Australian health system: What needs to be done

The Australian health system is often criticised. Chair of the Australian Centre for Health Research Alan Castleman says while the system is working well, there is room for improvement that requires changes in the way we think and act.

Australia has an excellent health system with highly competent medical and other health professionals, plenty of good hospitals and all the other infrastructure necessary to provide a 21st century system. The overriding challenge is to keep improving it. This blog gives my views on that challenge.

We need to focus not on having more, but on having better, more relevant, higher quality, more efficient and more productive systems. We need to look to the future as well as the present.

Our systems are world class, have been improving, indeed could not be world class if they weren’t constantly improving. I also acknowledge that almost all the people who work in the system –scientists, doctors, nurses, pharmacists, physiotherapists, dentists, opticians, and all the other paramedical professionals and others – are not only highly skilled but dedicated and hardworking. I have immense respect for them all. But there is great scope for improvement and much of it requires changes in the way we think and act.

My background was in engineering, economics and finance, management and as a company director. I have worked at a senior level in many industries, including health, and in both the private and public sectors. Currently I chair the Australian Centre for Health Research, where we encourage improvements to our health system.

The characteristic I think most needs to change is culture. If we could instil a culture of continuous improvement, rather than the defensive cultures we now have, we would unleash forces for improvement which are currently too constrained. Health is full of people who desperately want to bring about good change but are stifled by forces they don’t seem able to overcome.

Here are some attitudes I would like to see change.

First, there are those who think that all is fine and no change is needed except for more government money. Highly productive companies are those which strive to do more with less, and succeed in doing so. Managing change is a complex but learned skill. It doesn’t always come naturally. There are people in health who have no idea how to bring about change but just want to hold their current job, and that sometimes involves resisting change.

We have trade unions and colleges for which an important focus is on protecting the status quo, (or seeking more remuneration), but which in the process stifles desirable change. I don’t expect them to admit this, and sadly some don’t even realise the stifling impact they have. This comment does not imply that all groups in health are appropriately paid. I feel that some are underpaid and a small number of the top professionals indecently exploit their position for money. Unfortunately this happens also in other professions and in business. The groups who represent vested interests and their members need to understand the negative impact they have on the wider interests of the health system.

Second, we need to break down the ideological attitudes that permeate many areas. For some Medicare is a sacred cow because it was introduced by a Labor government. Never mind it is failing now and in some ways never delivered as promised. Some of these people seem to believe that all would be well if only government would kill off the private sector which is encroaching on their preferred health model. Equally, those who can’t recognise the necessary and legitimate role for government, need to take off their blinkers. The facts are that we have a mixed system which works pretty well. We need to improve all parts of it, not take refuge in turf wars.

Third, we need to throw out the idea that health is different and thus should be exempt from the normal disciplines that the rest of the country have to accept. Everyone needs to accept that if they take an income from the health industry, they have a duty to help improve the system.
It’s not good enough to say that changes should occur elsewhere. That is sloppy and selfish thinking. Similarly, it is a real cop out to say that all you need is more government money or money from private health insurance. That is just asking other people to pay.

Finally, we need to build our collaborative skills. The great advances for humanity are almost always the result of clever and open minded people working together. A brilliant leader is also the leader of a team. We need to shed the idea that our leaders, be they political, managerial, or clinical, have all the answers and should find solutions to problems. Leaders should facilitate innovative thinking, analysis and decision making by the smart people working for them. This is what having the right culture is about.

The nature of the health challenge is constantly changing, as is the science, our knowledge, and the equipment, drugs and techniques available to us. Health is now our largest industry and it will stay that way because the demand for better health and longer lives will continue indefinitely. When we extend a life, we may create more health demand and more cost. However we should have generated even greater value for our society and this is of course, our honourable purpose.

Our challenge is to keep creating greater value for humanity through better health and longer lives, and in doing so to minimise the costs incurred, costs which society must bear. Only in that way can we ensure the health industry has the resources it needs and the support and respect of our society.