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Little progress in distributed clinical leadership

19 August 2019

Little progress in distributed clinical leadership; represents a lost opportunity and is downright scary

“District Health Boards are failing to foster a culture of distributed clinical leadership, despite its demonstrated benefits to the sector,” says Ian Powell, Executive Director of the Association of Salaried Medical Specialists (ASMS).

ASMS’ latest survey of clinical engagement, or distributed clinical leadership, reveals that more than half of respondents (53%) believe their DHB does not encourage distributed clinical leadership by hospital specialists.

There has been little change in this measure since the last survey, in 2015, when 58% said their DHB did not encourage distributed clinical leadership, and that survey showed virtually no improvement on the previous one, in 2013.

Key findings from the 2019 survey include:

• A mere 24% said their DHB encouraged distributed clinical leadership.

• South Canterbury topped the table for distributed clinical leadership - its specialists were most likely to say the DHB was committed to distributed clinical leadership, followed by Whanganui and Canterbury. Canterbury has slipped from first in 2013 and 2015 to third.

• Not a single specialist at Wairarapa DHB believed the DHB was committed to distributed clinical leadership. Southern, Taranaki, and Tairawhiti also ranked in the bottom four.

• When asked if they felt able to speak out about patient care quality concerns, less than half of respondents felt able to speak to their Chief Medical Officer, and only a quarter felt able to discuss concerns with their Chief Executive.

“DHBs’ lack of commitment to encouraging extensive clinical leadership represents a lost opportunity to improve the quality and accessibility of patient care and financial performance.

“The lack of confidence of hospital specialists to raise within their DHB quality concerns over the care of patients is downright scary.

“DHBs continue to largely ignore the huge potential for senior doctors to step up and help solve the myriad challenges facing our health service, including financial wastage,” says Mr Powell.

“DHBs expect more and more of hospital specialists in workload, but, with some exceptions, they fail to recognise their leadership and innovation potential.

“It is time Health Minister David Clark stepped up by fostering a culture of genuine clinical leadership in DHBs. The two main beneficiaries would be the quality of patient care and the financial performance of DHBs because what makes good clinical sense also makes good financial sense,” Mr Powell says.

A total of 1158 ASMS members responded to the survey, a response rate of 26%.

The full results, published as an ASMS Snapshot, can be read here: https://www.asms.org.nz/wp-content/uploads/2019/08/commentary-on-the-DCL-survey-2019_172201.5.pdf


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