David Meates MNZM, Chief Executive, Canterbury DHB has led a workforce through some of the most extraordinary challenges imaginable.
He has been in a CEO Executive Learning Set facilitated by Kevin Hardy at different times over the past few years. Kevin spoke with David about some of the extraordinary challenges, one of which is etched in all of our minds – 15 March 2019, the day of the Christchurch mosque shooting.
David shares a video of how exceptional the Christchurch Emergency Department team are in responding to the tragedy that unfolded that day. Team members share truly inspiring stories.
Kevin: Canterbury DHB has been through challenging times. What have you learnt about leadership as a result?
Canterbury has been through a lot over the past 8 years and the Canterbury Health system has had to respond in extraordinary ways.
- 4 September, 2010, Mag 7.1 earthquake
- 22 February 2011, Mag 6.3 earthquake
- 13 June 2011, Mag 6.4 earthquake
- 23 December 2011, Mag 6.0 earthquake
- 2013 and 2014, Several Serious Floods
- 14 February 2016, Mag 5.7 earthquake
- 14 November 2016, Mag 7.8 earthquake
- 13 February 2017, Port Hills Fire
- 15 March 2019, Terrorist Attack on Mosque
- 29 March 2019, New Outpatient facility flooded with 15,000 outpatients appointments cancelled / re-scheduled
Throughout 2018/19 CDHB has also implemented a new financial system, a new patient administration system (PAS), a new HR platform and planning for NZ’s largest hospital migration.
Following the February 2011 earthquakes, Canterbury DHB has demolished over 40 buildings and continues to operate out of earthquake damaged and earthquake prone facilities. As of last year, over 2,000 of our staff were still dealing with earthquake related damage / insurance claims.
The health system in Canterbury should have imploded following the earthquakes. It didn’t as Canterbury was also well underway bringing to life an integrated approach to health service delivery. Within days of the earthquakes the whole Canterbury Health system was able to start adjusting the way that it was working based on relationships, trust and a common sense of purpose that transcended 122 primary care practices, 4,000 aged care beds in the community, 117 community pharmacies, 70 NGO providers as well as the DHB owned and operated hospital and mental health services.
We had re-orientated our health system throughout 2009 and 2010 underpinned by three strategic goals:
- People take greater responsibility for their own health – the development of services that support people / whanau to stay well and take increased responsibility for their own health and wellbeing
- People stay well in their own homes and communities – the development of primary care and community services to support people / whanau in a community-based setting and provide a point of ongoing continuity, which for most people will be general practice.
- People receive timely and appropriate complex care – the freeing up of hospital-based specialist resources to be responsive to episodic events and the provision of complex care and support and specialist advice to primary care.
In a crisis you do not want to start trying to build relationships.
Leadership matters. In times of crisis both staff and communities look to leaders that are authentic, brave, are able to provide confidence and most importantly are able to create a sense of hope and future. Being able to give meaning to multiple different audiences that they can connect with and to invite people into how to create the future.
There is nothing more dis-empowering than giving teams and communities solutions that have not involved them in meaningful co-design.
Also don’t bullshit –people are smart and will do extraordinary things.
Some key leadership observations:
- Use patients / citizens time as a metric of performance – if we truly value patients’ time we would remove all the wastage and crazy ways that we organise health.
- Share a problem, to empower and entrust people to solve.
- The language we use connects and aligns, to create an identity of purpose.
- Integrated networks trump organisation hierarchy for empowering and enabling change.
- Create a shared vision, and key principles, that shape our behaviour and actions.
- Patient and staff stories encourage continuous improvement.
- Reignite the passion and commitment.
- Shared experience enhance engagement and learning application.
- 1,000 stories of change, giving permission to have a go, to make improvements, and inspire personal commitment to ‘Make it Better’.
Kevin: When you are selecting an Executive Team what do you look for over and above technical skills and knowledge?
The key attributes that underpin both the Executive Team and the key Operational Teams include the following:
- Diversity – add different thinking and challenge within senior teams
- Don’t appoint mini me’s
- System thinkers – able to think beyond narrow areas of responsibility and to be able to understand how the ‘whole system’ works.
- Ability to deal with ambiguity
- The sum of the whole is more important than the individual parts
- Ability to understand the power of ‘collective impact’
- All senior appointments need to be grounded by and driven by the Vision
- Balance experience across the team – health vs other sectors, internal vs external
- If you haven’t got the right mix DON’T appoint.
Kevin: When someone starts a new leadership role what would you recommend is essential for them to know about when they go to a briefing?
When starting a new leadership role, it is important to have ‘Big ears and a small mouth’. No one really wants to know how wonderful you have been in your last job and no one wants to hear that you have all their solutions.
Be curious, respectful and allow the possibility that all the experts that you need are already in the room.
Part of being a good leader to inspire teams is to create the environment where teams can be successful. In senior leadership roles you are NOT there in your capacity as a technical expert. You are there to lead.
Kevin: What does culture mean to you and what are the sentinel elements of a successful culture?
Culture is how we do things around here. For the Canterbury Health system, it is underpinned by ‘Doing the right thing and being enabled to do the right thing’. This requires systems to be orientated to making it easier for people to do the right thing.
Co-designing workflow whether it is clinical and HR processes enables people to see themselves reflected in what is brought to life and engenders people to give their discretionary effort. Our Community Health Pathways, Hospital Health Pathways, Healthone (Canterbury’s electronic health record), MAX (our people platform) are just a few examples of the power of meaningful and real engagement.
And a critical ingredient that is now such an important part of the Canterbury Health system is trust. Change happens at the ‘speed of trust’. Teams are empowered and backed. When it doesn’t quite work then that is the role of a CEO / Executive to front to provide protection for teams. When it is outrageously successful, then that is where you want teams to tell their story.
Kevin: What makes you proud in terms of your organisation and your people?
The Canterbury Health system should have imploded after the earthquakes – it didn’t because of the commitment from every part of the Canterbury Health system to make sure its community could have some stability and did not suffer any more pressure in the uncertain world that was facing everyone.
Continuous improvement is now built into every aspect of the Canterbury Health system – it has just become part of how we do things around here. It is everyone’s responsibility and accountability to sustain patient flow throughout the system. Our teams don’t do ‘crisis’ and are driven by an absolute focus on the patient.
We now operate a system in Canterbury that has a single source of data truth and a system that is now run with real time data and information that enables active 24/7 patient flow. Every discussion about services is immersed in data and how to ‘make it better’.
The focus and orientation of the Canterbury Health system is on ‘how to make it happen’ as opposed to ‘why it can’t happen’.
The Canterbury Health system is curious, comfortable with innovation and rapid change (as long as they have been part of designing it) and most importantly every part of the Canterbury Health system ‘gives a damn’ about its community, citizens and patients.
David Meates, MNZM – Chief Executive, Canterbury DHB