Sandra Leggat: Empowering health managers

Due to rising costs and neglect in forward planning, the financial position of Australian hospitals has never been worse.

THERE is plenty of discussion about the sad shape of the Australian public health system, but this quote is not from today. It appeared in 1955.

Management of the public health sector is difficult. It was difficult in 1955, and is even more difficult now.

Public health sector managers regularly deal with conflicting policy goals, increasing demand coupled with decreasing resources, a wide range of stakeholders with disparate interests, and a highly trained, largely independent and industrially sophisticated workforce.

Alarmingly, recent inquiries into health system failures have consistently pointed to a lack of management systems and processes, suggesting that our current approach to management development is not working. Studies focused on human resource management practices that would be considered basic in other industries, have found these to be severely lacking in health care.

The paucity of employer-supported education in public health care has negative implications for the performance and potential for improvement of the sector. Even the National Health and Hospital Reform Commission recommended “investing in management and leadership skills development and maintenance for managers and clinicians at all levels in the system”.

How did Australia come to the situation where a $95 billion industry essential to our health is characterised by unskilled managers and leaders?

There is a perception that effective management skills can be learned on the job. Competent clinicians are often “promoted” into management positions, often without management training.

It is estimated that there are more than 30 000 managers working in the health care system in Australia (in government departments, hospitals, community health services etc), but less than a quarter display the formal qualifications required for membership of professional associations of Australian health care managers (Australasian College of Health Service Managers and the Royal Australasian College of Medical Administrators).

We need more effective approaches to the development of management skills. Health professionals are required to hold evidence of competence, so why are managers not held to the same standard?

In 2007, the Victorian Health Services Management Innovation Council initiated a management development program using just-in-time action learning principles. The program aimed to enhance the capacity and confidence of the participants to implement change, and to deal with a range of situations using strategic thinking and problem-solving skills.

The program ran for 3 years with 137 participants from health services throughout Victoria. Action learning addresses real problems of importance to participants in real time through a quasi experimental approach that follows a cycle of “problem–diagnosis–action–review–learning–action”.

The evaluation of this program suggested that many public health sector managers felt inadequate, alone and unsupported. Following the program, the respondent participants reported that their work was more meaningful; they were more confident about their ability to do their job; they were more self-assured about their capabilities; and they had more opportunities to decide how to do their work. That is, they reported greater empowerment in their roles.

The ability of the program to strengthen empowerment was an important finding of the evaluation. If managers are not empowered, they are less likely to provide opportunities for their staff to participate in decision making.

The evaluation, which I coauthored, suggests that we can strengthen engagement of health professionals in organisational decision making — not by establishing more committees, commissions and bureaucratic solutions, but by simply ensuring that managers in this important, but complex, industry have the necessary skills.

Professor Sandra Leggat is professor of health services management and head of the School of Public Health and Human Biosciences at LaTrobe University, Melbourne.

Detailed references available on request to editor@mjainsight.com.au

Posted 23 January 2012

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