On the contradiction at the heart of our search for better leadership @Medici_Manager @pash22 @muirgray

MELISSA SWEET | JUN 30, 2013 5:46PM http://bit.ly/13iudhC

This post brings together a range of reflections upon leadership – with some specific references to health – in these tumultuous times in national politics.

It is deeply sad but also somehow fitting to be compiling this post while watching the State Memorial Service for the late Dr Yunupingu, who gave us such an inspiring example of leadership at so many levels, and across so many fields.

At the bottom of this post is a link to a clip about the Garma festival, which I had the privilege of attending in 2007 (as described in this article forAustralian Rural Doctor magazine). I recommend the Garma experience to Croakey readers.

This post includes:

1. A call for national political leadership from Gordon Gregory, executive director of the National Rural Health Alliance (who provides the sort of community-focused leadership that is too often lacking in the health sector).

2. A summary of the valedictory speeches of the Independent MPs Rob Oakeshott and Tony Windsor, with particular reference to rural health and the social determinants of health.

3. Some reflections on healthcare leadership from nursing leader and blogger Philip Darbyshire.

4. The actor Jack Thompson on why every Australian child deserves the experience of attending the Garma festival.

5. The post’s final words belong with another strong leader, Yalmay Yunupingu, whose tribute to her late husband includes a rousing call to resist assimilation in education policies and racism more widely.

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1. The politics we want: an eight-point plan for rehabilitation

Gordon Gregory writes:

Politics in Australia has got itself a singularly bad name. And without the likes of Tony Windsor, Judi Moylan and Rob Oakeshott, who is going to lead its rehabilitation?

Despite its under-valued success in enacting important business, the 43rd Parliament has failed to halt the slide in the reputation of politics and of many of those who engage in it.

The leaders and managers of the major parties must take the responsibility. To the ongoing turmoil of the Labor Party’s leadership situation has been added the persistent refusal of the Opposition to fully accept its status as an opposition and the validity of the elected Parliament.

It is ironic that Tony Windsor and Rob Oakeshott, who have resolutely provided the support the Gillard Government has needed in order to govern, made improved parliamentary processes an important part of what they required for cutting the deal.

The Parliamentary Budget Office has been strengthened, which should mean greater clarity about the cost of commitments made in the election campaign.

There has been a significant focus on regional health infrastructure – not just in New England and Lyne – and the two have played a key role in nation-building changes in taxation, disability and education. But many of their aspirations for improved parliamentary processes and behaviour have not materialised.

The Parliament now ending has been industrious, including on matters of interest and importance to the people of rural, regional and remote areas. There have been a great number of Parliamentary Inquiries, including those of the House of Representatives Standing Committee on Regional Australia which owes its existence to the regional Independents: on the FIFO workforce; and on the Murray-Darling Basin.

Senators such as Claire Moore, Sue Boyce, Rachel Siewert and Fiona Nash have done a power of work with and for the people of rural and remote Australia.

But the profession within which they work is let down by its systems and the systems’ managers.

But hopefully all is not lost. Here is an eight-point plan for rehabilitating professional politics in Australia.

1. The focus of political discussion should be on policy issues, not power and leadership. The citizens of Australia need to see the connection between what politicians are discussing and the citizens’ daily lives – and what they care about beyond that.

2. There must be a much more bipartisanship, rather than continual ‘oppositionalism’ in the name of party brand differentiation. Voters don’t mind if political parties agree on issues, and they can be trusted to differentiate between the various parties on other grounds. The current bipartisanship on Closing the Gap in Indigenous health and wellbeing, and on DisabilityCare Australia, are good examples of the sort of credit political parties can easily earn.

3. The corpus of politicians should reflect the whole community. There should be equal numbers of men and women; and representatives of ethnic and cultural groups in due proportion. This is something that only the systems can achieve, not individual politicians.

4. Whatever political model or principle our politicians adhere to, top priority should be given to the needs of Australia’s most disadvantaged and marginalised people. Until it is so, the divide will increase between those who have substantial education, work, good income, housing, safety and health – and those who do not.

5. Whatever issue is at stake, the politicians’ search should be for the national interest – not just for the next three years, but for future generations as well. Investments in nation-building infrastructure such as the NBN, and in major social reforms such as DisabilityCare Australia, should not be judged by their costs and returns in the life of a single parliament.

6. Politicians must recognise that Australia is a wonderful part of a fabulous but fragile global system: ecologically, economically and socially. The identification of Australia’s national interest will take account of how it impacts on other people, other economies and the global environment. This is the context in which Australia’s decisions on refugees and migrants, climate change and the UN’s eight Millennium Development Goals should be made. People want their politicians to help them contribute to “building a better world” for the future.

7. When politicians talk to the public or to each other, one would like to hear real people exchanging real views. It is disappointing to hear the same practised catch-phrases and daily lines being spun from the mouths of those with responsibility to think and make policy decisions.

8. It is fine for the major political parties to insist that they are ‘broad churches’. This is something to be celebrated rather than used only as a justification for party members who fail to follow centrally-agreed party lines. (It is so depressing that the best speeches are heard triennially as valedictory addresses.)

Good luck to those who, right now, are considering a life in politics and are willing to risk some independence. We need you. And thanks to those who have tried to be better than cogs in a party machine. We understand about the personal costs but it’s a great pity the wisdom of the electorate won’t be tested on the value you have given.

“It’s good to be with you.”

• This article was first published on the NRHA website

Note from Croakey: Compare and contrast the leadership reflected in the article above with the statement that the AMA rushed to release after Kevin Rudd’s resurrection:

“AMA Vice President Professor Geoffrey Dobb said the first decision (PM Rudd) needs to make is to abolish the $2000 cap on tax deductions for work-related self-education expenses.

Professor Dobb said the cap was poorly conceived and would undermine the ability of doctors to undertake the training needed to keep their knowledge and skills up-to-date, with consequences for the quality of care they could provide for their patients.”

Really. Is that the most pressing health concern to be drawn to Prime Ministerial attention?

Let me count (just some of) the ways that statement missed the mark:

1. Climate change
2. Health inequalities
3. Closing the Gap
4. Children living in poverty (Judi Moylan begins her recent article in The Guardian with this: “After 20 years of economic growth and a world-class welfare system, there is something fundamentally wrong when 600,000 Australian children currently live below the poverty line.”)
5. The need for real structural reform in healthcare to put the community’s needs ahead of where practitioners choose to practise (whether in geographic or specialty areas).

This is what a community-focused health statement might like.

It was presented recently at the WONCA (World Organization of Family Doctors) conference in Prague, by the organisation’s new president, Australia’s own Dr Michael Kidd (primary care researcher, medical educator, dean of the faculty of health sciences at Flinders University, and a past president of the Royal Australian College of General Practitioners).

To be fair, the AMA statement did at its end acknowledge wider community health issues: “He added that a more compassionate approach to the treatment of asylum seekers was a must, including improvements in health services for those held in immigration detention centres – particularly children.”

Nonetheless, the AMA statement is a timely reminder that while professional groups are very good at representing professional interests, policy makers are not serving the wider community interests if they allow the professional lobby a dominant role over health policy.

****

2. Oakeshott and Windsor

I recommend reading the valedictory speeches of Rob Oakeshott and Tony Windsor in full (search on those links for their names and you will find them).

In addition to the personal and political insights, and the human interest value, there are many reflections relevant to wider health concerns.

On the social determinants of health

Both raised concerns about “Ugly Australia”.

Rob Oakeshott:

“I sent the then Prime Minister a text that said her father would be proud of her. I am a father of daughters and very proud of it. Some of the things that have been said in the last three years have been discussed. They cannot be accepted, whatever happens from hereon. We have to find a way to get back in control of the public square and this is the place where that happens. The fringe has invaded the middle; it has to be put back on the fringe.

We all deal with it. I remember sitting in the back of a bus in Broken Hill, on an NBN trip, and we all swapped stories about crazy emails that we all look at and go: ‘I can’t believe this is a view that is held in Australia today.’ It is off its lead. We have got to do something about it and if it takes a few of us to fall on swords to fix it, then so be it. The nation needs to deal with it; this parliament needs to deal with it.

I have been shocked, frankly, over the last three years to meet ugly Australia and just to see the width and depth of ugly Australia. I leave here optimistic. I am proud of my country. I think we are a resilient, entrepreneurial, strong and exciting nation, but we have got to deal with ugly Australia – we have got to deal with it somehow.”

Tony Windsor apologised to his wife Lyn and family for the vitriol they had suffered, and called for a more civil and constructive public debate:

“I have great concerns personally about the vitriol, the short-term negative issues that are pushed, the fear campaigns. I am not accusing one side or another. It is out there in our political world and it is something that we should have a very, very serious think about, because democracy is fragile —it does not just go on and on, and if people lose faith in it this country will suffer the consequences.

There is a fellow lying pretty close to death, I think, in South Africa. We should reflect on the efforts that he went to to create the circumstance where people could have a vote, where people could actually try and have some impact on their own futures. I think that is something that we all need to do.”

Rob Oakeshott described the Australian Education Bill as “arguably the significant reform of this parliament. I think to blow up a funding formula that was rubbish and leading to disadvantage is a credit to everyone involved”.

On climate change

Tony Windsor congratulated the former PM Julia Gillard and former Minister Greg Combet for their work on climate change, and said:

“One of the issues I am proudest to be involved in is the climate change issue. I think it is absolutely disgraceful that we have picked that as a target. … As a farmer I know that if we suffer climatic change that is detrimental — not necessarily less rain, but maybe more intense rainfall and longer dry periods — that has an incredible impact on our economy. Anybody who is trying to assess risk in any shape or form would have to look very seriously at the science and try to do something about it. And if you are going to try to do something about it then, regrettably, there is no cheaper way of doing it than putting a price on it. We can have our arguments about the global linkages et cetera, what all that means later on and what the fixed price is now. …the abattoir at Inverell is going to be an extraordinary example that reverses all of the nonsense that we have heard. The unit cost of production will actually go down.

Utility prices, whether it be gas, heat or electricity, will be controlled within an almost closed loop. The very thing that we are talking about: renewable energy, value-adding to agriculture — all of the stuff—and that is why you have not heard anything from the meat-processing industry.

The smart money has moved. It is not only good for the climate, it is also good business…”

On rural health

Rob Oakeshott said:

“I am thrilled that because of agreements reached in this parliament we managed to get the investment of $1.8 billion into over 130 regional hospitals, Port Macquarie being one of them.

I take my hat off to Prime Minister Gillard — I will still call you Prime Minister — when she was Deputy Prime Minister and education minister she helped to start that strategy rolling. It is delivering on a number of fronts. We have the University of New South Wales who from 2015 will deliver a full medicine degree in our community. We have Charles Sturt University rolling out oral health clinics and a food, soil and water research clinic, and wanting to build a campus. We have a model where TAFE facilities and other universities in pathways and collaboration are working together to put the focus on students, not over the fence on other universities, the TAFE sector or the schools sector, trying to be competitive. That is the model that we have invested in that is now starting to bear fruit.”

Tony Windsor said two initiatives arising from the Independents agreement with the Government were the Health and Hospitals Fund and the Education Investment Fund.

“100 per cent of those two funds went to country areas. We have been criticised that this was all about pork-barrelling our particular seats, but nearly $2 billion came out of the Health and Hospitals Fund when you add some of the cancer clinics to it as well when there was a regional round. Nicola and Tanya, thank you for the work that you have done.

Thanks also goes to Tony Abbott for the work that you did previously in terms of the university department of rural health, which led quite quickly to the University of New England developing a medical school.

One hospital in my electorate got some money, 134 somewhere else got some money, and there are similar statistics in relation to the university and TAFE funding.”

Tony Windsor also told a wonderful story about the power of grassroots advocacy when a small rural aged care service was threatened with closure because it only had ten beds, and was deemed “uneconomic”.

“Probably one of the most pleasing activities that I have been involved in was the saving of the Bundarra Grace Munro aged-care facility. Grace Munro was the founder of the CWA and lived in the Bundarra area.

… The provider from Inverell said: ‘We don’t want to do it any more. They can all come to Inverell.’ A little committee was formed. I was part of that, and we went through all the ramifications of what would happen, how we could make it economic. The departmental people, who were playing the departmental card at the start, became sympathetic.

The minister, who was Justine Elliot, the member for Richmond, had a good look at it and the community found some money. A lot of people made a contribution to get it going and, since then — that is about five or six years ago now — it has made a profit every year. So don’t let anybody tell you that 10 beds is too small and that you have to go to the next biggest feed lot to get service. That is not correct. Small communities can do enormous things if they get together.”

He also urged country people to look more strategically at politics, to ensure they weren’t taken for granted by political parties, highlighted the importance of the National Broadband Network for regional Australia, and spoke of the detrimental impact upon rural communities of FIFO (fly in fly out) workforces.

On asylum seekers and refugees

Oakeshott said:

“I think it is the unfinished business of future parliaments, whoever is in them, to resolve the issues in and around asylum seeker and refugee issues that are dressing themselves up as border protection issues and the either/or choices that are being put to the Australian community — it is either onshore or offshore; it is either community detention or mandatory detention; it is either Malaysia or Manus Island. This is not an either/or choice; it is going to be a little bit of everything. That is the answer.”

Windsor  said:

“.. the tragedy of this parliament, if there is one, is  the refugee issue. I think we are all guilty. Let’s hope that we can do a bit better across the political divide on that issue. There is no need for the circumstances. There are ways through this. I encourage all members of this parliament and future ones to really have a hard look at that and try to remove some of the fear tactics that have been used.”

***

Meanwhile, the National Rural Health Alliance acknowledged the work of Windsor and Oakeshott in this statement:

“The people of rural and regional Australia are losing two strong advocates for their cause with the retirement from politics of Tony Windsor and Rob Oakeshott.

Thrust into a position of great national responsibility, these regional independents have played key roles in the effectiveness and industry of the 43rd Parliament and, in particular, in delivering some valuable national focus on rural Australia.

Impressively, the two have found time and energy for national issues such as parliamentary process, taxation, fly-in fly-out workers, broadband, education and the Murray Darling Basin, while at the same time advocating effectively for their own electorates.

Windsor and Oakeshott have delivered substantial benefits to the people in very many parts of rural and remote Australia. Some of these been related specifically to health, such as the regional round of the Health and Hospitals Fund valued at $1.8 billion. Other achievements with which they have been associated are concerned with the social determinants of health – building the sustainability and vitality of rural communities through better communications, businesses, infrastructure and natural resource management.

Parliamentarians from all Parties as well as the other cross-benchers have no doubt worked just as hard, and nothing could be achieved in Parliament without the combined effort of many. But Windsor and Oakeshott have consistently provided a collaborative, reasonable and common sense approach, and reflected from lived experience on the real situation facing businesses and families in rural areas.

Particularly in politically turbulent times, Tony Windsor has become many people’s preferred commentator on Canberra’s political affairs.

Both men have had some unfair criticism from competing forces, but have remained resolute, consultative and dignified. Time will surely honour their achievements and their legacy will soon be properly recognised.

Whoever represents the people of New England and Lyne in the 44th Parliament will have a hard act to follow – not just for the people of those particular electorates but also for the general wellbeing of the people, the communities and the resources of rural Australia.”

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3. Imagining passionate, authentic leadership in healthcare

Philip Darbyshire writes:

In response to yet more allegations of sexual abuse and humiliation of women by some members of the Australian army, the Chief of Army, Lieutenant General David Morrison, AO, posted a message on YouTube to the Australian Army.

https://www.youtube.com/watch?v=QaqpoeVgr8U&feature=player_embedded

General Morrison’s statement has been widely lauded as one of the most powerful examples of genuine Leadership that we have seen in public life in many a year.

It is a stunning display of controlled anger and concern combined with a laser focus on values and integrity, utterly unencumbered by any of the usual spin-doctoring that normally pollutes such public pronouncements by our ‘leaders’.

I wondered, as did many who watched him, why we do not have such clarity of purpose and values and such demonstrable integrity in politics and public service in general.

Why, for example, don’t we have a Minister of Health or Health CEO anywhere capable of setting out such a values driven vision for Health Care?

In the wake of some of the ‘health scandals’ that we have experienced here in Australia such as Garling and Bundaberg and those that have preoccupied the UK such as the Francis Report, I couldn’t help but wonder what the General’s address might have been like if he was in charge of Health Care:

“I have spoken to the media today in response to reports that some members of our health services have systematically betrayed the people that they are charged with serving and caring for.  I cannot go into individual details today but I can tell these people that from this day hence, there will be no place for them to hide.

A small but significant group of staff, policy makers and politicians, through their actions and inactions have blighted and undermined the foundational values that we stand for and hold dear in health care. This minority and their metasteses have been found at every level in our health organisations, from ministerial offices and executive boardrooms to the wards and communities of clinical practice.

Through their demeaning and contemptuous treatment of patients and colleagues these staff have made it abundantly clear that they have no place in a modern health service.

Our health service is here to care for people at some of life’s lowest ebbs and most fearful moments and to provide this care with compassion, kindness, creativity and competence. These are not luxuries or optional extras, so if you cannot or will not create the culture that enables such care, or will not provide such care, get out of health care now and make room for people who can.

Healthcare is also based on teamwork and inclusivity where every health professional, manager, support worker and indeed patient, makes a valued contribution to care. What is most galling in these reports is the behaviour of some of our senior people who have a clear leadership role.

If you think that your power and influence make it acceptable to create a toxic culture of fear, intimidation and silence where staff or patients are humiliated, belittled and browbeaten and where your default position is to cover up, I am here to tell you today that your days in healthcare are numbered.

I don’t care whether you are the Minister of Health, a CEO or a clinical leader. If you cannot live up to the highest of values that we set for our health service, then find somewhere else to work.

Our health service exists first and foremost to serve our patients, clients and communities. It is not here primarily to guarantee you a power base or a job for life regardless of your performance, or to pay your mortgage or your kids’ school fees.

Poor care, negligence, abuse, bullying, humiliation and thuggery are intolerable and we will root them out.

If you stand by in silence and lack the moral and professional courage to challenge these affronts to our culture, our values and to human decency, you are as culpable as the perpetrators.

We want staff with moral courage who know the right thing to do and who do the right thing. ‘The standard that you walk past is the standard you accept’.

Our health service has a proud history and tradition of caring for and serving others and I will work with and support you to protect that legacy now and for the future. Betray our values and shame our principles however, and you will have no part in that future.”

Now wouldn’t THAT be something to hear.

• This article was first published on Philip Darbyshire’s blog.

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4. Jack Thompson: Garma is an experience that everyone deserves

https://www.youtube.com/watch?v=vLTs_NpUBXE&feature=player_embedded
***

5. We want power to be shared

And finally, I hope you had the opportunity to hear the tribute from Yalmay Yunupingu to her late husband, and particularly her emphasis on the importance of Indigenous knowledge and two-way education (you can read more about the background to the struggles for bilingual education in this article at Inside Story by Lisa Waller). She spoke about the ongoing impact of assimilationist policies and racism:

We want power to be shared and we reject being told what we should do or how we should live our lives. We want our voice to be heard, not to be silent and ignored.

Perhaps that is the most important aspect of leadership, as alluded to by many of those featured in this post: the contradiction of true leadership is that it works both for and against power. Those who accumulate power must also strive for its more equitable distribution.

On a related note, the slide below comes 19 challenging thoughts about leadership, a presentation from The Future Leadership initiative at the Antwerp Management School. Thanks to NHS leader Helen Bevan  for sharing it via Twitter.

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