I would like to officially announce “austerity” as healthcare’s middle name. Although the title “health austerity care” (as it will now be known), has only just been announced, its impact is already bringing governments to their knees.
So why do we need austerity measures? Well, basically the baby boomers are about to cause an unprecedented spike in health service utilisation, and our system hasn’t been designed to accommodate it. In fact, over the next two to three decades the population over the age of 65 will double. Considering the 65-plus age demographic contributes to over 80% of total healthcare demand, we know that demand will at least double, with dire projections suggesting it could quadruple.
So, is Queensland’s decision to put downward pressure on healthcare costs rational?
I believe there is some method to the madness, but the approach leaves a lot to be desired. If we continue “business as usual”, the rising costs associated with our ageing population will consume every state budget within 20 years.
Yes, you heard right, if we don’t transform the way we deliver healthcare quick smart, state governments will soon have no money for water, no money for schools, no money for roads, nothing; the cost of healthcare will consume every last penny. Considering this, you can begin to understand why state governments are taking such radical action.
Are massive workforce cuts are the answer? Hardly. Slashing wages is a “quick and dirty” way of putting downward pressure on costs, and although it works as an economic solution, it fails to recognise that there is more to the business of healthcare than economics.
When the government and Treasury made this decision, I wonder if they considered what impact this might have on quality and safety? I wonder how many lives was it acceptable to lose to make this saving worthwhile? Did they factor in the cost of the long-term societal and community impacts? Did they account for the loss of productivity and higher workforce turnover? Or the impact on organisational culture? Did it cross their mind that it might be difficult to reorient the system towards a more cost-effective preventive model when the entire preventive health workforce has been axed?
Does the government have a plan to mitigate these risks, or was this decision as blunt and shallow as it appeared to be?
Unfortunately, health-austerity-care measures are not only confined to Queensland. I recently returned from Tasmania where a similar number of its health workforce was cut over the past six months. The only difference being that Tasmania only had a workforce of 12,000 to start with. An already flailing Tasmanian health system has compounded the challenges it faces by cutting 25% of its health workforce. Of course this might save money in the short term, but what about the long-term sustainability of the health system?
If blunt and short-sighted policies are the best the state governments can do to enhance the sustainability of our health system, then we are in for some tumultuous times over the next 20 years. It is simply impossible to avoid serious and long-lasting consequences when you decimate a workforce in this way.
So what would good leadership look like in these situations?
Good leadership would begin by having an honest conversation with the community. If the community understands the gravity of the challenge we face, I believe they would support us and find solutions. At the moment the public have not been informed that we face an impending crisis in healthcare, nor are they aware of the urgency for change.
Secondly, I believe the government needs to create a 10-year change vision for health services and communicate the vision for buy in. This is essential if our governments have any hope of wanting the public to understand and support their actions, otherwise all they will get from the community is anger, frustration and confusion; has anyone seen any evidence of this lately?
Once good leaders have created an urgency for change, established a strong vision, and developed a coalition of support, they need to empower broad-based action. Often that means getting out of the way and trusting the community and the health system to come up with sustainable and innovative solutions.
The role of government should be to remove obstacles wherever they can by doing things such as reviewing legislation and regulation, and generating public support. Governments need to create an environment conducive to change, rather than driving change down people’s throats. They should invest more time into recognising and rewarding success, as opposed to sacking experienced leaders within their departments for system failures typically not within their control.
Great leadership would see governments create quick wins, and then build on the change before incorporating the changes into the culture by articulating the connections between the new behaviours and organisational success.
Great leadership is achievable. In fact, the model outlined above is drawn from the most widely used leadership model in the world called “Kotter’s eight-step model for leading change“, a simple but effective leadership approach taught in many ACHSM leadership courses.
So while austerity remains the dominant discourse in healthcare, let’s hope the practice of great leadership does too.
*This article was first published at the ACHSM blog