EDITORIAL
Vol. 18 No. 3 November 2002
Reflections on Life as a District Health Board Member
It is now almost one year since my election to the MidCentral District Health Board (DHB). It was therefore timely to be asked by Nursing Praxis to reflect on my experiences over this period. These reflections necessarily come from several perspectives: the personal, the professional and those as an elected representative of an urban community.
Personally it has been a time of learning and adjustment. On a very basic level one challenge has been to build into my weeks the time required to read and analyse the vast amount of material forwarded prior to the Board and various subcommittee meetings. In this regard the most difficult area for me has been learning to make sense of the financial data provided for scrutiny. Finding the bottom line and seeking meanings behind the figures has required new skills, some of which I am still learning. Another challenge has been learning to cope with the huge sense of responsibility I feel for meeting competing health demands within pressing financial constraints. As an elected representative this has been acutely sensed - the voters had placed their hope and trust firmly in my hands and I know they are closely watching my steps.
One year on, and certainly on a personal level, I am feeling a sense of comfort that each individual Board member’s voice is welcomed and listened to. I personally feel able to raise concerns, ask probing questions, seek further information and if necessary challenge recommendations being made. This may not be the experience of all Board members throughout the country, and is something that people need to address if the new DHB model is to be effective. Professionally, as both a registered nurse and an educator, I have taken particular interest in certain areas:
• Health workforce issues
Recruitment and retention of an appropriate and well-prepared health professional workforce is central to effective health care delivery. As a health professional on the Board I have sought to ask probing questions and raise challenging issues around health workforce development. There are however no simple solutions particularly in today’s environment of shortages of experienced staff resulting in imbalances in skill mix. The biggest difficulty still lays, I believe, in fostering a sense of pride and collegiality in a sector that has been besieged by many health system changes over the last ten years. Being valued and having a voice that is heard are a starting point in developing a workforce that wants to stay within the sector and wants to make a difference.
• Quality in health service delivery
On a national basis the media is quick to pick up on those things that go wrong in the health sector. Understandably New Zealanders become justifiably alarmed at some of the things that come to light. As a nurse on a Board I find these events disturbing particularly where they involve inadequate care on the part of health professionals. The public should not be put at unnecessary risk and I know that Boards are genuinely concerned with the maintenance of safe clinical standards. Finding the tools to accurately identify deficiencies and then sourcing effective ways to overcome them will continue to be a challenge in the future. I sense a longstanding guardedness within health that resists open examination of what is done. Boards however have a responsibility to ensure full assurance quality improvement systems are
actively critiquing service at all levels.
• Good use of the healthcare dollar
District Health Boards have finite budgets to work within. Most Boards started their terms under the weight of heavy deficits and continue to struggle their way towards the black. On top of this the Ministry of Health has published a wondrous array of ‘Strategies’ challenging Boards to meet an increasing list of targets - the difficulty being how to spread the available resources around to meet them all. Learning the intricacies of where and how the money is spent is no easy task, especially for those of us from a non-financial background.
What has been encouraging for me to see, however, is the drive within our Board to gain efficiencies predominantly in non-clinical areas. We are also seeing increasing levels of collaboration between Boards, both at regional and national levels, which include sharing of resources to reduce overall costs. However, resources will always be in higher demand than those available. It will mean having to make difficult choices, and these will require careful research, community consultation and Boards that are able to cautiously consider all alternatives.
• Meeting health care needs across primary, secondary and tertiary levels
of care
Two of the principles of the New Zealand Health Strategy (2000) are good health and wellbeing for all New Zealanders and to gain improvements in health status for those currently disadvantaged. These require a population health focus which is something that Boards are currently working to develop through their funding divisions. The duel funder/provider roles of a DHB require constant scrutiny. Secondary and tertiary provider arms consume the vast majority of a DHB’s budget. Funding of primary health care will have to continually compete with these large beasts - at a governance level the Board must always be cognisant of the imperatives to improve health status in its widest possible sense. Services aimed at personal health cannot be allowed to overtake those required for improving and maintaining public health. So what are the opportunities for nursing within this reconfigured health care system? Without a doubt nurses are being looked at to play an active role in shaping new service models of the future. Nurse Practitioners will be an important element in this, although I see that it will be some years before their full impact is felt. Today’s pioneers will be closely watched by many in terms of the difference they may make in improved health outcomes.
The introduction of Primary Health Organisations (PHO) also offers nursing a unique opportunity to get in on the ground floor as key partners. Establishing an equal footing at the setup phase of a PHO is essential. Likewise nurses need to seek innovative ways to contribute more autonomously within the provider/ hospital arms. Each of these requires nurses who have met the joint challenges of continuing postgraduate education and developing their own scope of practice to an advanced level. As a profession we must be able to demonstrate high level skills, delivering health care in ways that make a difference to the community’s health. I believe that in NZ we have the nursing leaders and nursing role models to enable us to seize these chances and take nursing to a new level of respect within the national health care sector. Let’s show them what we’ve got!
Janet Olliver, RGON, MA (Applied) (Nsg)
Professional Head of Nursing, UCOL, P.N.
Member, MidCentral District Health Board
Reference:
Ministry of Health (2000). The New Zealand health strategy. Wellington: Author.
