Australian College of Health Service Executives NSW Branch 2006 NSW State Conference Leadership in H

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Australian College of Health Service
Executives(NSW Branch)2006 NSW State
ConferenceLeadership in Health ReformFriday 7
April 2006 Providing Leadership to Achieve
Clinical and Organisational Change330-430pm

• Prof. Michael H. Moodie
• (Former CEO King Edward Memorial and Princess
  Margaret Hospitals, Perth W.A.)
• michael.moodie_at_bigpond.com

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The presentation will address

• Leadership in Health Reform by Inquiry
• Case example of King Edward Memorial Hospital
  (KEMH)
• Douglas Inquiry has an international reputation
  and ranks with the Bristol Inquiry. Douglas is
  often referred to as Australias Bristol.
• Implications for Leadership

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REFERENCES

• Douglas, N. Robinson, J. Fahy, K. Inquiry into
  Obstetrics and Gynaecological Services at King
  Edward Memorial Hospital. Nov, 2001.
• Australian Council for Quality and Safety in
  Health Care. Lessons from the Inquiry into
  Obstetrics and Gynaecological Services at King
  Edward Memorial Hospital . July 2002
• Mclean, J. Walsh M. Lessons from the Inquiry into
  Obstetrics and Gynaecology Services at King
  Edward Memorial Hospital 1990-2000. Australian
  Health Review Vol 26, No.1 2003

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Leadership has been defined by Kaplan (1994)
as Leadership is about responsibility, above
all. It requires acceptance of the importance of
ones self coupled with an appreciation of the
greater importance of others over oneself
leadership entails liability for those who are
led.
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• KEMH is an example of Clinical and
  Organisational Change that was initiated by an
  external force - an Inquiry, to radically change
  culture and improve the delivery of clinical
  services.
• The Douglas Inquiry was significant as it was
  initiated as a result of internal processes
  established by the CEO to report clinical
  incidents. The CEO reported the incidents.
• Most other inquiries e.g. Bristol and Bundaberg
  resulted from the actions of whistleblowers
  externalising the issue to the media and the
  community.

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KEMH is Western Australias only tertiary
referral service for obstetrics and gynaecology.

• 250 Beds
• 5,000 gynaecological operations per annum
• 5,000 deliveries per annum.
• An isolated site and an isolated culture

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The Douglas Inquiry cost in excess of 7M and
provided a text book approach to the delivery
of safety and quality systems for any tertiary
hospital. Performance deficiencies were
identified at state, board, and hospital level
contributing to poor outcomes for women, babies
and families. The Inquiry raises important issues
about clinical governance, leadership and
culture, accountability and responsibility,
safety and quality systems, staff support and
development, and concerns for patients and their
families. (McLean and Walsh 2003)
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Significant improvements have been made at KEMH
with the delivery of clinical services The
culture has been improved.
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The Douglas Inquiry has important implications
for anyone undertaking a Leadership role namely
a CEO

• These implications or effects can be
  categorised as
• Choice
• Four Corners
• Inquiry
• Google
• Life After

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In difficult situations such as those associated
with clinical incidents a choice will need to
be made An essential part of defining the issue
or problem. The choice will often be between
your responsibilities to the organisation and
your responsibilities to your clients or the
community. The implications of the choice can
be profound both professionally and
personally. CEO has a delimma
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The Four Corners effect refers to the issue
being externalised to the community. Control is
lost The message is simplified Many players
become involved Allocation of blame is
commenced CEO participation is often restricted
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Inquiry is the preferred method of solution for
serious issues relating to health care
delivery An external and legal process About
assigning accountability Inquiry outcomes are
known CEO will be removed
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The Google effect relates to the impressions
that are formed as a result of published media
attention The Google effect is everlasting and
very powerful Often in the negative Everybody
uses Google CEO has a reputation
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Life after has already been determined by
others Probable you will not have your job.
Likely you may have another job Be mindful of
follow up inquiries/investigations
 Liability CEO career over
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Solutions for discussion
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The End