Despite the fact that clinicians are becoming increasingly
specialised and sophisticated in treating health problems, it is
apparent that the health of many individuals and demographic groups
is substantially compromised at times. This may occur because of
deficiencies in the planning and delivery of basic health care or in
the coordination of specialised treatment services. Some doctors
move into health management after working as specialists and
discovering that the potential benefits of their specialised
knowledge and skills are often not fully realised. Frustration with
existing systems or resources may motivate them to do something to
improve the situation. Other doctors decide earlier in their careers
to pursue this path and undertake training in population health
specialties such as public health medicine.
A major appeal of working in health management is the knowledge
that improving the systems, support and working environment for
colleagues in the medical profession will enable them to provide
better health care to people. The ‘multiplier effect’ of assisting
others in this way can often result in much greater gains than may
be achieved by the same amount of effort or time devoted to treating
individual patients by less efficient means.
You should possess an interest in complex systems, particularly the
interactions and workings of people and organisations. You should be
sensitive to the needs and wants of a wide range of parties
(including health care and other professionals, patients, advocates
and politicians). The competencies of emotional intelligence such as
self awareness, self control, an ability to develop rapport,
persuasion and an ability to sustain co-operative relationships are
vital. You need to be able to encourage and motivate others. Heated
situations can occur, so you must also acquire skills to
constructively deal with other people’s anger. You need to be able
to function well in circumstances of uncertainty and inconsistency
and where you lack reliable information, and you must be able to
respond to crises and make decisions under time pressure. Many of
these decisions will be subject to both political and media scrutiny
and it is important to communicate clearly the choices faced and
options chosen. To succeed in health management you will require
courage and you must be prepared to ‘dare to be different.’
Much of the working day involves meetings, usually with individuals
or small groups. These meetings are where problems are explored,
decisions are made and action is planned and reviewed. Preparation
may involve reading and analysing written papers and data. The more
senior your role, the less time you will spend alone in detailed
analysis; problem assessment and decision making tend to occur
during meetings at senior management level. The predictability of
your working day will also depend on your position. Continuous
changes in the health infrastructure mean that managers at senior
levels frequently have to deal with emergent problems that require
them to re-prioritise their daily schedules.
Those who work in health management face the challenge of improving
systems and processes. Major gains usually necessitate devising
alternative ways rather than implementing better management of
current processes. It can be a difficult and delicate task to manage
change in a constructive way, although the hierarchical ‘command and
control’ model of health management is gradually giving way to
systems based on devolved responsibility in which local solutions to
local problems are encouraged and supported.
Those who work in health management are also responsible for making
decisions about areas of priority in health care. Such decisions are
becoming increasingly challenging, since the technical potential to
improve people's health often exceeds the actual capacity to deliver
the necessary services. Increasingly, too, the diverse views of the
community and politicians are becoming more influential and the
medico-legal and ethical considerations are becoming more complex.
Decisions and solutions must work in practice, balancing multiple
viewpoints and aspirations with the constraints of funding, resource
limitation and acceptability.
You should obtain broad experience of health systems, both micro
systems within organisations and macro systems in different areas of
the health sector in New Zealand and overseas. Such experience will
provide invaluable opportunities to learn about different systems
and to assess their effectiveness. Your initial years of medical
experience can be gained in a range of specialties but it is
advantageous to seek specialist qualification and experience. Many
practitioners in New Zealand have entered health management after
spending ten years or more in another specialty. Specific training
programmes in health management are becoming more widely available
and in future it may be possible to undertake such training early in
your career. However the experience of working in a clinical
specialty or in primary care will always afford unique insights into
the ways in which health systems and health professionals work.
Experience in health management can begin as soon as you have the
responsibility or the opportunity. Registrars, for example, need to
learn the skills of prioritising, delegating, supervising and
coordinating in relation to their ward teams, and these skills might
usefully be applied later in management roles. If you are interested
in health management you should seek involvement in projects such as
audits, which always consider issues of how services might be more
efficiently or effectively delivered. Reading or taking courses on
management and leadership will increase your awareness of the
dynamics of systems and interpersonal relationships and assist you
to make your own critical observations. Above all you will have to
like dealing with people and “people issues” because many of the
issues which arise relate to interpersonal or inter-disciplinary
conflict.
The opportunities for doctors who are interested in health
management are extensive. Medical training and experience are
advantageous, and if you are willing to learn the disciplines and
skills of health management you will be well placed to take up
health management responsibilities at various levels in the health
system. At present there are relatively few New Zealand doctors
involved primarily in health management. There are many
opportunities overseas and more will arise in New Zealand over the
next ten years or so with increasing recognition of health
management as a legitimate and rewarding career option for doctors.
Travel enables you to gain valuable experience. There are job
opportunities in other countries and health management skills are
relatively transferable, especially for short-term projects.
Communication skills are essential to work in health management, so
overseas opportunities may be somewhat limited by your ability to
converse readily in the local language. The training for health
management is flexible and there is no difficulty in being away from
New Zealand for a period of time. Similarly, taking parental leave
or working part time while looking after children is relatively easy
to arrange. Indeed, caring for children can hone skills that are
valuable in a career in health management.
Although it need not necessarily have this effect on family life,
health management can be quite intrusive. At more senior levels you
may not easily find a colleague to cover your after-hours
responsibilities in the way that colleagues assist each other in
clinical specialties. The problems of health management are often
complex so it is harder to ‘switch off’ when you go home. There is
also a tendency for health management in New Zealand to be very
crisis-driven, so there are often tight deadlines to meet and
problems that emerge unexpectedly and require urgent attention. Key
skills that you must learn if you are to succeed in health
management include time management, the ability to share problems
with others and the ability to listen to others. One contributor
commented that unfortunately some practitioners take rather longer
to learn these skills than others, not least because ‘workaholism’
is endemic to (and often glorified in) the medical profession.
Practice in health management includes dealing with poor
performance. Sometimes this necessitates addressing quite difficult
issues with other doctors who may not react well to criticism of
their professional work. Those who work in health management roles
are often involved in hard decisions that involve rejecting good
ideas because of competing priorities or limitations in funding or
resources. It can be particularly difficult to communicate decisions
to colleagues who are unwilling or unable to accept the associated
reasons. Frustration and disappointment often provoke angry
responses and you may bear the brunt of these.
Unfortunately health management as a career option for doctors has
had little respect within the medical profession in the past and has
been rather poorly developed in New Zealand in comparison with many
other countries. This is rapidly changing, although at present there
are relatively few role models and there is no clearly defined
career path. (This is not necessarily a disadvantage but some may
find the uncertainty disconcerting.)
There are many routes into a career in health management. No
specific qualifications are required at present so the training is
very flexible and can be adapted to your individual needs. Many
doctors who are currently involved in health management roles in New
Zealand have no formal management training. This is far from ideal
and in future it is likely that training in the skills and
discipline of management will be required, although there will
probably continue to be a range a ways of obtaining this training.
Formal programmes that are currently available in New Zealand
include the Medical Administration training programme (see the
relevant chapter for further information) and the following courses
that are offered by various universities:
Master of Business Administration
Master of Public Health
Master of Public Policy
Diploma of Business
In addition there are a number of short courses in health
management run by institutions that include the University of
Auckland, Massey University and the Clinical Leaders Association of
New Zealand (CLANZ).
A major appeal of working in health management is the knowledge that improving the systems, support and working environment for colleagues in the medical profession will enable them to provide better health care to people. The ‘multiplier effect’ of assisting others in this way can often result in much greater gains than may be achieved by the same amount of effort or time devoted to treating individual patients by less efficient means.