The public may not be convinced of the reality of the commissioners' claim they have begun turning the rudder on the good ship Southern District Health Board.
During the commissioners' four years, the DHB has been dogged by crises and controversies, including in urology, ophthalmology, gastroenterology, and maternity services. As we have previously observed, failures in health services are not abstract events and can cause immeasurable harm to individuals and those around them. The deficit is up, along with those of other district health boards, partly because of increases in employees' pay and reimbursements to correct miscalculations over holiday entitlements, but also because of a blowout in operational costs The commissioners were always adamant their role was not slashing and burning in order to reduce the deficit but to work towards a more sustainable future for the DHB. They consider they have laid the foundations for this.
During the commissioners' tenure, work on planning a new Dunedin Hospital, the redevelopment of Lakes District Hospital and an upgrade to Dunedin's intensive care unit were all projects which people could relate to. It is hard to tell if the emphases on improving the integration of primary and secondary care, "putting the patient first" and improving patient flow through the system have been readily understood and tangible for patients.
In the foreword to the annual report for last financial year, outgoing commissioner Kathy Grant and chief executive Chris Fleming say improving healthcare requires the whole system working together. The report acknowledges the need for the board to confront how it addresses "genuine conflicts".
"We know we will continue to have challenges, and that there will inevitably be differences of views, sometimes strongly held, by individuals working within constrained resources but with the shared goal of doing their best for our patients and community.
"We must acknowledge and prioritise the reality of this difficult aspect of roles, and build constructive processes for handling the challenging situations this inevitably brings."
Mrs Grant and Mr Fleming drew attention to the board's second annual staff engagement survey, heartened by improvements across all priority areas, signalling that as a place to work "we are moving in the right direction".
However, the brief snapshot on priorities from the survey results later in the report is sobering. Half of the board's staff took part (2234) and 50.5% of them considered they had been subjected to bullying behaviour in the workplace, down from 55% the previous year. This may be moving in the right direction, but not very far.
That means more than 1000 staff believed they had been bullied (and likely more who did not participate in the survey).
Less than half of respondents felt leaders communicated well so they always knew what was going on. Not an encouraging statistic when teamwork is an essential part of healthcare.
Only about two-thirds of respondents said they had the equipment and supplies to do their jobs properly. This had increased from 56% the previous year. Again, this is an improvement, but there must be large numbers of staff who feel frustrated by a lack of relevant resources.
The inadequacy of funding will continue to be a bugbear for the board. Already, new board chairman Dave Cull is making noises about lobbying for changes to the DHBs' funding model. The bulk of board funding comes from the complex and poorly understood population-based funding formula (PBFF) which is due for its five-yearly review next year. Previous reviews have done little more than tweak the formula.
Whatever happens over funding, as they steer the still listing ship, the new board and management should not become so obsessed with money that the need for improvements to the workplace culture gets lost overboard.
Better ways of dealing with conflicts, wherever they occur, must be found for the good of staff and patients.
