Working together for everyone's sake

Gynaecologist Digby Ngan Kee isn't one who sees a glass half empty. His outlook is the polar opposite. It's this sort of "can do" attitude that he has brought to his new job, as the first regional clinical director of women's health for the Whanganui District Health Board (WDHB) and neighbouring MidCentral District Health Board.
Dr Ngan Kee took up his role in May last year but his appointment should resonate across the country because it signals a sort of cross-pollination that's happening in our public health system.
More recently, both WDHB and MidCentral have been beavering away on what they call their "centralAlliance", which is essentially an effort by both boards to make better use of resources.
"The position arose out of a staff crisis at Wanganui Hospital a few years ago. A ministry taskforce looked at the issue and concluded that we should set up a regional women's health service," said Dr Ngan Kee.
"We're very much a pioneering service in bringing the two DHBs together."
The value of a shared service has been almost immediate, with the boards able to successfully recruit overseas for specialist clinicians. But hiring staff was one of the first challenges for the new service because there was an international and national shortage of obstetricians and gynaecologists, said Dr Ngan Kee.
"We've taken time to recruit and at the moment we're fully staffed with consultants. It's been difficult but we've been successful.
"I think one of the big advantages of the regional service is that doctors joining the group are lining up with a bigger group of clinicians, and where there's more collegial support, there's more chance to develop their interest in sub-specialties," he said.
Dr Ngan Kee said the combined populations of both DHBs created a critical mass which also allowed the clinicians to develop their special interests and services.
"Like all branches of medicine it's about having the chance to develop these specialist areas of interest."
He said they did use locums when necessary but said within a few months "we'll be fully staffed with permanents rather than locums".
He said the collegial support was important because it attracted quality clinicians and led to success in attracting junior staff and training registrars.
He said the specialists concentrated on work in their location but the plan was to work them across the region depending on where their particular skill was required.
"The point is with a larger critical mass of consultants you can develop these specialist services to provide a better service to the whole population."
Dr Ngan Kee has been working as a clinician for 22 years so is no stranger to local health services and has witnessed a raft of changes at governance level. He has also seen enormous changes in health services.
He is NZ vice-president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists.
Although he has not been in his new regional role long, he said he was proud of the change in the culture that he had seen develop.
"People are now committed to a regional women's health service at all levels.
"We've inculcated that culture and there's a great degree of goodwill between the different clinicians.
"The midwives work very well together and we've got a midwifery leadership function developing so at most levels people are working extremely well together," he said.
One other benefit had been the development of a joint colposcopy database. Wanganui did not have one but Palmerston North did and this has been rolled across to the River City at very little cost.
There is another programme under way to define a joint perinatal database to work across the regions.
"We've also just been selected as one of four sites in the country to pilot a maternity quality framework."
Dr Ngan Kee said despite suggestions that centralising functions spelled an end to Wanganui Hospital as a secondary health centre, the introduction of joint shared services actually strengthened Wanganui's hospital. "This is about senior clinicians and managers sitting around the table and developing a service that bolsters the services to the community.
"What you have to remember is that boundaries are actually artificial because patients don't realise where one DHB starts and another ends.
"The people go across both regions and it's sensible to approach the health organisation regionally."
Dr Ngan Kee said the speed of change in the past 20 years also served to illustrate that change was constant.
"Resisting change is being unrealistic, so you work to make changes as good as it can be, for Wanganui and Palmerston North," he said.
"Clinicians need to get involved in leading that change but that's something a lot of us avoided in the past. We can't moan about it. We have to get involved and make sure that the management and boards understand the clinical imperative."
He said a lot of work remained to be done to bring the regions together fully.
"We've made great clinical gains but there's an awful lot in terms of systems that need to be drawn together."
However, Dr Ngan Kee said it made sense for health to be modelled this way so patients moved seamlessly between DHBs in their treatment journey.
He said recruiting had definitely benefited from the boards being able to highlight the regional women's health service.
"Most of those we recruit come from big centres in the United Kingdom or USA and they are used to that scale of operation."
Wanganui Hospital is helping out MidCentral by taking up to 150 gynaecology operations. A Ministry of Health contract will see those women come to the River City for their surgery.
"It's a good example of balancing that resource across the two regions, and these will be through here by the end of June," Dr Ngan Kee said.
"This is happening at no detriment to the people of Wanganui and it hasn't increased waiting times for other surgery.
"It's just that Wanganui currently has the capacity to handle the work," he said.