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#002: BEYOND2020 - Reflections from David Dean

BEYOND2020: Reflections from David Dean

8 November 2020

The Health Roundtable has a unique and privileged place in the Australian and New Zealand health care systems. However, the early years of the organisation required a combination of foresight, determination, the right place at the right time, collaboration, expertise, and pure effort. David Dean, Health Roundtable Founder, and long-time General Manager represents all of these qualities and was critical in the establishment and success of the Health Roundtable. Now happily retired, we asked David for his input on some key topics. The thoughts he shared below bring to light his reflections on the organisation he was integral to for over 20 years.


What was the background to the HRT’s establishment? What were the issues that were being explored?

Bill Kricker (CEO of Alfred Health) and Sir Rod Carnegie had worked to set up a Commonwealth-funded collaborative of three hospitals in three states in 1994. This was modified by the Commonwealth into a much larger National Demonstration Hospital Program (NDHP), which was not fit for the purpose that Bill intended.

Fortunately, in August 1995, Bill was approached by CSC Australia (David Rubenstein and Peter Reeves) who wanted to sell the Alfred a new computer system. Bill argued that CSC didn’t understand the needs of major hospitals and that he could assist them in understanding these needs by getting CSC to sponsor a collaborative discussion amongst major teaching hospitals about the issues they were facing. CSC agreed to sponsor the discussion and provide about $35,000 in funding.

I was consulting to The Alfred at the time, on strategic planning, and was asked by Bill to facilitate the collaborative discussion. He recognised that it would seem self-centred to ask fellow CEOs to attend an “Alfred Event.” As a result, he contacted John Youngman in Queensland to ask him to co-host the meeting. They agreed on a topic: “How to Get Patients Into and Out of High Occupancy Hospitals While Maintaining High Quality Patient Care”. Then Bill contacted several other CEOs across Australia and New Zealand by phone and had agreements to participate within 48 hours from all but one of those contacted. 

 

What data was collected and analysed? How did this occur?

Bill and I developed an extensive survey document exploring each aspect of the topic.  There was no data-sharing amongst hospitals in 1995, so all information had to be gathered manually. I personally collated all the information over several weeks, including a very rudimentary casemix analysis of 20 DRGs. Bill, his team and I, then reviewed the responses with each of the participating Executive teams using Telstra Videoconferencing studios from Melbourne and obtained corrected information prior to the November meeting. I then prepared a Briefing Package that was sent to all participants (by Express Post) before the meeting.

 

The first event was held at the Mona Vale Conference Centre south of Sydney, in November 1995. What memories do you have of the event and the networking that occurred?

This was held on a Friday, Saturday, and Sunday, requiring two nights away from home for each of the senior executive teams.  We arranged hire car transport from the airport to Mona Vale and back, partly to ensure that it would be difficult for anyone to walk out! Mobile phones were uncommon, so we had everyone’s attention throughout the weekend.

The meeting had a “solutions focus” to identify ways to improve patient care, with interdisciplinary cross-hospital teams tasked with identifying barriers (“the rocks”) and solutions. It was an intense weekend with lots of butcher paper to review afterwards!  We also recorded all of the work session reports on audiotape and transcribed these to capture all the feedback from the participants.

Photo: Attendees of the first Health Roundtable Event at the Mona Vale Conference Centre, November 1995.

Photo: Trophy given to Members at the first Health Roundtable in November 1995.

What reflections do you have about the outcomes from that event? What actions did it lead to for you personally, and for your organisation?

Bill Kricker provided a keynote introduction “Change the Focus” at the meeting which is still relevant today.  I’ve quoted the first bit below: “If only we could increase private insurance, reduce government regulations, have unions who were more reasonable, minimise Commonwealth/State overlap, increase primary care, install this new computer system then the health system could get back to looking after people in the way it did in previous years.”

The refrain is familiar, appealing, and even seductive, but it is profoundly misleading.  The root of the problem lies deeper.  Where the Health Sector has fallen short is in the strategic determination - and the ability - to make excellence in operational management a key feature of the Health System. It is the fundamental premise of the Health Roundtable that to achieve cost-effective high-quality health systems we must focus first on operational management and seek excellence.

Excellence in operational management is also the missing link in considerations of health strategy.  There is a belief that macro-policies can readily provide the solution to detailed problems; this is not so. The best macro-policies are based on micro-understanding of the cause and origin of problems. Micro-understanding is greatest amongst people who actually have the problem. Policy must draw heavily on informed, sophisticated operational experience.  Complex problems require detailed solutions, not general policies.

It took a few months to digest all the information from the meeting into a summary document, called the “Guidebook.”  This listed 120 potential solutions to Getting Patients In, Getting Patients Out, and Managing Capacity.

The group of hospitals who participated were very enthusiastic about continuing to work together by the end of the weekend.  In anticipation of this, I worked with Bill to set up a non-profit company that was not affiliated with any individual hospital that could serve as the vehicle for future collaboration.  We recognised that having any one hospital or consulting firm in charge of the data would be counterproductive to the ongoing sharing of information.

 

When you reflect on the organisation now celebrating 25 years, what do you think are the critical issues that HRT has contributed to in health care?

Compared to 25 years ago, the key contribution by the HRT today is that most hospitals now have informal networks across Australasia to call upon to help with difficult issues, as well as a shared, trusted comparative database of patient data. The Roundtable’s ongoing focus on improved operational performance and improved patient safety has led to major improvements in patient care.

 

What are the 3 or 4 future-focused topics that you believe hospitals and HRT members could best explore? Why are these important?

Many of the topics raised at the original Roundtable are still relevant today.  For example:

  • Delays in deciding whether to admit a patient
  • Lack of senior medical staff in ED in “unsociable” hours
  • Conflicting agendas between acute, mental health, nursing homes, and GPs
  • Lack of internal coordination around the patient, e.g. swallowing studies, fasting, theatre availability
  • Imbalances in supply of surgical time relative to demand
  • Lack of incentives for GP involvement in chronic patient care

 

What advice or suggestions would you provide to hospital staff to maximise their learning experience and the support from HRT?

Member hospitals get the most value from the process when the CEO is an active participant, or at least actively engages in monitoring the action plans of each participating team who attends a Roundtable.

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