New Bay health boss rings the changes

By Paul Dykes
His first aim was to change how Bay health services are structured. Now, Phil Cammish wants to keep people out of hospital.
Six months into his job as chief executive, Mr Cammish has already made his mark on the Bay of Plenty District Health Board.
About 50 management and administrative jobs have gone and another 40 or so have been created at the sharp end of the business.
He is delivering on one of his selling points at his interview for the chief executive job late last year - the ambition to put doctors back in charge of doctors and nurses back in charge of nursing.
He felt it was time for clinicians to get back into the decision-making process.
On July 3, his new-look management structure goes live, almost six months after he took the top job.
All key positions have been filled and some big names have gone - including Alan Wilson, the former general manager at Tauranga Hospital.
From that date, services will be based on clinical units, each covering the whole board region rather than being focused on Tauranga or Whakatane hospitals.
Eight clusters of clinical services have been set up, covering mental health; surgical; medical - women, children and family; clinical support; Maori health; non-clinical support; community health and disability services.
To enhance clinical decision-making, doctors report to the medical director and nurses to the director of nursing.
"This is not driven by funding," Mr Cammish told the Bay of Plenty Times.
"It was part of my commitment to get clinicians back. It is designed to deliver high standards - clinicians decide on how resources are applied."
Mr Cammish said the region-wide cluster structure would enable the new cluster leaders to look wider and to control their own resources, giving them flexibility.
One person would be nominated to head the three-person management group for each cluster, either a doctor, nurse or manager from allied health.
They would report to the chief operating officer, as well as the chief medical officer and director of nursing.
"The principle was important - I came here with that principle," says Mr Cammish. "It was one of my planks at the interview - if clinicians are not engaged with the business then it is very difficult to run an organisation."
He said he came to the Bay deliberately and found an organisation in good hands, well organised and focused on delivering good quality care.
"This just needed refocusing and emphasis on primary care/preventative care."
He said former hospital general manager Alan Wilson had left of his own accord, having been offered a role within the Project Leo enterprise.
"He had options but decided to take the [severance] package and go and do his own thing."
The second major ambition for Mr Cammish in his new job is to focus the board's efforts on sickness prevention, removing a lot of the hospital workload by treated the causes of illness in the community.
"I want there to be a strong primary health organisation and GP sector, with much more emphasis on wellness and illness prevention.
"I don't just want to shift the focus away from always being the ambulance at bottom of cliff - I want to remove the whole cliff."
Another ambition is to set up a multi-disciplinary clinical education centre in the Bay to develop research capacity here.
"It's an idea that was under way when I arrived. I've stimulated its resurgence and I'm pushing hard."
"It would focus on Maori health, rural and remote medicine. I'm keen to see programmes based in Opotiki, Te Kaha, Kawerau - it makes a difference.
"It is important that education is undertaken in the environment in which we operate. It gets links within those communities.
"When people train in a particular place they go back there and reinvest in their community."
As part of his self-imposed induction, Mr Cammish has spent lot of time "getting out there", attending staff forums, contributing to bulletins, going out into the community- particularly with Maori providers.
"I've taken every opportunity to go and listen. There's lots of stuff I can read or research but what better than I can go out and ask people direct re health needs.
"I'm trying to get an understanding of what Maori providers think."
Further down the track, Mr Cammish wants to see strong kaupapa Maori services, the clinical school up and running and Project Leo completed.
On the financial side, he wants the board to be strong fiscally - at break-even or better. "Then you can make choices about how you can apply health services."
He wants to hear that his clinicians feel they are involved, in control and have a say in the decision-making processes.
And, in general, that people are healthy.
As for waiting lists and the board's poor performance in meeting Ministry of Health emergency department triage times, he says he has given an undertaking that the board would be compliant by June 30.
The recent junior doctors' strike may require more flexibility in that target, he said, "but certainly by September 30 we will be compliant".
"It's not that we're not doing the work, just that we took on more than we could reasonably complete in the time."