Why health managers need more training

Why health managers need more training

14 Oct 2009

sandy-leggatt-thumb Professor Sandy Leggat
Email: s.leggat@latrobe.edu.au

If we are to believe the National Health and Hospitals Reform Commission (NHHRC) there is a crisis in the management of the Australian health care system – and from my position as the coordinator of one of the largest tertiary programs for health service managers in Australia, I would agree.

The final report of the Commission was made available in July of this year. The Report, A healthier future for all Australians is the culmination of six months of consultations and deliberations aimed at providing advice on performance benchmarks and practical reforms to the Australian health system.

Most of the recommendations support existing directions of the Australian health care system, re-affirming universal entitlement, expanding wellness and health promotion programs, encouraging personal responsibility for health, providing accessible information including personal electronic health records and investing to improve the health of Aboriginal and Torres Strait Islander peoples. These are recommendations that one might find in any health system review of any country confronted by a largely unaffordable public health care system.

However, this report also has a set of clear recommendations that suggest that our health care system is at risk of ill informed and inadequate, or possibly even dangerous, management practices.

The recommendations stress that “incentives for improved outcomes and efficiency should be strengthened”. An educated manager has the competencies to look for and advance continual improvement in operations – few competent managers need external incentives to accomplish this. The Report also stresses that there is a need for “a culture of mutual respect and patient focus” and “improving clinical engagement.” Again, an educated manager knows the research that shows that high performance work systems, which include a range of human resource management practices, such as selective hiring, information sharing, teamwork and employee participation, are required for organisational performance.

Managers, with the requisite skills and education do not need to be told how to do their jobs. The fact that these recommendations, which any educated management practitioner would know address basic aspects of good management practice, have been made in the report of a National Commission suggests a crisis in health care management.

Perhaps it is related to the underlying notion that anyone can manage in the health care system. While it is estimated that there is in excess of 30,000 managers working in the health care system in Australia (in government departments, hospitals, community health services etc), less than a quarter of these managers display the formal management qualifications required for membership in the professional associations of Australian health care managers (that is, the Australian College of Health Service Executives and the Royal Australasian College of Medical Administrators). The traditional practice of entrusting good clinicians with management responsibilities without any formal management education needs to stop.  

Granted, the Commission also recommended “investing in management and leadership skills development and maintenance for managers and clinicians at all levels in the system.” But one wonders how Australia came to this unfortunate situation - where a $95 billion industry directed to our health is managed by unskilled managers and leaders?

This is not the first report that has identified the limitations in the management of our health care system. Just about every state in the country has had its own management crisis and resulting review, study or report.

One outcome of these studies of rogue medical practitioners and inadequate management systems and processes has been an increased focus on ensuring the health professionals working within our health care system have the appropriate credentials. Unfortunately, there has been no emphasis on ensuring the same standards of professional management qualifications for those who manage the system.

I suggest that we need to address this crisis in health care management - not by establishing more committees, commissions and bureaucratic solutions as recommended by the National Health and Hospitals Reform Commission - but simply by ensuring that those who are managing in this important, but complex industry have the necessary management credentials.  

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