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ASMS National Conference Speech

Presidential Address

Jeff Brown - ASMS National Conference 2007

Delegates, kia ora. Guests, kia ora. Visitors, kia ora.

At this 19th Annual Conference, we reflect on a momentous year, and plan for an even more challenging one. During the next two days we will contemplate supervision and competence with John Campbell, will confront health funding and spending with Pat Snedden, will consider employment relations in DHBs with Ross Wilson, will concern ourselves with how Australia is aggressively recruiting us. And we will tread a delicate and deliberated trail through the jungle of MECA, contemplating our possible paths.

While we debate and discern I offer you two polarities to ponder.

Connect, and Disconnect.

Let us first look at some examples of the joy and positivity when we connect.

That marvellous medical momentum when doctors and patients connect. When they trust each other to inform without asking, to question without threat, to advise without favour, to learn together on the journey to healing or to dignified demise. We all know the power of such connection. How it enriches while shortening the time required in each clinical encounter. How it helps guard against the moments of slippage, and forgives the inevitable human failings. How it improves productivity. Productivity in all its clinical, ethical and moral dimensions. How connection keeps both doctors and patients safe in the system.

That magical moment when doctors and managers connect. When they trust each other to provide the acumen and the infrastructure. The best medicine and the spoon with which to give it. The right knife and the skill with which to wield it. We all know the power of such connection. How it encourages clinically based rationing and the financial leverage to support it. How it promotes innovative services and networks of experts. How it improves productivity. Not just the portion of productivity the Ministry measures, but all the dimensions it does not. How connection keeps both doctors and mangers in the system. When, in the lovely silvery lines of Browning, “we regret little, and we would change still less”.

So why the profoundly sad sense of disconnect? Of disenchantment? Of disbelief? Even of despair?

Why each week do we hear of another hospital specialist leaving for Australia, or for private practice? While those in charge search for evidence of a problem. While another workforce group takes more months to make up its mind. While the story is plain for all to see on the front page of yet another morning paper.

Why these egregious examples of disconnect?

Accountability is a word thrown repeatedly at doctors. Individually and collectively we are accused of shirking accountability for our actions. Of demanding autonomy but avoiding accountability. Of being profligate with the taxpayer’s money and greedy in our own demands for remuneration. But let’s interrogate the evidence of DHB executive behaviour for leadership by example. We see a DHB advocate use misrepresentation, exaggeration, and downright lies during protracted negotiations. His behaviour was protested through many avenues, yet DHBs kept him in charge. He negotiated his own CEO remuneration at almost $100,000 above his predecessor, while moonlighting for a Canadian health authority to which he suddenly scarpered. He seemed to live by Oscar Wilde’s dictum – “a little sincerity is a dangerous thing, and a great deal of it is absolutely fatal”. This abysmal behaviour should not tempt us to demonise an individual but surely we, and the public, are entitled to ask the DHBs – where is your accountability? For his actions. For your actions and inactions. For disconnecting DHBs and their doctors.

Workforce is what DHBs want to manage. They see their greatest costs and poorest productivity in their workforce. So they set out to count it. And get it horribly wrong. Despite hundreds of hours collating their “base data report snapshot” there are errors of hundreds of percent in some of their figures. Yet ASMS and the DHBs had a working party to address medium and long term workforce and other issues. For which the DHBs were obviously unable to prepare and resource at the same time as conducting their version of MECA negotiations. And they have established another medical workforce group with token invitation to a single representative from the RDA and ASMS. As well as telling us they intend yet another working group to examine the evidence for SMO workforce deployment, and that it will proceed with us or without us. This strange inability to connect with the specialists in their hospitals must surely indicate a mindset, relatively hardwired, in the leadership of DHBs. A mindset that seems unable to turn hollow words into any sort of solid action. That disconnects DHB leaders and their doctors.

Primary health is trumpeted as a success of this millennium. Access to GPs and other providers, spending on PHOs and other quangos, immunisation and other public health campaigns – all laudable and a source of pride to the Minister, his Ministry and his DHB chiefs. But it is hard to ignore that he, it, and they often act as if hospitals are an embarrassment, that while building some new ones it would be preferable if those who work in them would hide away. ASMS has promoted health professional led networks as high as the Prime Minister as an evidence based way of improving patient outcomes with rational use of expertise and resources. While exploring some patchy initiatives for regional and national collaboration, your Minister has nevertheless allowed the DHBs to water down any joint proposal so that it totally excludes mention of such networks, and disconnects ASMS from any collaboration. His behaviour and inertia in response to advice and alarm from many groups of doctors is mind-boggling. Your Pan Professional Medical Forum, the NZMA, various Colleges, have all tried direct personal advice, written submission, collective representation, only to hear him claim the opposite in the House, or consign them to the scrapheap of no response augmented by inaction. Is the disconnect deliberate, or dithering, or disdain?

My own DHB recently threw another big bash celebrating primary health awards. The Minister was there and commented that the awards looked like a celebration of his policies and priorities. All well and good. But I note there are no such secondary care awards. Our neighbouring DHB turned itself inside out on the front pages of their newspaper and in the chambers of their city council. Yet at the very time they should have been treasuring their remaining specialists they seemed to set out to alienate them. It is hard to resile from the impression that connection is often lost with the large buildings containing thousands of highly trained staff looking after seriously ill and injured patients. That the spirit of Wayne Brown lives on. That DHB leaders, and those they assign, fail to acknowledge the incongruity of this dismissal of such a dedicated workforce. Of their destructive disconnect.

No wonder if even the best of DHB chiefs disconnect from their hospital specialists that we end up with strikes and stopworks.

Last Annual Conference, reflecting on the RMO strike, I said it was hard to recall a more challenging time for ASMS and for me as your President. Trying to represent your diverse views ranging all the rainbows of ethical, industrial, financial, collegial and professional behaviour. But this year, the national stopwork meetings trumped all that.

These meetings over almost four weeks placed the greatest logistical demands your national office has ever faced. They resulted in the impact of the highly improbable. The war chest was raided and the campaign conducted to maximise the participation and profile of hospital specialists. I acknowledge the supreme efforts of Yvonne, Barbara, Kathy, Ebony and their helpers. Their work enabled Henry, Jeff and Sue to provide industrial grunt before, during and after the campaign. And supported the outstanding unflagging fight from Ian and Angela.

Your National Executive gave sterling service fronting the stopwork meetings in their own DHBs, as well as some in neighbouring DHBs, and other members of the MECA negotiating team did likewise. Personally I was humbled by the turnout, the passion, the unity and the support at the six meetings I attended. And invigorated by the public and patient feedback I received from our media appearances. The dynamic challenge we faced from such a watershed in our working lives, from an unprecedented requirement to connect with our membership, the sheer hard labour, was rewarded in the strengthening of all of us as a union.

This strength, individual and collective, will be tested even further as we contemplate the necessity to force DHBs to connect their ears to their cortex. They heard our stopwork meetings, but they did not listen. They need to be forced to focus on investing in specialists to run their hospitals, for the good of the public who consider that DHBs are the Government. They need to be forced to revoke the pretence that the Minister has no say in what they do. Forced to acknowledge that when specialists say their colleagues are leaving, that is the truth.

If it takes a ballot on limited industrial action to make them connect, we must be resolute and bold enough to run that ballot. If it takes limited industrial action to make them connect, we must be resolute and bold enough to take that action.

Michael Millenson, in his book “Demanding Medical Excellence: Doctors and Accountability in the Information Age”, joins the increasing chorus of experts including Professor Sir Brian Jarman who spoke at our 2003 Annual Conference. They urge that if we were all to use what is already best practice we will achieve far greater improvements in patient outcome than any future breakthrough in medicine. That miracle cures and fantastic new discoveries will achieve only a fraction of the improvement that is possible if every doctor, clinic, team and hospital performed as the top decile do. But haranguing the individual achieves little, except frustration that they cannot improve. Improvement requires systemic action.

Action to demand connection. To demand use of that connection. To demand connection between those who are paid to administer and those who are paid to deliver. To demand use of those connections. Because just a connection is not enough. Like neuronal networks that react, respond and remember, perform, plan and polish, unused connections are pruned and wither. Only the frequently used connections become hardwired into reflex behaviour.

Right now the disconnect is more apparent. The disuse and misuse. The ‘dissing’ of a hospital specialist workforce. Sounds like us?

Us in the eyes of others? Maybe. But not as victims. We refuse to adopt the mindset of victimisation. We throw off the shackles of being done to. We even forgive our enemies – for nothing annoys them so much. Collectively, we rally to be the conscience of the public health system we serve.

I call upon you fine folk, at this Conference. Connect with your colleagues. Demand connection with your teams. Connect with solidarity and certitude. Together, more than ever, we need to demand connection from our paymasters. From those who show in their actions, in the behaviour of those they employ, in the outcomes of their connections – a better way. For the future of hospital specialists. For the future of the public hospital system.

Kia kaha

Jeff Brown

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