KEY POINTS:
Two health boards, two meltdowns: there are striking parallels in the crisis gripping Wellington's troubled board and the blazing public rows which beset the country's biggest health system in 2003.
Now the doctor who helped heal the the festering wounds which threatened to tear apart Auckland District Health Board in 2003 says he sees the same elements present in the mess which has forced the Government to intervene in the affairs of Capital and Coast District Health Board.
The Wellington board this year has dealt with child cancer problems, system breakdowns and reports of discontent among clinicians. Health Minister David Cunliffe installed Sir John Anderson as chairman and put Northland obstetrician and gynaecologist Ian Brown in as Crown monitor, effectively a government-watchdog role.
Go back just four years and Auckland was mired in similar problems: it was moving to a big modern hospital, the budget was blowing out and the chief executive, Graeme Edmond resigned and then-chairman Wayne Brown fought publicly with his senior hospital clinicians.
At the southern board Judith Aitken - chairwoman until Sir John took over last week - was at loggerheads with her former chief executive Margot Mains.
In both cases the management chaos trickled down to undermine staff morale, especially that of hospital clinicians. Back in 2003 Dr David Galler, an intensive care specialist at Middlemore Hospital, was one of those who spoke out against hospital management. His criticisms infuriated Mr Brown, who accused him (and his brother Les, an intensivist at Auckland City Hospital) of being grumpy, probably as they didn't have enough toys when they were growing up.
The Galler brothers' main complaint was around the way health managers were out of touch with clinicians and clinical imperatives and that money was being spent in the wrong places.
At the time David Galler was an activist member of the Association of Salaried Medical Specialists and briefly vice-president and president of the union.
One of his initiatives had been to invite the then-Health Minister, Annette King, to a union executive meeting. "We had a talk about the quality of the advice she was getting: we didn't think it was as broad - and the quality as high - as we thought it should be. There was a feeling that the ministry didn't serve the sector as well as it should and that if it was better connected to the sector everyone would be better served."
That meeting led to the creation of the new role of Independent Adviser to the Director-General of Health and Minister of Health. Before long, Galler was in the ministry, working alternate weeks in his job at Middlemore and second, as the highly influential independent adviser in Wellington.
Now, four years into the role and speaking from Los Angeles, he says the same thing is happening again.
"It's pretty clear that Capital and Coast Health are at the extreme end of disengagement between clinicians and managers," he says.
"It's gone on a long time. The board has a core of very senior specialist staff, but no mechanism to engage them over decision-making, making them inclined to feel, as the years have gone by, 'why bother?'."
Which is where, says Galler, the board is missing the key to getting the hospital back in working order. As he points out, Wellington, as Auckland was, is moving into a new hospital.
And that part of the rationale the board would have used to secure funding for the new building programme, would have been an undertaking to change the model of care and introduce new efficiencies. What they probably did not do, however, was use their clinicians to work out how they could achieve those efficiencies.
"Have I made a difference? I think definitely in some ways. There's a definite realisation we [doctors] have got to work more with the sector."
Certainly 52-year-old Galler has not become a grey, boring, public servant. Every moment he can he changes into his favoured shorts and sandals. He likes cooking and gardening.
"Is my new job a way of getting difficult people out of the front line? To give them lots of money and make their lives too comfortable [to shut them up]?" he repeats, eyebrows high. "My life is hardly comfortable. It's very stressful actually."
He finds the weeks in Wellington, away from his wife and grown children, unsettling at times. Most of the time he stays with his mother or good friends. Nevertheless, it is refreshing to get a break from Middlemore's high-stress emergency department.
Wellington is a different kind of pressure: Learning his way round the politics; arguing long and carefully to change entrenched Ministry thinking.
"And if I can't turn them I will talk to them about it and use my other contacts to get my views heard - and their views modified."
"The important thing for me," he says, "is realising where the money is. Where are the great gains to be made? Where are the greatest efficiencies? If we can do that, the budget thing sorts itself out. Capital Coast Health is a real example of the necessity to change. There have been significant changes at the top [of the DHB] and explicit recognition from the minister down that the solution lies in working together".
"The way to do it is to improve the quality of care they provide," he continues.
"The challenge is to get the clinicians on side. Weasel words won't do it. The system has to be transparent and palpable - so people can actually see that they actually mean it."
"Your credibility rises enormously if you know how to approach difference. If you do things openly, honestly and transparently you become trusted - far more influential - and your ability to influence and change things is enhanced. If you're constantly going behind peoples' backs and are sneaky about it or are abusing people then you can't do anything. You're paralysed."
Now Galler, who constantly gets criticised for going over to management, has a standard line for colleagues who attack him because he has joined the other side: "I'm trying to do my bit. Things are far from perfect. Where I can I try to make things better. So get off your fat **** and do the same."
