The impact of the Canterbury District Health Board structure on the efficiency and efficacy of clinical operations

Objectives: The purpose of this study is to gain a better understanding of the level of satisfaction from the clinical teams within the Canterbury District Health Board of the CDHB structure and its impact on the efficiency and efficacy of clinical operations. The objective of this research is to explore the healthcare system governance model in place for the CDHB and the clinicians’ view of the system for this region, with particular reference to the four key questions asked from a clinical perspective. • Should the system embrace greater centralisation or greater regionalisation? • Should the healthcare system be administered by a board or by management? • Should the administrative governance team be elected or appointed? • What degree of public participation should there be within the public healthcare system? These questions reflect the current stresses that affect the delivery of clinical services in the region. There are various factors affecting clinicians within the secondary healthcare sector. This paper reports on five critical influences on clinical practice and what effect they have on clinical operations: The Ministry of Health (MoH), the Canterbury District Health Board (CDHB) Board of Directors, District Health Board Management, the general public and other clinicians. Four pivotal overarching concepts relative to organisation structure serve as core organisational concepts: the administrative distinction between the Boards and management, elected versus appointed membership, centralised versus decentralised structure and the degree of public participation in determining clinical practice. Methods: Semi-structured interviews with a mixture of Clinical Directors and academic Heads of Departments from Christchurch central hospital were used to collect data. All management level clinicians were approached and asked to participate. Out of 37 requests, 27 agreed to participate. As part of the interview, participants were asked to respond to both rating scale measures and open ended questions about the nature of their work with and evaluation of the CDHB and its impact on clinical practice. Results: Clinicians saw public input to the CDHB as a having a positive effect, though the manner in which participation is achieved does not allow fair public representation. Management and clinicians are working closer together to effectively deliver healthcare for the region, though clinicians would like to have greater input on decisions at both management and Governmental levels. The impact the MoH has on clinical decisions is minimal yet clinicians would like more say in how the MoH makes those decisions. Rather than direct clinician input to MoH, there was a suggestion that the Council of Medical Colleges may be a better body to aid in the decision-making process for the MoH. Conclusion: Though greater centralisation is taking place around certain aspects of healthcare, the regional system presently in place is viewed as preferable when compared to a fully centralised system the like of the NHS from the United Kingdom. Public participation is seen by the clinicians as an important aspect of a public healthcare system and this is presently achieved through an elected member to the Board. The manner in which publicly elected members are selected is presently not providing fair representation of the general public, nor does it result in elected Board members having the required skill sets needed to govern a DHB. The governance role could be performed by a mixture of elected and appointed members, but should also have some input from a central healthcare body. The present move by the primary healthcare sector within Canterbury could be an area of further research as a way to improve public input while addressing a lack of strategic, financial and clinical governance leadership that has been raised by academics and the government.