KEY POINTS:
Sandra Budd has a voice it's easy to imagine being used to calm a fretful newborn or reassure a woman stressed by labour.
It's soft, composed and soothing - you get the feeling that, with such a voice, Budd could make just about anything seem reasonable. You can
imagine it might come in handy when explaining to staff that their model of working has to change and their roles will be vastly different in just six weeks.
It would help when encouraging two workforces to create a unified service, persuading them this would improve their own professional satisfaction.
Perhaps it would also be useful in explaining to a government that your hospital could deliver the change it wanted, but it would need a $7 million funding increase - and then getting that funding. And it might help to convince a public accosted from all sides with requests for donations that your charity really was one to give money to.
Budd has no doubt used her voice to great effect in most of those scenarios. Now, as chief executive of the Royal New Zealand Foundation of the Blind, the last one - raising money - is one of her key challenges.
A nurse and midwife who moved into hospital management - most recently responsible for workforce planning, development and human resources strategy for more than 5000 health service employees in New South Wales - Budd has returned home to head the foundation Readers' Digest named as one of New Zealand's three most trusted organisations.
Now responsible for just 350 staff and 2000 volunteers, she acknowledges that some might see her new role as a step down.
"I see it as a natural progression for me. It felt like things fitted and the fit was right."
So what was right about it?
"It was the opportunity to step up and be my own boss. Mind you," she laughs, referring to her board, "I have 10 bosses. Let's say the buck now stops here. And while it looks like I've stepped out of health, I'm in human services, [which is] so linked with much of what I did."
Budd's career started in Wellington, where she worked as a hospital aide, trained and worked as a nurse, had her children and volunteered for health-related charities.
A shift to Auckland saw her working in National Women's Hospital and gaining a midwifery qualification. And it also saw her move into management. Here she learned, through experience, how best to persuade a workforce that change was not only inevitable but also desirable.
As in most Western health systems, maternity care in New Zealand was not exactly focused on the needs of women and their babies - it was structured around the needs of the hospitals. Midwives were trained to care for women and babies throughout pregnancy, delivery and after birth but then specialised in one area, so their skills in the other two became rusty.
Women would often deal with several health professionals throughout pregnancy and labour, and often couldn't have their partner with them in the delivery room.
In the mid-'90s the health service underwent profound change - with maternity care being one of the first areas to bite the consumer-focused bullet. When funding started following women with the introduction of "lead maternity carers", obstetrics services had to focus on what women wanted and make sure their procedures delivered - which meant major changes at National Women's.
First, the hospital spent 10 months researching what women wanted and how to deliver it.
"They told us they didn't particularly like the way we were doing this before. They wanted to be able to identify who their caregiver was; they wanted to be able to tell someone something once [and not have to repeat it]."
That meant a new model of care was needed. Midwives now had to care for women and their babies from start to finish - and many needed training to recover those lost skills.
Budd admits that implementing the changes was "pretty scary at times" and that she was "challenged by the different professions" about whether this really was for the best.
But she had a very persuasive tool - that research, which showed women were unhappy with the existing service and wanted these changes.
"It was a very powerful tool to us to help our staff understand why they had to change. If you listen to your consumer, you will get it right. It also helps to improve the way that your staff can work; it brought us a lot of new, exciting ways that staff could work."
It helped that staff had been instrumental in developing the new model - 150 of them had been interviewed to find out how processes could change.
"The fact that we had put in safety nets to help people rekindle their skills was an important part.
"One of the successes of this was that we enabled people to talk about what their issues were and what needed to be done differently in the future. There is always resistance, but it was about taking them along with the process."
When it came time to research how women felt about the new service two years later, one major thing changed - they no longer related dissatisfaction with the way they were treated.
"A lot of that had gone really, and they started to talk about safety and security and buildings and things like that."
In 2001 Budd was asked to apply for a clinical services role in South Australia. While she hadn't really thought she wanted to leave New Zealand, she was ready to spread her wings.
"I knew that I needed a wider experience. I was ready to make a move; I was ready to try something different. I saw it as a challenge: 'I've done some stuff here, I wonder if I can make it in a bigger country?' It was an adventure."
On her first day in the job she was presented with just how big an adventure it would be: the hospital had two emergency departments, one for women in labour and one for children. The State Government wanted the departments to merge - Budd's role was to make it happen.
"There were huge philosophical differences about whether you could bring these two together in the same environment, the main thing being women's health is a natural process and children, when they come to hospital, are sick."
So how do you get two such different departments to agree on a common way of working?
"You get people to identify what the issues are. You take that on board, you get them to go away and investigate and find out what the options are and bring them back."
And what you get them to bring back are solutions to the obstacles they have identified.
"The argument was always 'there won't be enough money for this'." So Budd told them: "Tell me the best way to do this and I will work on the funding later."
Once everyone had agreed on the best outcome, Budd went to the State Government and the hospital's corporate sponsor and told them: "Yes, this is the model, this is what it will cost and these are the benefits."
As a result, the new department was established, funding rose from $3 million to $10.2 million, and the changed processes flowed throughout the rest of the hospital.
The lesson she's taken from both of these experiences is all about who should be at the centre of any change: "If you focus on and listen to what your consumer is saying and then share that information with the staff - we're all there to get the best for the consumer and get the best outcome - it helps us as professionals to understand.
"For me it's all about putting the consumer at the centre of everything you do."
And she's also learned that "restructuring isn't change".
"Sometimes, we think that there's something not working and we think if we change who is managing it or how it's being managed, that will improve.
"My experience has been that the change comes from the people on the floor. It comes from looking at the service delivery you should be providing."
Now the foundation she heads is looking at how it has to change to meet the challenges of the future - and when two-thirds of your money comes from charitable donations, funding will always be one of those challenges.
"It's becoming more difficult to raise money. We have skilled people providing our services. We are always in competition with health and education and the public sector for skilled people."
She understands some people are probably experiencing compassion fatigue, tired of being asked to give.
"I also think the economics are such that everybody's looking at their own dollars. [The challenge] is how we can inform people of the benefits of what we are doing."
No doubt Budd will make giving to the foundation sound eminently reasonable.
Sandra Budd: CV
Royal NZ Foundation of the Blind
(July 2007-)
Chief executive
Greater Southern Area Health Service, NSW
(2005-May 2007)
Executive director, workforce development
Children Youth & Women's Health Service, South Australia
(2004-2005)
Executive director, clinical services
Women's & Children's Hospital, South Australia
(2001-2004)
Executive director, clinical services (nursing/midwifery); acting chief executive
National Women's Hospital
(1981-2001)
Staff nurse, midwife, neonatal charge nurse, newborn nursing service manager, newborn service manager, acting general manager, maternity manager
Wellington Hospital
(1977-1981)
Staff nurse
Hutt Hospital
(1968-1972)
Nurse trainee, staff nurse
Paraparaumu Maternity Hospital
(1968)
Hospital aide
