“We have come too far not to go further, we have done too much not to do more”

Sue was delighted to introduce Kathy Grant Commissioner for the Southern District Health Board. With extensive experience in the education, commercial and Health sectors, Kathy had encouraged Sue back in the day to have an active role in both Primary and Secondary Board’s of Trustees and they both received their Paul Harris awards on the same evening. Married to Stephen Grant, Mother to Michael and Rebecca and grandmother to two Scotsmen Elliot and Blair, Kathy has always been a great supporter of our Club.  

For Kathy it was a welcome change to talk speak to a group of familiar faces. I do like a bit of history, sometimes that can be hard to come by in such a young country. Kathy however, has a strong historical connection to Dunedin and the University, Otago University’s first woman graduate Caroline Freeman, is Kathy’s great, great Aunt. I also have it on ‘blunt’ authority that one must live in a place for 40 years to be considered a local so yes Kathy, you have the heritage and the right to be called a Dunedinite. 

Kathy has been asked to share her experience as Commissioner for the SDHB and reflections on the “pathway forward as the organisation returns to the usual Board structure following the local Body Elections.”

A natural place to start would be June 15, Day 1 for the Commissioner Team and their first scheduled meeting with the CEO. Best described as similar to the first day of school, no one had any clear ideas on the rules of engagement, let alone a hand book. As mentioned before, Kathy has extensive governance experience and knowledge around transformational change but was new to the Health Sector. Her colleagues Graham Crombie bought a financial background encompassing business restructure and Richard Thomson, the former Chair of the Otago DHB. Day 1 - they became a Team. 

What is the role of a Commissioner? 

With direct accountability to not only the appointing Minister and the MInister of Health. So one may be driving through snow in Winton or in the gym changing room if the Minister asks “Kathy do you have time for a chat?” then yes one does. Part of that obligation is to keep the Minister informed. Media or  fellow politician questions should never be a surprise. The model of corporate governance irrespective of the sector, identifies that a Board governs and Management implements. Together they formulate a strategic plan and are ultimately responsible and accountable to deliver. A Commissioner sits somewhere between the two. Obviously the Board model hadn’t worked all too well previously so the Team unusually, became involved in the business aspects of the DHB. Not there to decide the colour of the bandages, more to provide input into the CEO’s team, primary care, engage on an ongoing basis with communities, staff, clinicians and stakeholders. In other words, engage more in the business of ‘the doing side’ as well as the expected governance. This can lead to disempowering the CEO and team. The formal authority, ability to make decisions, sign documents etc, sits with Kathy. 

What is it like being the Commissioner?

Admittedly the initial scrutiny into her life was daunting, in this job one lives in a fish bowl. Too old, too young? Continued disclosure of expenditure. Interesting introductory responses “So you're the Commissioner - I thought you would have been bigger!” For Kathy even though recognised as the Head, the Team fronted up together - personal accountability. Health comes with baggage, one is poised to react, the majority of injustices while very real or re lived, are just that historic, unfortunately not adequately addressed. Yes there was initial suspicion (I have to include this story.) Nine months into her appointment, 7 am on a Sunday morning, the Charge Nurse had just been told who she was and asked if she was a ‘secret shopper?’ Our beloved Stephen was lying on the bed with oxygen, morphine and moaning. Kathy took one look at her very sick husband and replied “perhaps not!” In her own words “the experiences have been richly varied” including observing a surgical procedure in a bus in Oamaru!!

In response to the often asked question re developing a thick skin, Kathy concedes to a ‘teflon jacket.’ In health the stakes are high life and death, the ability to remain empathetic, to connect, respect and respond to individual concerns was a top priority.

Time for reflection.

  1. A big focus on reshaping the delivery of health services - a huge challenge considering the geographical size of the SDHB. A model of an integrated network of care as opposed to a series of silos in splendid isolation.  

  2. A critical pathway of the future is work stream around the culture of the DHB. Engaging directly with the communities, patients and staff - understand the issues and importance. The development of Listening Weeks - agreed values and behaviours. Reporting on the 7 + 7, staff and patient identified priority areas. Culture needs to be constantly revisited, its importance remembered. “A culture of kindness and respect, a recognition that we are ultimately motivated by the same purpose, to provide the best care we can to our patients and communities.”

  3.  The link between health and education, 150 years is worth celebrating, always inextricably linked. The health workforces are trained here, Clinicians, at the heart of Specialist care, employed - an inner city site therefore makes sense - Dunedin is seen as a teaching Hospital, a value add on for both the Hospital and University.

  4. Aging Population. Those aged 65+ will increase 70% in the next 25 years. A challenge for the health system as people live longer and require more complex car. Technological development provides opportunities for care closer to home.

The pathway to only doing more of the same is unsustainable. The focus therefore is on service delivery changes, what service can only be delivered at the Hospital, what services can be managed in a primary or community setting. Hence the development of two complementary strategies. While this reshaping needed to happen, the Hospital rebuild has been a catalyst for such discussions. The change needs to come now and be reflected in the design, be clinically owned and led. Yes to architectects and health planners but the staff have a voice and it deserves to be heard. The challenge - build a new Dunedin Hospital not a new old one. 

How does the Commission measure success?

Not always about cost cutting, in reality it was never a focus. True sustainability comes from removing waste, investing in change. The workforce is their most valued resource. Tackle the uncomfortable areas, address the issues and as always strive for financial sustainability, live within your means, invest in order to fund change. 

Kathy believes the future lies in these initiatives to determine the future models of care. She leaves it in a far more resilient state than Day 1 in 2015. Her motivation in accepting the appointment? A southerner is more suited to recognising the needs of the locals. Her coping mechanism? The ultimate litmus test - can she sleep at night?

There were a number of questions, which in my view, Kathy handled with the aplomp of one who has dealt with tricky and controversial questions before. When politely declining an answer, I felt Kathy respected the question and the person behind it with diplomacy. Rob thanked Kathy for enlightening us on a topic dear to one's heart, especially in light of the upcoming elections. 

I will finish on the below - Story - three workers on a building site laying bricks - when asked what they were doing, the first response was “I am laying these bliming bricks” the response from the second bricklayer was “I am feeding my family” and the response from the third bricklayer was “I am building a school so that the children in this community can be better educated and secure better jobs.” Health is like that. Kathy feels part of something bigger which brings a sense of purpose, sense of team and a sense of satisfaction.