Taranaki's Dr Jonathan Albrett has just been awarded Australasian Clinical Educator of the Year for his initiatives addressing systemic stress.
Motivated by experience of hierarchies often reinforcing a reluctance to consult, Albrett devised an acute skills teaching programme to give confidence to first-year doctors in sole-charge of wards.
In a recent RNZ interview Albrett credits greater reporting to less tolerance of bullying – and of the "ferocity" often evident 20 years ago. And credits initiatives like his.
Executive director of the Salaried Medical Specialists Association (ASMS) Ian Powell welcomes initiatives promoting systems more responsive to stress feedback.
For Powell, challenges within the system involve "a high level of unmet need, long-standing shortages of senior medical specialists, significant under-resourcing of hospitals and disruptive privatisation moves".
Health Minister David Clarke's recent appointment of an independent advisory board reinforces his commitment to address frustrations about the relationship between health boards and the ministry. But he says no changes will take place until it is clear what needs to happen.
Welcoming a structural review of funding mechanisms, Powell insists governments can create necessary change. Meeting budget key performance indicators (KPIs) can be different to meeting funding needs, he say.
Top-down demands that boards be responsible for meeting budgets do nothing to acknowledge "unrealistic budgets based on inadequate calculations." Powell wants boards to "engage with these deeper issues, to examine the systems producing them."
For Auckland's Professor Cris Shore an audit mentality has become pervasive in public service. His co-authored Audit Culture and the New World Order tracks how a politics of accountability can fail to recognise "not everything countable counts".
A Royal Society award recently recognised Shore's contributions to understanding relationships between policy ideas and governance.
Shore traces audit culture's origins to 1980s demands for efficiencies producing a mentality blind to, or unable to process, its perverse effects. He prefers engagement, evidence-informed findings and professional judgment to a reliance on "flat numbers".
He cites a psychiatrists' conference invitation for him to speak, motivated by concerns about employer pressures on them to declare the least number of sessions needed to cure PTSD.
Powell believes some DHB chairpersons have also been living in a bubble about what is going on in hospitals over which they have stewardship.
Citing economist Bill Rosenberg's 2017 published figures revealing shortfalls in both clinical and operational spending for all DHBs, Powell says surveys at five DHBs indicate significant spending was required "just to meet even present needs" for recruitment and retention.
His solutions: a review of population-based funding systems, "distributive clinical leadership" where specialists are responsible for a range of leadership tasks, and increased spending on primary care.
Powell acknowledges the consequences of a 1990s' removal of clinical leadership layers – and that it takes courage to advocate, especially if command-and-control leadership styles exist.
Founder of Canterbury Charity Hospital Phil Bagshaw believes much continuing staff stress stems from the false economising of this leadership removal.
"Countless studies" show austerity is counter-productive, he says, that present health investment saves future expenditure.
In a recent RNZ interview Bagshaw sketched the demise of an advocacy able to challenge a managerialism that confused professionalism with institutional loyalties. Or saw political engagement as undermining them.
He wants public trust restored by an advocacy that speaks up for the patients physicians serve. He instances the Royal College of Surgeons of England's reversal of disengaged professionalism. It now gives weekly updates of published articles about NHS underfunding realities
In her first speech in Parliament Chloe Swarbrick used a simple fable to highlight the difficulties of analysing systems we are immersed in: A dog calls out to a fish swimming upstream, "What's the water like? The fish replies: What water?"
Bagshaw admits that while no profession consensus exists, many overseas medical schools are now teaching an open advocacy that promotes social justice.
Perhaps such advocacy can now also be seen as part of Sam Hazeldine's doctor self-care.
Steve Liddle is a researcher and independent journalist based in Napier.
Views expressed here are the writer's opinion and not the newspaper's. Email: editor@hbtoday.co.nz
