Martin Bowles: how leaders influence big shifts in policy

By Martin Bowles

October 27, 2016

For me “Making Things Happen” is what it is all about. How do we, leaders in the health care space, make a difference to the many and varied patients we interact with? As we know there are many challenges including the rise of chronic and complex conditions, the ageing population, technology change and consumer expectations.

We also need to manage preventive, primary and acute care interfaces, rural and remote health, public versus private health and hospital systems, and concerns about Indigenous life expectancy. And there is the state and territory versus the Commonwealth funding issues that need careful management all amidst the backdrop of continually rising costs.

But with the challenges come opportunities.

With a spend in 2014/15 of $161 billion, which is growing faster than GDP, we should note that health is 10% of the economy, 13% of the workforce. It is a driver of the economy and we must look at things from a long term perspective. For me, now two years in the job as secretary of the Department of Health, I have been concentrating on moving the department from a tactical perspective to be a strategic policy department. One where we understood the challenges and came up with ideas. Ideas that fit into a strategic narrative.

To do this we put data, analytics, evaluation and research at the centre of our policy thinking. We have invested in data analytics and behavioural economics — not without risk I might add! This has allowed us to deliver a number of reforms which includes a major revamp of primary care, with a focus on chronic disease. Recommendations from the Primary Health Care Advisory Group have resulted in the new, ground-breaking Health Care Homes initiative which offers a whole new way of providing locally based primary care with better coordination and a new, blended funding arrangement.

In addition the review of the appropriateness of MBS items is already showing results and a review of Private Health Insurance and another on Pharmacy Remuneration and Regulation are ongoing. Another major reform is the establishment of the Primary Health Networks where local communities can make decisions about what health services will be delivered in their local communities.

A big focus of their work will be on mental health. From July 2016, the PHNs will be empowered to commission mental health services according to locally identified needs.

So from a leadership perspective, how did we implement these big shifts in health policy and implementation?

8 factors that make or break a leader

  1. Team — recognising your skills and those around you — empower the team, trust them and the job becomes much easier.
  2. Stakeholders — you need to understand the environment. There will always be self-interest but you must listen to them — you don’t have to agree but you need to understand.
  3. Risk — this can be difficult but you need to engage with risk not flirt with it. This has been a big problem in the department but it is improving.
  4. Fostering a Permission Culture was important. Punitive cultures drive issues underground to surface when you least expect it. In a Permission environment people can think differently, challenge norms, try different things, make mistakes and learn from them. Of course we must not be careless!
  5. Linked with both Team and Risk is Difference. This is vital if we are going to change our world for the better. It’s a very complex world — health providers are different, consumers are different. So value difference. My life experiences is different from yours. No less or more important. I often say, “I am my life’s experience” If we value this difference we will be able to come up with solutions for the future of health care.
  6. Courage — another thing I have learnt over the years is the notion of Courage. Courage to pursue ideas. Have courage around saying ‘no’, sometimes even to the powerful people; to call it and deal with the consequences; to allow others to do what they need to do.
  7. Calm — when you are in the middle of the complexity we know as Health a key skill is to remain calm. If you are not others won’t be calm either.
  8. And finally, be authentic. People watch you — lead by example — words and actions aligned is important.

This is an extract from an address by Martin Bowles to the Joint Australasian College of Health Service Management congress in Brisbane on October 26.

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