2022 HEALTH SYSTEM REFORMS – challenging context, usual playbook, and finding the right leadership talent
After two-plus years of the current pandemic, many health systems are tittering towards catastrophic collapse. And once again the bells of radical reforms are ringing. In NHS England1, the call to fix the post-Covid long list of backlog services is setting the scene for more radical system reform. In New Zealand2, the ”once in a generational health and disability system reform” kicks off on 1 July 2022. And in Canada's British Columbia and Alberta, there is genuine concern that their health systems are "crumbling at the worst possible time3."
A common theme for many health systems is an urgent catch-up on a long list of non-Covid 19 related health services typically led by cancer, heart disease, respiratory disease, diabetes, mental health and aged care.
However, any catch-up initiative or the more comprehensive reform will require the buy-in of the health workforce that is burnt out and exhausted. And current high inflation is likely to lead to the inevitable tightening of governments' purse strings and make the prospect of significant additional investment more challenging.
A familiar playbook
Health system reforms have historically followed a familiar playbook. Such a playbook always relies heavily on injecitng a significant amount of additional funding (which some argue is never enough). Aside from the funding issue, the other content of this playbook includes:
Restructuring organizations,
Greater horizontal and vertical integration
Moving care closer to home and community
Setting up “independent” monitoring watchdogs (commissioners and ombudsman),
Centralizing or decentralizing decision making,
Writing new strategies and plans,
Changing accountability and responsibility (strategy, policy, funding, and provision),
Reformulating different funding models (fee for service, capitation, bundled),
Revamping performance and monitoring measures, and 10. Ramping up communication and engagement with stakeholders for buy-in and support.
Every one of the above is necessary for reform but why then is the report card on “delivery and impact” of historical reforms using this playbook is at best mixed. It sometimes feels like two steps forward, one step back, and one step sideways. Fundamentally, the issue centers around having the right “implementation” talent to do things differently in the face of a strong gravitational pull to do more of the same.
Right talent
Make no mistakes; many health systems are on the precipice of significant system failure. The mission ahead is a rescue rather than making a good organization or system great. The leadership talent of the late Richard Webb of Melbourne, Australia, provides a textbook insight into what it takes to lead a rescue mission. He was the CEO of Canterbury Health Limited, Christchurch, New Zealand, from 1996 to 2001. He arrived when the organization and system were spiraling out of control and at a dangerous crossroads. His values on patient safety, better health services, and fiscal responsibility anchored his actions. He understood the gravity and weight of his responsibility as a health system leader. He was a fearless reformer, unequivocal on his mission, with high expectations of himself and his team. His reform agenda was always full, the pace blistering and with a great sense of urgency. He led from the front and achieved what many failed to do in their entire professional career in four short years. Every one of his achievements was difficult, and everyone got over the line because he had the courage of his conviction to do things differently. He was an accomplished strategist and master tactician. Every meeting and discussion had a purpose. He did not like to waste time (both his and others). His attention to detail and ability to see the wood from the trees made his "questions" daunting for politicians, board members, senior managers, and clinicians alike.
Suppose the leadership responsible for the current reforms does not have Richard's attributes. In that case, the tragic consequences of lack of delivery with impact will trigger even more drastic reforms for years to come.
Final word
There is no denying that the post-Covid health system needs a radical shakeup – a rescue mission. The environmental context in 2022 makes the timing of such radical reform highly challenging and risky.
Health reforms, at the best of times, are disruptive. The 2010 LSE report "Making and Breaking the Whitehall Departments" points out that staff can take five to six years to regain their former productivity after a major restructure.
Health reforms historically follow a familiar playbook that requires significant additional funding from the government. The report card of previous reforms using this playbook is, at best mixed. The most critical determinant of success or failure is, without a doubt having the right talent to lead the implementation process and team.
The late Richard Webb's leadership talent is a worthy “checklist” for any CEO hired to lead the “rescue mission” of the current round of health reforms. What's at stake is very high, and it is not a job for the faint-hearted.
Chai Chuah 2 May 2022, Wellington, NZ
Notes 1. https://www.gov.uk/government/speeches/health-and-social-care-secretary-speech-on-health-reform