dr stephen child gp / director of clinical training auckland district health board
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Dr Stephen Child GP / Director of Clinical Training Auckland District Health Board. 0. Will the Doctor Please Stand Up? -Dunedin, August 2013-. Dr Stephen Child MD, FRACP, FRCPC General Physician/Respiratory Interest Deputy Chair, NZMA Director of Clinical Training - PowerPoint PPT PresentationTRANSCRIPT
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Dr Stephen ChildGP / Director of Clinical Training
Auckland District Health Board
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Will the Doctor Please Stand Up?
-Dunedin, August 2013-
Dr Stephen ChildMD, FRACP, FRCPC
General Physician/Respiratory InterestDeputy Chair, NZMA
Director of Clinical TrainingAuckland District Health Board
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Outline
1.We have a problem?
2.Leadership is key?
3.How to lead?
4.Professionalism
13 min
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The Problem
“Healthy” population
- Quality of life
- Productivity
$
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Big Picture
Social Security(33%)
Education (17%)
Defence Government ServicesLaw & OrderTransportEconomic Services
20%($14.1 b)
$ 70.5 billion
• +$1.1 b – ACC
• =83% Public $
• $2987/person
• 10.1% of GDP
17% “Private”
• insurance
• non-profit org
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How measure?
Performance
Other
Productivity
Access
Ambulatory – Sensitive Hospitilisations
In-hospital care
Amenable Mortality
Life Expectancy
…. and how “benchmark” inter
intra
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Examples
- Pharmacy
• Warfarin prescribing• immunisation• “designated” prescriber
legislation- Nursing Council
• 3 level nurse prescribing
- Physician Assistants Demonstration Projects
- Clinical Assistants Trial
- Theatre Assist Projects
- etc
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Minute Clinic
- QuickMedx – 2000 St.Paul,Mn
- 2005 = 19 clinics ……2009 = > 600 clinics
- JCAHO accredited
- > 12 million/year
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Internet
Mexico (2010)
= 10% via mobile phone
US( 2011 ) = 68% happy with e-consult
= Google diagnosis = 15/26
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Internet
NZ = 60% used internet for Dx (2007)
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What does this mean for us ?
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Role of Doctor
“Doctors regularly take ultimate responsibility for medical decisions and diagnoses …”
Role of Doctor consensus statement, NZMA, 2011
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Role of Doctor - Leadership
“Doctors have a key role in providing higher level sector leadership …. (and) … have a responsibility for ensuring patient safety and monitoring both individual and service level outcomes”
Role of Doctor consensus statement, NZMA, 2011
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Leadership
MOH = 111 hits Business Unit = “Clinical Leadership
Protection and Regulation (CLPR)
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“Good Leadership begins with solid values”
Transformational Leadership
Jeffrey Gandz
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American Charter of Professionalism
1. Professional competence
2. Honesty with patients
3. Patient confidentiality
4. Maintaining proper relationships with patients
5. Improving quality of care
6. Professional responsibilities
7. Just distribution of finite resources
8. Scientific knowledge
9. Maintaining trust by managing conflict of interest
10.Improving access to care
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Professionalism – Patients Perspective
N = 953 55 items 1 – 5 score
1) Respecting confidentiality 4.60
2) Respecting patient autonomy 4.47
3) Treating fairly and without prejudice
4.47
4) Behaving honestly and with integrity
4.45
RCP, Clin Med 2010, Vol 10(4):364-9
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Honesty and Integrity?
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Professional?
1. Cancel public list for “private” benefit
2. Commercial benefit via devices
3. Unnecessary treatment eg. skin cancer removal
4. Creating demand
5. “Unreasonable” profit ($5000+/hour)
6. etc
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What to do
Do I work in a professional manner?
Is my altruism vs “self interest” appropriate?
Do I “speak out” for professionalism?
Do I “speak out” for patients?
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Summary
1.Change is coming
2.We need to lead
3.Leadership comes with values (professionalism)
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Do I make a difference? ….. more than just the patient in front of me?
NZMA
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Adjust skill mix (Productivity)
i) Non-doctors performing tasks
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Definition of Professionalism:1912 : Judge Louis Brandeis
1. A profession is an occupation for which the necessary preliminary training is intellectual in character, involving knowledge and to some extent learning as distinguished from mere skill.
2. It is an occupation which is pursued largely for others and not merely for one’s self.
3. It is an occupation in which the amount of financial return is not the accepted measure of success.