Fast worker in charge of operations

The man heading South Auckland Health has a problem-solving approach that looks beyond the wards, writes MICHELE HEWITSON.

On a low table in David Clarke's office is a sculpture of a small man pushing a large rock uphill. It's one of those slightly twee little office toys produced for the senior executive who has everything.

But in Mr Clarke's case, it provides a tidy metaphor.

He is a trim man with expressive hands whose job it is to grapple with large rocks every day.

Because Mr Clarke became, in 1997, the chief executive of South Auckland Health.

Consider the figures on his balance sheet: the number of children admitted to Middlemore Hospital rises by 10 per cent a year. A figure which means that the number of admissions doubles every five years.



South Auckland has the largest concentration of urban poor of any hospital and health service in the country.

Spot the man at the helm of a growth industry, in an industry where growth is the last thing a chief executive wants to encourage.

Same rocks, different job. Four weeks ago, Mt Clarke moved into his new office in a business park which is still being built around him on a soulless stretch in central Manukau.

Rooms full of empty desks wait for staff. The place smells of new paint and carpet underlay. It also has about it the faint scent of expectation ... although the cynical might say that that is the tired old smell of health reform number ... Well, who by now has bothered to keep counting?

Mr Clarke has a new title: chief executive officer, Counties Manukau District Health Board. His new job comes courtesy of a health-sector change: the breaking up of the four regional health boards into 21 district health boards. The move represents a shift to a population and community based approach to healthcare.

Mr Clarke is cautiously optimistic. He is in the possibly enviable situation of having a restructuring catch up with his philosophy of healthcare.

Put simply - and he likes to put things simply - "the health system we've had for the last decade is not going to fix the problems of South Auckland health. We've got to think of something better."

"If you look at it, what have we got as a system? First you get a hospital bit here and a primary bit here, and they generally operate independently. There is no national strategy, but there are some promising moves to link information consistently between the GP and the hospital sector.

"Now," says Mr Clarke, who hits the ground talking, "the patient goes from one to the other. And if you follow the patient instead of traditional hierarchical models, will we not think of the view that we need to share information about key patients? And the answer is: of course we do. Do we do it? We do not."

This move off-site from Middlemore is deliberate, and tactical. And it reflects Mr Clarke's long-held view that you have to look outside the hospital to prevent people ending up there.

In terms of location, he is now a long way from the bustle of a trauma hospital which treats 300,000 patients a year.

Under Mr Clarke, Middlemore last year got a new emergency department to replace one which was designed to cater for 35,000 patients and was trying to cope with double that number.

Under Mr Clarke, the foundations were laid for a desperately needed children's hospital, Kidz First. It is typical of him that he didn't sit around waiting for Government money. "We could just sit on our hands and wait for someone to help us, or get on with it."

Getting on with it meant - and this in the public health sector, remember - taking out bank loans and embarking on a huge fundraising and sponsorship drive to raise the $60 million needed.

While David Clarke is more than happy to talk about his pet project - and he says people were still doubting even while the foundations were being poured - he is adamant that there is more to healthcare than building hospitals.

He cites a recent meeting with senior clinicians. Afterwards, one of his staff wondered aloud: "We've just had a two-hour session and we haven't talked about patient care at all. We've talked about community and diabetes weight-loss programmes. What's happening to us?"

What's happening is something very interesting, says Mr Clarke. "Because six years ago it would have been bigger and better wards and MRIs and drugs and blah, blah, blah. There's been a rethinking."

Of course, he says, "you can't avoid the fact that the hospital is still a major institution that's got to perform well for the public. Those public hospitals are the backstop."

Still, you can see that he has moved on - and not just geographically. He's thinking ahead. And thinking in simple, back-to-basics terms, of long-term initiatives on immunisation and breastfeeding.





The man who heads 4000 staff and oversees a $600 million industry has a reputation for being that rare chief executive who is seen on the workplace floor. He has also, says one senior member of staff, managed to get his staff to believe in "a united vision."

It's an accolade other CEOs might revel in hearing. Mr Clarke is more analytical of such praise.

"It's not a one-way thing, you see. A lot of people think that the CEO goes away and develops this vision and everyone buys into it. Not everyone's going to come with you, that's for sure. It's slow and you work it out. The issue for me now is to buy in constituents who don't work in the organisation, and that requires a community alignment."

Getting the community to buy in is something to which he's committed. As is living in that South Auckland community - albeit on 4ha at Karaka, where he lives with his wife and three children. They ride horses; he sticks to his mountain bike.

He has family links to the area: his parents grew up here. His dad went to Otahuhu College and, now retired from the police, drives a bus which picks up South Auckland Health volunteer workers. His mum runs a patient group. His sister is a primary school teacher trainee who was last week at a Manurewa school.

"I think it's important that you identify," he says of living in the area his health board finances.

It means there is no chance of detachment when "someone you know whose kid's got a broken leg goes to hospital and it gets reset wrong. That's the big stuff that really keeps you awake at night."

One other thing about David Clarke: He came second equal with film-maker Peter Jackson, behind Rob Waddell, in the Herald's man of the year poll.

He is genuinely nonplussed, and he can't figure out why we're interested in talking to him.

The not-at-all famous (but more interesting than he supposes) David Clarke started out as an engineer at New Zealand Steel in 1982.

He added a commerce degree to his two engineering degrees, moved to Goodman Fielder Wattie, then into healthcare as a consultant at Tauranga Hospital. He then did an MBA. He's now 42: "So I think I've done enough."

It's likely that it's only on the topic of tertiary studies that you'll hear Mr Clarke offer such an utterance.

Perhaps it's something to do with his engineer's mind. He's the sort of person who would spot a large rock blocking the road to where he wants to go to, and start making plans to drill through it, tunnel under it, or circumnavigate its surface.

Or perhaps he'd get on his beloved mountain bike and simply ride right over the top of it. Well, it's just basic common sense, isn't it, he'd say.