Issue 15 / 5 May 2014

THERE are a number of well known challenges facing our health system, including the increasing burden of chronic illness and the rising costs of health care.

To ensure there is a judicious clinical perspective on innovation, patient care, efficiency processes and resource allocation in the health system, doctor involvement in health management and leadership is vital.

Recently, we witnessed the ongoing doctors’ dispute with the Queensland Government, which threatened to affect patient care.

The government proposed changes to senior medical officer contracts that would have taken them from a collective agreement to individual agreements, challenging clinical autonomy and undermining basic workplace rights and conditions.

Although talks between the government and the doctors’ representatives appear closer to resolution, there continues to be a possibility that the dispute could evolve into a serious workforce crisis, with a number of senior doctors still expressing their intent to resign or reduce their working hours in the public system. The potential loss of experience has major implications for health care available in public hospitals and the teaching of junior doctors.

The collective and concerted action of the Queensland doctors has been a major contributor to the movement towards resolution. The level of collegiate support during this debacle has been both unprecedented and inspiring.

Many doctors without formal leadership positions demonstrated impressive leadership behaviour. Those with an aptitude for organising and mobilising shone in the workplace and in social media.

It is this collaborative leadership approach that we must harness and encourage, especially within the field of health management, to avoid further crises in the health system.

In addition to greater doctor involvement in health management and leadership, we believe that these strengths in areas outside traditional clinical practice may serve to strengthen advocacy and lobbying for the health of Queenslanders. This may also increase the mutual understanding between doctors and government officials.

The Australian Medical Council’s Good medical practice: a code of conduct for doctors outlines the principles that characterise good medical practice, including the professional obligations of doctors to safeguard patient care and act as stewards of the health care system.

For the next generation of doctors to function as effective stewards of the health care system, skill diversification will be beneficial. It is not enough for our medical leaders to focus exclusively on the mastery of highly technical clinical knowledge and skills. For health advocacy to flourish, doctors must also develop their skills in public health, and in legal, political and business leadership and management.

There is evidence to suggest that when doctors are engaged in leadership, hospitals and health services have improved performance, including quality improvement and lower rates of morbidity and mortality. In an era of increasing bureaucratisation of health care, the role of doctors is paramount.

If the medical profession is to address current and future health priorities and challenges, we must encourage and foster engagement in areas beyond clinical medicine. Promoting doctor involvement in health leadership is possible through innovation and investment in educational reforms.

Promisingly, we have witnessed positive developments in this area, with all Australian specialist medical colleges adopting the Physician Competency Framework, which recognises both clinical and non-clinical skills, including management and health advocacy competencies. A number of structured education programs also exist. However, an ongoing paradigm shift is needed to acknowledge the growing importance of workforce diversification.

We encourage our colleagues to develop and utilise their skills in health leadership beyond clinical medicine to safeguard and further enhance Australian health care.

Dr Malcolm Forbes is a medical registrar at The Townsville Hospital, NHMRC Postgraduate Scholar, and adjunct lecturer in the School of Medicine and Dentistry at James Cook University, Queensland. Dr Harris Eyre is a psychiatry registrar at The Townsville Hospital, a 2014˗15 Fulbright Scholar and is undertaking a PhD in preventive psychiatry at the University of Adelaide.


Would more doctors in leadership roles help in safeguarding the quality of Australia's health care system?
  • Maybe - depends on their skills (53%, 37 Votes)
  • Yes - they are ideal leaders (40%, 28 Votes)
  • No - doctors aren't managers (7%, 5 Votes)

Total Voters: 70

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4 thoughts on “Malcolm Forbes

  1. Diane Campbell says:

    PostGraduate qualifications in  Health Management & IT  helped me to understand that not only do hospitals and DOH make wrong decisions,  their processes for choosing options and then implementing are often wrong as well.  Not sure that any of this helped me to cope with resultant messes – the Cerner implementation in NSW being an excellent example.

    The  colleagues whose clinical leadership I  most admire and respect;  have done no “leadership” or other management courses.  Conversely,  some who have,  get bitten by the management-track bug,  and the usual way to demonstrate that they are now one of the (management) boys is to denigrate  and disadvantage the departments in which they previously worked.

    By all means,  training and support for those with both the capacity and attraction for clinical leadership.  But let’s turn this around.  Maybe the best way  to get administrators at any level to appreciate  problems   at the coalface is to put them there.   DONs and DMS to spend at least one session a week in clinical practice,  others can relieve the receptionists, porters,  or the lady at the “enquiries”  desk.  If the DMS can’t maintain  previous level of  skill as a consultant physician or surgeon he can assist..   And everyone should get a BLS assessment every year.

  2. Malcolm Brown says:

    The reality of big business is that it is run by marketers and accountants, many of whom have little understanding of human psychology let alone the broader business of health and medicine. Health is absolutely unique – it does not follow usual market rules, and almost everyone working in the sector is highly motivated. Normal business principles do not apply. One of the main reasons Australia has such high health standards is that doctors have taken leadership roles in maintaining the independence of the profession and have promoted public health issues like road safety and immunisation, while criticising unscientific complementary approachs. There are many people who would like to take profits out of the health sytem and plenty of charlatans who would like to get involved in treatment. If you want to see the outomce where doctors are not leading, think back to Soviet Russia, or a few hundred years ago in the west before regulation of doctors and pharmacists. Quacks everywhere and poor outcomes. If doctors don’t take the lead, patients will suffer.

  3. Yaacov (John B.) Myers says:

    Doctors are needed, especially those who respond to patient need not to anything else, i.e. who value the sanctity of the doctor patient relationship based on trust. There needs to be transparency, openness and trust, objectivity, integrity and context based decision making – to remove self serving agenda driven regulators and bureaucrats from the list. That takes guts, determination and grit which is not what people are made of these days, which is why AHPRA, bureaucrats and other self-serving agencies including governments who do nothing to reign in these culprits, allows them to get away with it. Politicians who are not redolent in permitting this need to be exposed because it erodes entrepeneurship, choice and financial independence. The Tribunal system needs to be replaced by honesty, integrity and accountaiblity and common garden sense. Well done guys.

  4. Allison Garcia says:

    Thanks for posting such a knowledgeable post. Health leadership is a very good and useful skill which every doctor should possess. Education programs should be brought into action more and more to develop the skills by both clinically and non-clinically. The Australian medical council’s are doing a great job and
    I appreciate their efforts in developing their skills beyond clinically. Hope to see more of such programs and spirit like this. Health management is very crucial and thanks for putting light on my wisdom. Great post!!


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