‘Leadership’ positions are reportedly set to skyrocket under a new DHB restructure plan. But what’s needed isn’t yet more overpaid leaders, writes Andrew Dickson – it’s efficient and effective managers.

I was staring blankly at the departure screen at Auckland airport, waiting for a flight back to Palmerston North, when I noticed someone who had been very important to me.

He was a doctor who didn’t know me from Adam, but I knew him alright – he’d been integral to diagnosing an urgent health condition in one of my family. I remember at the time feeling completely terrified; it seemed to me that one of my loved ones was on the edge of life and I had no power to intervene. But this doctor was calm and assured – he knew what was wrong with barely a glance. Such is the power of the clinical system in our country. Five years in university lecture halls, then detailed and close mentoring on-the-job, experience, practice and skill, for years and years.

Spotting an opportunity to break my airport boredom I sidled up and said hello. He peered at me, looking vaguely wary. In stumbling prose I attempted to tell him why I recognised him. I think I probably felt like one of my own first year students approaching me on a Friday night at the pub: “Dr Dickson, can you please read my draft essay?” (that actually happens…). Unsurprisingly the doctor didn’t remember the unmemorable case, despite trying valiantly to do so. He probably saves heaps of people, like Batman.

Unsure of how to resolve the awkward conversation moment I asked him what he thought about the recent restructure plan at the MidCentral District Health Board. The plan had been leaked to the local media in Palmerston North by staff disgruntled at the proposed changes. Doctor and community health campaigner David Hill has described the plan as “little more than a shuffling of the pack” and warns that it will create yet more walled siloes out of departments that should be working together.

I asked my doctor acquaintance about the restructure plan. He didn’t try to mask his disdain one little bit and muttered “same shit, different day”. Four words, and a damning indictment of the way health services are structured in New Zealand.

A king’s ransom has been spent on so-called ‘leadership’ in the health sector and those on the front line are ambivalent, at best. They get on with the actual work of health – broadly, fixing people. Like my doctor, they do this without thinking too much about what happens at the ‘top’ of the pile; they’ve got a lot of other things to think about. They perform their daily miracles in spite of their ‘leadership’, not due to it.

We heard recently about a suppressed report authored by Dame Paula Rebstock who was brought in to review the Ministry of Health. It appears that the report will be “highly critical of the ministry’s leadership team, according to sector sources”. No surprises there, but the ministry is not the only problem.

The number of ‘leadership’ layers between embattled Health Minister Jonathan Coleman and an actual practicing clinician is staggering. There is an entire ministry, 20 Board chairs, 20 elected boards and 20 CEOs who all, apparently, require a staff of leaders in order to deliver healthcare. That’s a lot of expensive bodies.

And what do we get for this taxpayer investment in the leadership industry? According to Radio New Zealand the relationship between DHBs and the ministry’s top officials has “eroded almost completely”. The health sector is now one very expensive sandpit with nobody playing nicely. What is required is a greater focus on relationships and collaboration – i.e. what good managers do – and less on the creation of leaders. I’m certain that a group of primary school teachers would do a much better job.

I haven’t seen the MidCentral leadership plan but the word is that the number of leadership positions in the organisation is set to skyrocket. I understand that a draft version of the plan used the term ‘leadership’ 102 times in 15 pages – that’s seven times a page. ‘Management’ by contrast was mentioned only nine times. There was even something called ‘The Organisational Stewardship Leadership Team’. I’m still trying to figure that one out.

UK academic Professor Marianna Fotaki argued recently that the people at the top of our public institutions have much in common with narcissists; that is, they fail to adequately empathise with other people. Without this empathy they tend to see other people not as equal humans, but rather as instruments to be used in the pursuit of their own grandiosity.

And here lies the dirty secret of the leadership industry – it actively seeks those people more prone to becoming narcissists but labels them ‘aspiring leaders’. In this way they are able to perpetuate these so-called leaders and make instruments out of the rest of us in the process.

So how does management differ from leadership? To understand this we only need to consider the fundamental purpose of a public organisation. Since their inception managers of public services have been aiming for two basic things: effectiveness and efficiency. Not profit.

These are the two things demanded by society in return for paying tax. In the health sector they are represented by a range of public services goals – low waiting lists/times, fast ambulance response times, low wastage and, to state the obvious, people getting better. It’s important to remember we don’t want more healthcare, we want more health!

Good managers have the goals of effectiveness and efficiency at the front of mind when making decisions. They understand that they work for society, which means they aren’t working primarily for their own ends. This is one of the hardest skills to learn in order to be a good manager – applying the principles of society despite the pull of their own individual drives.

This skill doesn’t resonate with the leadership industry because they are making a fortune by massaging their own and other’s egos. They want us all to aspire to be ridiculous over-inflated and over-paid ‘thought leaders’ – in fact the Auckland DHB is currently advertising for one!

Here’s one more problem with the leadership industry: it labels good managers as tedious cardigan-wearers (if they are worried about efficiency) or sticklers for policy (if they are worried about effectiveness). But what they don’t realise is that those cardigans are actually super-hero capes. Frankly, we badly need tedious cardigan-wearing sticklers for policy to manage our health sector right now. Lord knows they’d do a better job than their leaders.

Dr Andrew Dickson is a senior lecturer in Organisation Studies at Massey University and a director at Other Side Consulting.

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