Abbott’s plan for hospital boards is one that can work
If you spend time in our public hospitals as a patient or as someone who works there you are acutely aware of all the concerns about the state of the system and the level of care.
The people who serve in the public hospital sector are generally committed above and beyond all call, and are constantly frustrated if they feel that cannot provide the correct and best care for a patient because of the limitations of staff, equipment, time and capacity.
Many of us have called for hospital boards and now once again the idea has been floated, this time by Tony Abbott.
As a patient you want to know that each person you encounter in your care is accountable to you as an individual and in the scheme of things works in a hierarchy and system that supports them and is accountable to the community.
Currently, even though each doctor or nurse or ward staff may want to function that way, they work in a system where the accountability is remote to a health department. There are layers of self perpetuating bureaucracy who are remote from the coal face and have little practical reality as to the impact that their decisions make. They have no understanding of the cost burden they themselves heft on the health system and how it sucks money out of patient care. There are many real examples where beds and wards have been closed in order to open desks for public officers.
Within a Federally funded or State funded structure, (and Federal funding and control means even greater distance from the patient, the servant and the services), the best model for accountability and responsiveness in hospital administration is to have hospital boards in place. Where a geographic or demographic situation demands it, local or regional boards should be created.
This idea is not new. Many States had a hospital board structure in past. These were dismantled because governments and health departments wanted more control. They wanted to destroy “pride” that institutions had in themselves and the “competition” between them for excellence. The Chairs of Boards could embarrass government if they underfunded or showed lack of compassion.
There was a pointed voice that could target the government specifically and with authority. Government did not like that aspect in particular. The Boards could advocate for the needs of the community, and at the same time ensure that business was conducted at its very best to provide delivery of high quality care in a cost effective manner.
Government preferred to create a lowest common denominator controlled more centrally, rather than allow for development of service delivery based on recommendations from those who are experts in delivery and those who carry responsibility and accountability to the people.
There is merit to a structure where a CEO of a hospital is accountable to a Board and the Board is accountable to the community. In fact the Board is made of significant community members with expertise in business , senior doctors and clinicians, nurses and providers, those with legal expertise, consumers etc. The makeup of the Board will require the diligence that you would place in the selection of people to run such an important institution as a hospital. That Board, our representatives, then holds government accountable.
The CEO is hands on, relating to the staff and the service provision and the patients. He walks the corridors, listens and responds to his providers, manages the budget and day to day operations, and reports to an interested board who is engaged. The security of patient care with excellence and efficiency are goals. These models exist in the private sector, and they would serve the public sector well.
Confidence in the hierarchy that supports your working environment is a start to job satisfaction. When you can see it translated in support for the work you do in looking after patients then there are better outcomes for all concerned. Knowing that you can use your skills to the utmost in caring for people because you have the tools, the time, the efficiencies and the capacity, ( be it bed capacity, staff, or investigative or discharge to step down or rehab care), then you want to stay in your job. The crucial recruitment and retention of doctors and nurses will become easier as the environment in a Board run hospital changes.
Of course, we have to have sufficient funding to enable the service delivery. That denominator does not change. But there will be improvement in the effective use of that dollar translated into service delivery under hospital Boards.
Central take over’s are not the answer. The buck does not stop with the PM. He is too far away.
Let the buck stop with those who live in the community in which the hospital serves. Let it be held in those who are trained to provide the standard of clinical care we should expect in this country, Let it reside in those who know how to run a complex service provision business like a hospital. Let us bring back pride and a desire to work in our public hospitals. Let us allow the hospital to integrate with the community needs and be part of the plan for our increasing aging population.
Let’s bring in the public hospital Boards and they will be accountable to the communities they serve and they will bring government into account.
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