entrepreneurship and economic growth.

*https://www.emeraldinsight.com/doi/abs/10.1108/JHOM-11-2018-0336


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