Kathy Grant has stepped into the health arena to steer the financially troubled Southern District Health Board into a better position after its board was sacked because of the deficit. She spoke to health reporter Eileen Goodwin.
When Kathy Grant applied for her first job as a lawyer, she was told she was the best qualified applicant, but the firm already employed a woman, and one was enough.
Almost four decades later, Mrs Grant has been sought out to take the helm of the Southern District Health Board, its board members having been sacked by the Government.
It is likely Mrs Grant (62) handled the sexist rebuff in 1970s Dunedin with the same circumspect briskness she has brought to the role of board commissioner.
She has maintained a remarkably low profile thus far for someone in her position. She is chairwoman of the Otago Polytechnic council and a director on key city boards. Her husband of 39 years with whom she has two children is Stephen Grant, a partner at Gallaway Cook Allan where she is a legal consultant.
Mrs Grant is not one for grandstanding. And she is not all that keen to talk about the thornier issues facing the debt-ridden board.
''I just don't think it's appropriate for me to make a series of sweeping statements at this stage.''
Largely unknown in the health sector and to the public, Mrs Grant has the benefit of being local, but not carrying baggage from previous roles. No-one should expect details of the reportedly tense relationship between management and the senior doctors to be aired by her in public.
''I don't know that there is an issue; that certainly hasn't been drawn to my attention particularly,'' is her response to a question about senior doctors' concerns.
She admits the task of pinning down the actual deficit in 2015-16 - identified by Health Minister Dr Jonathan Coleman as a priority - is proving more difficult than expected because of staff departures and an outdated computing system.
Three weeks into the job, she is diplomatic about the difficulties, speaking of ''engagement and dialogue with affected entities''.
She favours an ''inclusive'' style to managing tension behind the scenes. While every organisational leader claims as much, it seems to be a genuine hallmark of her style.
''It's just my personality. It's who I am. And I'm probably too old to change,'' she says.
People who have worked with her talk of a cautious approach, an aptitude for hard work, a consistent and methodical nature.
She is credited by one person with turning around the fortunes of the polytech, a suggestion Mrs Grant dismisses, saying it was in a good position under chief executive Phil Ker when she was appointed in 2010.
When contacted, Mr Ker said Mrs Grant was ''not a person with a big ego''.
''Kathy plays the issues; I've never known her to even come close to playing the person.''
Her ''extraordinary skill set'' meant she would be able to deal with difficult issues in her new role, he believed.
''I would be surprised if she allowed personalities to come to the fore at the expense of the issues of the day.
''She brings a balanced view to the governance table in the sense that with the polytechnic you've got the issues of finances, but you've also got the issues of educational performance, and she's always held both of those in equal regard.
''She will be as concerned with health outcomes as she is with financial performance,'' Mr Ker said.
Another, who declined to be named, said Mrs Grant was ''not a revolutionary'.
Mrs Grant: ''My style is not to go in waving a big stick saying: 'Follow me'.
''I'm far more a person who works collaboratively with others and being quite willing to take significant steps and be innovative, but not in the sense of being a revolutionary in the sense of crying from the parapets.
''That isn't my style, and it never has been.''
Guiding the polytech as it embarked on a building programme was her biggest governance achievement, she said. Major capital work is also on the agenda in her role as commissioner, as the plan for the $300 million clinical services building at Dunedin Hospital slowly grinds towards fruition.
Reluctant to link the delay approving the replacement of the run-down building with the need to get the board's finances under control, she says the issues are separate.
Her immediate focus is the books: ''Financial sustainability means we can't operate with the level of deficit we currently have.''
The board must be ''clinically sustainable and financially sustainable''. Clinical and financial sustainability is a mantra in the health sector, and she is reluctant to be drawn on what it means in respect of a health shake-up in the South.
She cannot rule out the possibility of patients facing more travel to Christchurch to access services now available in Dunedin. Specialty services are up for review, and some people think Dunedin provides too many for its population.
''I think it's too early to make comments like that, but what I have said is that the people who live in this part of the South Island are entitled to expect the same access to healthcare services.''
She is keener to point out opportunities for shifting services to general practice or rural hospitals.
She acknowledges that shifting services to the community in itself does not reduce cost: ''It only saves money if you can, as part of that process, remove fixed costs in the centre hospital''.
These have been key messages of the board for years - so what will be different?
''It makes me sound very boring ... look I'm trying my best,'' she says, laughing.
She is a ''great believer'' in informed decisions, and says her team will be ''honest'' with the community when the time comes for making them.
''Where we land in relation to a particular issue isn't going to please everyone and it's simply unrealistic to think we are going to be able to please everyone and meet everyone's expectations.''
Exhaustive reviews and reports in the past had gone ''looking for the missing pot of gold'' and had failed.
She will not make the same mistake: ''It's pretty clear there is no pot of gold''.
She says she is not ruled by edict from Wellington.
''I haven't been given any clear direction as to what is or isn't on the agenda.''
The South's tendency to mobilise to resist health cuts is viewed with wariness, and was cited as a factor in the board's financial failure by Chris Fleming, a sector leader brought in to examine the problem.
In his report, he said community victories in various health campaigns had a deleterious effect on the board's financial sustainability. Mrs Grant seems to have some sympathy with that view.
''I think the risk is, and I'm not making this comment in any particular context; the risk is an agenda gets driven and it reaches the point where you can only keep going forward, whereas some reason and calm heads at an earlier stage might have seen some other options''.
The Grants live in Dunedin but spend most weekends on their farm near Middlemarch. They feel like the ''colonial outpost'' of their children, who are living in England and France.
After a ''pretty ordinary upbringing in Oamaru'' as the middle child of three, Mrs Grant moved to Dunedin to study at the University of Otago. She has lived in Dunedin since ''so I consider myself to be a local''.
One of just a handful of women in her first year in law school, Mrs Grant attained a bachelor of arts in English and history as well as a law degree.
Work has been a central part of her life. When Michael (32) and Rebecca (26) were born, she took no more than six months off before going back to work, part-time at first.
Her son works in information technology in London, while Rebecca is studying for a masters in international development at a Paris university.
One of her proudest achievements is juggling the demands of family with work and community commitments. Her legal work involves property and trusts; maintaining relationships with clients is crucial to meeting their needs. At first, it was daunting to take on governance roles on top of everything else.
''I can remember when I first held a governance position and saw it as time-consuming and overwhelming.
''Finding a way to juggle and meet a number of different expectations - that really is something that you get better at.''
