Just the man to get things moving

Lester Levy has already made changes at North Shore and plans many more. 'I'm pretty focused. I know what I have to do.' Photo / Greg Bowker

The medical term Lester Levy chooses to describe troubled North Shore Hospital is compelling.

"This hospital," says its chairman, "is like, constipated. It's hard to push things through."

Levy sees his task as clearing the blockages. He has the ear of Health Minister Tony Ryall; he appears to be winning over its 6000-strong workforce, and there are signs with all the hard-hats swarming over the windswept Takapuna site that a $50 million state-of-the-art new emergency department due to open in 18 months means its reputation may soon turn a corner.

"We are a hospital on the mend," says Levy, a doctor-turned-manager-turned-institutional-fixit-figure.

"It can't happen overnight. When I came here I defined the place as ready, aim, aim, aim. It talked about what it was going to do but it never did it."

Waitemata District Health Board serves more than 525,000 patients, more than any other board. Its problems have been well catalogued: overcrowding, patients in corridors, A&E delays, men and women sharing faded wards.

Levy's board has got a bricks-and-mortar programme steaming along.

He reels off milestones from the last 15 months: $90 million in capital works, the new 50-bed emergency unit with a cardiac floor above it, a new 25-bed medical ward at North Shore, a round-the-clock paediatric emergency unit at Waitakere Hospital, more nurses everywhere and signs that clinicians want to join the workforce again after shunning its doors. The design brief for the new wards puts an end to beds in corridors.

Proving more intractable is changing hospital culture, attitudes which appear to lie behind a flow of patient complaints after Leanna Kairua went public in the Weekend Herald two weeks ago about her daughter Veronica's treatment for suspected appendicitis.

There was Andrew Wheeler, who waited in vain - and in pain - for two days at North Shore's emergency care centre for someone to help. Patient David MacDonald told another horror story about being shut in a room in agony with an inflamed appendix and no pain relief.

An unreported complaint from the daughter of an 83-year-old told how the family had to change the bedlinen after the man, who was moaning in pain, wet his bed.

Levy knows these complaints are unacceptable. Patients turning up at A&E should expect "safe care and consideration", he says.

"We still have a culture which isn't as progressive as it should be in some places. But I've been through this before," says Levy, a reference to the three years he spent at South Auckland: "Middlemore was a lot worse."

Each month, Levy puts his thoughts in a pamphlet called Healthlines which is emailed to hospital staff. In April, he wrote that his analysis of complaints sent directly to him revealed "bad attitudes, inadequate communication, lack of respect, and poor diligence relating to follow up. Most disturbing is what is often described to me as condescending behaviour."

In May, Levy returned to the theme, quoting a grateful patient who had a hip replaced. The woman said she felt safe and cared for "above and beyond what I expected".

The chairman remarked that he had reviewed all serious complaints sent to the board in the past three years, and found the majority cited bad attitude, lack of courtesy and poor communication.

He added: "Let this letter from this patient about her wonderful care serve as an inspiration for all of us as to what is possible."

So when can patients expect to see things improve? "It can take five years to make the kind of changes we need to see here."

Isn't that rather long? "We are asking for patience." He expects things will improve much sooner. He says there is a different climate among managers. Quite a few - as many as 30 - have gone.

"At the moment, if you arrive here on a certain day and a certain shift, you get brilliant care. If you arrive here on a different shift, you might not. Our challenge is we have to be consistent."

Levy says he doesn't want to criticise previous hospital management or dwell on history but he found on arrival that clinicians had been shut out of the big decisions.

"A lot of people who had been around here for a long time seemed to be disengaged. Things became what I would describe as stuck."

Last week, senior surgeons at North Shore gave an unprompted endorsement of Levy's approach. In a frank letter to the Herald, in which they acknowledged North Shore's deficiencies, the 12 surgeons said positive steps were happening under Levy to create a hospital that would meet the region's needs.

And the Resident Doctors' Association remarked when Levy took up the post that "Lester is no fool", and had a talent for getting things done.

Levy was shoulder-tapped by Ryall last year for the $50,000-a-year job chairing the Waitemata board.

"We've got big problems across the Bridge," Ryall told him, and asked if he would help.

The 56-year-old South African had runs on the board. Twenty years ago, he was a youthful general manager of the Western Bay of Plenty Crown Health Enterprise, which did what was demanded of it and turned a profit. He spent time as an adviser in the Department of the Prime Minister and Cabinet during Jim Bolger's term, and went on to run South Auckland Health, now Counties Manukau DHB.

For a decade, he carved out a career in the private sector. He headed the NZ Blood Service, was chief executive at the Mercy-Ascot private hospitals group, then changed tack heading into the academic world.

He is chief executive of the NZ Leadership Institute at the University of Auckland Business School, and professor (adjunct) of leadership there.

Earlier this year, he was appointed chairman and external director of Tonkin & Taylor Group, an engineering firm in Auckland, and made deputy chairman of Health Benefits Ltd, a government agency that aims to slash $700 million from the public health bill over five years by sharing services and bulk buying.

Levy is also an 'elite gold speaker' on the books of Celebrity Speakers. All of which makes for a busy life.

Is it possible, then, that he might be stretched too thin, given the pressing issues, as the Health Minister put it, across the Bridge.

Levy is firm: "Absolutely no. Look, I had no need for this role at all. I took it on because I care about patients. I'm pretty focused. I know what I have to do."

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Story with a happy ending

One of Lester Levy's many jobs is to tell stories.

Or, more precisely, to explain how storytelling can bring out the best in a workforce. It is a day-long seminar he teaches through the University of Auckland's business school.

Billed as "the leader's guide to storytelling", the popular $1100 short course tells participants they will learn how to tell "the right story at the right time to the right audience".

Levy this week offered a narrative to explain the overcrowding problems he is grappling with at North Shore Hospital's emergency department.

"Imagine if Air New Zealand had a number of people it needed to transport and it needed a 767. But it sends a 737 so there's a whole lot of people who don't get on board. And when they do get on, they are not happy because they have to wait.

"The next lot of people have to wait even longer. That's what we've got here. And even if people get safe clinical care, their perception is that it wasn't like that because of overcrowding or having to wait."

Levy returned to the aviation storyline later as he enthused about the hospital's new $50 million emergency unit.

As patients arrive they'll get sent where they need to go, instead of waiting around.

"We're going to have this massive flightdeck ... Everything will be visible."

The result of this "logic leap" will be faster, quicker, better treatment.

andrew.stone@nzherald.co.nz