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Ian Cowan. Published by Mary Egan Publishing, Feb 2015. ISBN 9780473326968. Contains 275 pages. Price NZ$35

This soft-covered 250-page book (with 246 references) is the work of Ian Cowan, a radiologist in Christchurch. Though a work of fiction, it covers the very real events around the changes in health provision that occurred from 1987 to 1998, leading up to the Stent report. This was a time when health systems were undergoing a dramatic swing away from patient-centred approach, and with doctors and nurses having a significant role in the management of hospitals, to the financial and managerial model seen in the ideologically different market-driven model. Management and non-clinical duties were removed from the clinician’s role, and management was brought in from business outside of health section to change the process. These were introduced with the usual misleading lies of increasing transparency and accountability and the better use of limited financial resources. This understandably led to major conflict of culture with some clinicians, as the New Zealand health system became an experiment.

It is with this backdrop that the story develops of a surgical registrar (Steve Cassidy), who thinks that by having time away from his clinical role and getting involved in management he can do more good than working as a clinician. As he takes on a management role he sees the clash of cultures. He moves from the issues around patient care, such as lack equipment, sick and complex patients on non-specialised wards, “safari” ward rounds, the ongoing public grandstanding and abuse of the self-righteous media about standards of patients, the burnout of clinical staff, to the issues of hospital management, driving change with a focus on the financial bottom line, which make most of the clinical issues worse.

Cowan worked in the health system as a clinician over this time and well understands the background of the change in philosophy that occurred from the Gibbs report to the creation of the Crown health enterprises (CHEs), and what happened in regard to clinical care. The story is an easy read of the issues involved and today makes an interesting look back in recent time as how we work in a healthcare model somewhere between where things were and where things were being driven to.

Many readers may have forgotten about how the Stent report was a HDC report followed on from a clinician-generated report “Patients are dying”. The Stent report stated in its conclusion, “It is my (Robin Stent) opinion that in 1995 and 1996 the Canterbury Health Board and management did not offer the leadership that builds trust and commitment, or the common vision and purpose to inspire employees and support them. They also did not implement the structure, together with systems for control and accountability, to ensure that responsibility was understood and exercised at all levels. This led to lack of cooperation and low morale. Canterbury Health was warned by many parties that the breakdown in relationships between management and clinicians could lead to a reduction in standards and this occurred”.

This book exposes the complex issues of that time in a way that is easy to read and understand. I would recommend it to those practising (or wanting to understand it) in the health system today, as these issues still keep recurring, and lessons learned by one generation are at times forgotten by the next.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Frank Frizelle, Department of Surgery, Christchurch Hospital, Christchurch.

Acknowledgements

Correspondence

Professor Frank Frizelle, Department of Surgery, Christchurch Hospital, Christchurch.

Correspondence Email

frank.frizelle@cdhb.health.nz

Competing Interests

Nil.

Contact diana@nzma.org.nz
for the PDF of this article

View Article PDF

c

Ian Cowan. Published by Mary Egan Publishing, Feb 2015. ISBN 9780473326968. Contains 275 pages. Price NZ$35

This soft-covered 250-page book (with 246 references) is the work of Ian Cowan, a radiologist in Christchurch. Though a work of fiction, it covers the very real events around the changes in health provision that occurred from 1987 to 1998, leading up to the Stent report. This was a time when health systems were undergoing a dramatic swing away from patient-centred approach, and with doctors and nurses having a significant role in the management of hospitals, to the financial and managerial model seen in the ideologically different market-driven model. Management and non-clinical duties were removed from the clinician’s role, and management was brought in from business outside of health section to change the process. These were introduced with the usual misleading lies of increasing transparency and accountability and the better use of limited financial resources. This understandably led to major conflict of culture with some clinicians, as the New Zealand health system became an experiment.

It is with this backdrop that the story develops of a surgical registrar (Steve Cassidy), who thinks that by having time away from his clinical role and getting involved in management he can do more good than working as a clinician. As he takes on a management role he sees the clash of cultures. He moves from the issues around patient care, such as lack equipment, sick and complex patients on non-specialised wards, “safari” ward rounds, the ongoing public grandstanding and abuse of the self-righteous media about standards of patients, the burnout of clinical staff, to the issues of hospital management, driving change with a focus on the financial bottom line, which make most of the clinical issues worse.

Cowan worked in the health system as a clinician over this time and well understands the background of the change in philosophy that occurred from the Gibbs report to the creation of the Crown health enterprises (CHEs), and what happened in regard to clinical care. The story is an easy read of the issues involved and today makes an interesting look back in recent time as how we work in a healthcare model somewhere between where things were and where things were being driven to.

Many readers may have forgotten about how the Stent report was a HDC report followed on from a clinician-generated report “Patients are dying”. The Stent report stated in its conclusion, “It is my (Robin Stent) opinion that in 1995 and 1996 the Canterbury Health Board and management did not offer the leadership that builds trust and commitment, or the common vision and purpose to inspire employees and support them. They also did not implement the structure, together with systems for control and accountability, to ensure that responsibility was understood and exercised at all levels. This led to lack of cooperation and low morale. Canterbury Health was warned by many parties that the breakdown in relationships between management and clinicians could lead to a reduction in standards and this occurred”.

This book exposes the complex issues of that time in a way that is easy to read and understand. I would recommend it to those practising (or wanting to understand it) in the health system today, as these issues still keep recurring, and lessons learned by one generation are at times forgotten by the next.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Frank Frizelle, Department of Surgery, Christchurch Hospital, Christchurch.

Acknowledgements

Correspondence

Professor Frank Frizelle, Department of Surgery, Christchurch Hospital, Christchurch.

Correspondence Email

frank.frizelle@cdhb.health.nz

Competing Interests

Nil.

Contact diana@nzma.org.nz
for the PDF of this article

View Article PDF

c

Ian Cowan. Published by Mary Egan Publishing, Feb 2015. ISBN 9780473326968. Contains 275 pages. Price NZ$35

This soft-covered 250-page book (with 246 references) is the work of Ian Cowan, a radiologist in Christchurch. Though a work of fiction, it covers the very real events around the changes in health provision that occurred from 1987 to 1998, leading up to the Stent report. This was a time when health systems were undergoing a dramatic swing away from patient-centred approach, and with doctors and nurses having a significant role in the management of hospitals, to the financial and managerial model seen in the ideologically different market-driven model. Management and non-clinical duties were removed from the clinician’s role, and management was brought in from business outside of health section to change the process. These were introduced with the usual misleading lies of increasing transparency and accountability and the better use of limited financial resources. This understandably led to major conflict of culture with some clinicians, as the New Zealand health system became an experiment.

It is with this backdrop that the story develops of a surgical registrar (Steve Cassidy), who thinks that by having time away from his clinical role and getting involved in management he can do more good than working as a clinician. As he takes on a management role he sees the clash of cultures. He moves from the issues around patient care, such as lack equipment, sick and complex patients on non-specialised wards, “safari” ward rounds, the ongoing public grandstanding and abuse of the self-righteous media about standards of patients, the burnout of clinical staff, to the issues of hospital management, driving change with a focus on the financial bottom line, which make most of the clinical issues worse.

Cowan worked in the health system as a clinician over this time and well understands the background of the change in philosophy that occurred from the Gibbs report to the creation of the Crown health enterprises (CHEs), and what happened in regard to clinical care. The story is an easy read of the issues involved and today makes an interesting look back in recent time as how we work in a healthcare model somewhere between where things were and where things were being driven to.

Many readers may have forgotten about how the Stent report was a HDC report followed on from a clinician-generated report “Patients are dying”. The Stent report stated in its conclusion, “It is my (Robin Stent) opinion that in 1995 and 1996 the Canterbury Health Board and management did not offer the leadership that builds trust and commitment, or the common vision and purpose to inspire employees and support them. They also did not implement the structure, together with systems for control and accountability, to ensure that responsibility was understood and exercised at all levels. This led to lack of cooperation and low morale. Canterbury Health was warned by many parties that the breakdown in relationships between management and clinicians could lead to a reduction in standards and this occurred”.

This book exposes the complex issues of that time in a way that is easy to read and understand. I would recommend it to those practising (or wanting to understand it) in the health system today, as these issues still keep recurring, and lessons learned by one generation are at times forgotten by the next.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Frank Frizelle, Department of Surgery, Christchurch Hospital, Christchurch.

Acknowledgements

Correspondence

Professor Frank Frizelle, Department of Surgery, Christchurch Hospital, Christchurch.

Correspondence Email

frank.frizelle@cdhb.health.nz

Competing Interests

Nil.

Contact diana@nzma.org.nz
for the PDF of this article

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