The turnover of senior managers in the public hospital system is remarkable, and the history of St Anywhere’s in this regard is not exceptional.

In one recent eight-year period, there were seven different CEOs, none medically trained, and all arriving with the public service handbook of hospital administration.

From close observation, I have learnt that this text, while not yet on the bookshelves, has several basic rules that are followed without question. These include:

  1. The previous incumbent allowed the situation to deteriorate to its current state. This is usually based on two grounds. Firstly, all staff with any form of grievance have booked up the first two months of appointments to try for the fourteenth time to explain why they require more staff and secondly, the budget is millions in the red.
  2. All positions must be frozen! This seems to occur in September, just when we are trying to advertise for new trainee medical officers for the upcoming year. By the time this is realised, all talented staff have been snapped up elsewhere and we are left trawling overseas for recruits.
  3. A review is needed. An array of consultants are recruited (usually from the CEO’s last hospital) at great cost. They bring with them ideas to improve the hospital’s output and efficiency. Unfortunately no hospital in the Western world seems to have actually been able to implement them, but by the time this question needs attention, they have disappeared, with only a report to follow. Recently such a report was done in such haste they even forgot to change the name of the hospital being reviewed several months earlier.
  4. Services need to be reduced. This approach usually ends the honeymoon period between the CEO and the Health Department and the local Minister of Health. All three agree a reduction MUST occur — providing no-one knows about it, no patient suffers (publicly) and talkback radio doesn’t get wind of it. Inevitably some patient, relative or member of staff exercises their democratic right. The issue is a local headline, the decision is reversed and the budget remains overspent.
  5. Staff must only speak to the media with CEO and Media Department approval. As a result of the reduction fiasco, all employees are reminded of their contractual obligation not to pursue their democratic right of free speech. This tactic usually worked well as few could afford to be dismissed.

By the time all these new initiatives have been implemented, at least twelve months has passed. Usually the best clinicians have started to look for alternative employment, no trainees want to or could come to the institution, and St Anywhere’s has missed the cut for next year’s new equipment funding.

It is generally around this time that the CEO gets a sudden offer to return to their state of origin (often with a twelve month termination deal). By late August, the new CEO has been appointed, and arrives clutching their newly-bound textbook of public hospital administration.

And so the cycle continues.

Peter Fray

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Peter Fray
Editor-in-chief of Crikey