Health services under siege: the case for clinical process redesign

To the Editor: The recent supplement to the Journal on clinical process redesign1 is a tepid attempt by NSW Health and their colleagues in South Australia to disguise their own shortcomings.

Astute readers need more than fancy jargon, acronyms and pretty diagrams to be convinced that reform of the sort suggested by NSW Health cuts the mustard. Indeed, some of the language (“The process will proceed with or without you”2) provides disturbing insight into the mindset of those at the helm. Also, the ideas exemplified in another section are at clear odds with what I experience daily as a senior clinician. To illustrate, McGrath and colleagues write of “engaging clinical leaders” and that “solutions need to be evidence-based”.3 Regrettably, the opposite is the reality. Senior medical clinicians are sidelined and the decision-making process becomes the domain of a few select individuals, thus making it sclerotic, remote from the clinical interface and, at times, autocratic. Further, some management decisions are implemented without any of the supposed evidence base that McGrath and colleagues3 refer to. Perhaps of greater concern is the notion of “stretch targets”.3 These are considered “essential to stimulate real innovation”, but, translated into plain English, sound like asking staff to work harder with no additional resources.

In the past 15–20 years I have witnessed several changes in senior hospital management, each bringing the “latest and greatest” ideas on public hospital reform. Sorry folks, we don’t need more of this nonsense. Rather than yet another futile cycle of reform per se, the community needs to have a debate on the level of health care that it wants, contrasted with how much of the “pie” should be consumed relative to other needs. Until that happens, we are merely pretending that “process redesign” is the answer to our problem.