Thinking About Three Decades in Health

One of the most insightful quotes I’ve ever come across is from the Danish philosopher Kierkegaard, who said that whilst life must be lived forwards, it can only be understood backwards. This quote was at the front of my mind recently when I realised, while stuck in a traffic jam, that I’ve just passed my 30th anniversary working in healthcare.

As I waited for the traffic to move, I started thinking of what life was like 30 years ago. For starters I had a great deal more hair and was several kilograms lighter. I was also at a stage of life where I thought I was invincible because back then I smoked. I started smoking because I thought it made me look cool and in fact it was quite normal for people at the health authority offices to smoke at their desks at that time. With the value of hindsight, starting smoking is undoubtedly one of the most stupid decisions I’ve ever made and I’m grateful that I chose to become smokefree many years ago.

Just as society has changed for people who smoke, we’ve also made huge advances in healthcare in the last three decades. Back then, there was far less that we could do in terms of looking after patients. So much of our job was to try and do what we could, knowing that we couldn’t solve the problem. AIDS was just appearing and there was a real sense that being diagnosed as HIV positive was a death sentence and that your death would be both imminent and painful. Though we haven’t yet found a cure, we now talk about people with HIV as almost living with a chronic disease.

Thirty years ago it was also quite common for people to die suddenly of heart disease or a heart attack. My own uncle passed away very quickly in this way. Now it seems that more people avoid such catastrophic events and live longer with increasing support from the health system. These days we can do more and more, and therefore wish to do more and more to help those in our care. Discussions around clinical safety and clinical quality have moved from being purely the role of the individual health professional to now becoming very much the responsibility of the team, the organisation and the system.

Without a doubt, healthcare has changed hugely in a relatively short space of time which prompts us to think about what we do and how we go about doing it. One of the characteristics that I think marks the New Zealand healthcare system and this organisation out as different is the extent to which we have stopped focusing on the problems of the 80s and 90s, and are instead looking at the challenges that face us now. Our work with Localities and campaigns like Beyond 20,000 Days are all innovative solutions to current challenges. With the opening of the Harley Gray Building next month, we now also have a hospital that is fit for the 21st century. Although there is still more capital development required at the Middlemore campus (with Mental Health, Rehabilitation and Maternity Services), the completion of the Harley Gray Building marks a watershed moment in our organisation’s history.

To make change happen, you have to commit to doing things differently and at CM Health, I think we’ve been very successful in doing just that. Through our great work as individual health professionals, through the emphasis the organisation has put on effective stewardship of our finances, and through our continual focus on quality improvement and the Granny Test, we now have a very strong foundation on which to build a future which delivers world-class health services to the people of South Auckland.

This is both an extraordinary opportunity and a significant responsibility. Undoubtedly the future will bring with it more change and different challenges. However, as Kierkegaard hinted at, the best predictor of the future is the past. When I look back at the last 30 years and at what CM Health has achieved in that time, I’m filled with enormous optimism. As the state-of-the-art Harley Gray Building testifies, this is an organisation that can indeed move mountains (but sadly not solve traffic jams).

Geraint

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Author: Geraint Martin

Geraint Martin was appointed Chief Executive Officer of Counties Manukau DHB in December 2006. It is one of the largest District Health Boards in New Zealand and services a population of half a million. He has significant experience over 30 years in national policy & in managing both primary and secondary care . Previously, he was Director of Health and Social Care Strategy at the Welsh Government .He authored a radical 10 year strategy of reform, including the successful “Saving 1000 lives” Campaign.Until 2004, he was CEO at Kettering General Hospital & had held senior positions in London & Birmingham.He has worked closely with clinicians in improving clinical standards,patient safety,chronic disease management & managing acute care to reduce hospital demand.In NZ, He has promoted clinical quality and leadership as central to improving patientcare. This has led to a significant increases in productivity and access, whilst maintaining financial balance. CMH has completed in 2014 a $500 m capital redevelopment programme, the largest in New Zealand. A central part of this is the establishment of Ko Awatea,the Centre for Innovation and Research which will underpin CMH as one of the the leading health systems in Australasia.In 2008, he chaired the Ministerial Review of Emergency Care in New Zealand, and in 2013 was an member of the Expert Advisory Panel on Health Sector Performance. Geraint has an MSc in Health Policy from Birmingham University .His post-graduate work has focused on health economics and Corporate Strategy . He is adjunct Professor of Healthcare Management at AUT and Victoria University, Wellington Elected in 2006 as a Companion of the Institute of Healthcare Management, previously he was an Associate Fellow at Birmingham University.He is is Chair of the Auckland Philharmonia Orchestra, a member of the Institute of Directors, on the Board of the NZ Institute of Health Management & previously the Board of The NZ Health Quality and Safety Commission.

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