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When I commenced as inaugural CEO in May 2006 I had no idea that I would also be here for the 5oth anniversary of the College.  

It is somewhat sobering to contemplate my contribution to the College particularly so in terms of the contribution of those who initiated the College fifty years ago.  Since 1967 the College has grown with the vision of those signatories and founding fellows. They provided stewardship through accreditation and recognition of management by doctors as a speciality practice of medicine. They have mentored and inspired the executive careers of many more medical administrators in the Australian and New Zealand health systems.  

In the beginning it was the Australian College of Medical Administration then came the magnificence of “Royal” status, then “Australasian”. In more recent times The Royal Australasian College  of Medical Administrators (RACMA) has become a colleague, friend and collaborator of the Hong Kong College of Community Medicine (HKCCM) and  other international associations and faculties for doctors in leadership and management -  through the World Federation of Medical Managers (WFMM).

More than 1500 highly skilled and impressive practitioners have become RACMA Fellows in the past fifty years through qualifying in the specialty of medical administration and they have established a RACMA brand that is now irrefutable.

When first I started

Gavin Frost was ‘my first President; Phillip Montgomery was the Immediate Past President. My office was at the end of the longish building at 35 Drummond Street, Carlton – a building bought some 40 years earlier with the foresight of those early College Fellows. I shared three rooms, a kitchen and a bathroom with Gary White and his nephew Ben who was there on a traineeship. Gary was not happy about my appointment and was not backward in making it known to me.    He soon left and then it was Ben and I.

With no delegated authority, I could not withdraw money from the bank to provide any amenity - washing up liquids, toilet rolls for Board meetings, catering for meetings, paper and pens without seeking a cash cheque to be signed by the Treasurer and the promise of enclosure in a speedy return envelope. One of my earliest challenges post Gary White was to collect your membership fees. This led to sleepless nights wondering how to cash your cheques and your credit card promises because I’d been left with no account information nor access. No Fellow was readily on hand to advise on this one. So several approaches,  spirited and tenacious discussions with the bank, form filling, etc. and pleading for help from “Cardlink” we got it sorted. It was May and June that year and I spent several hours a week transacting your subscriptions into the College accounts.

Shortly after this I secured accounting and bookkeeping support in Phil Staley and Jan Stephenson and we worked together to develop the College’s finance system. Phil and Jan are still working in the College. I knew what I needed in the way of financial reports and this enabled the three of us to develop the systems we now have. And thank goodness. In those days the annual operating income was $639K with a profit for the year of $23K. The College’s net assets were $1.4M. Today the annual income is closer to $2.24M, the operating profit more than $300K and assets around $5.5M.  At the time there was no Finance and Audit Committee. The Honorary Treasurer Peter Bradford was responsible for all money, fees and reporting to the Board. Today there is a Chair of Finance and Audit Committee in Humsha Naidoo and a committee which meets quarterly

Lee Gruner was the Censor In Chief  - of all aspects of the Fellowship Training Program (FTP); Kim Hill led the CEP program.  Then the FTP comprised 2 workshops and a national trial (including an oral presentation)  which preceded the Pre-Fellowship Oral Examination. In addition there was a 3000 word case study, the required masters degree in public administration (often the UNSW one), a set of preceptor reports and three years full time equivalent in a training post – all to be evidenced before presenting for the Examination.  The FTP today involves more work, particularly assessment and  the Research Training Program (RTP) is adding depth and rigour as it replaces the 3000 word case study. There are discussions happening now about programmatic training with work-based assessment in the medical management practice program (the old supervised training period).

Formal panel visits for the purposes of accreditation of training posts were not practiced - albeit I found records which showed policy and process around this had been earlier considered. Reviewing and implementing a formal program of accreditation visits was an early priority and it is well in place today. The Board of Training and Continuing Education (BOTCE) was the key Board Committee and its activity was for the most part expressed through the Board of Censors (BOC) and the CEP Committee. Today the Education and Training Committee (ETC) is more active under an elected Chair/Board Director and the BOC and CEP/CPD Committee lead in assessment design and delivery. The BOC has become an exemplary RACMA committee comprising dedicated Fellows.

The first Pre-Fellowship Examination, which I was required to organise and support, was in Hobart in 2006. I was impressed with the exam and simultaneously saddened to experience the impact on those who did not succeed. I can still hear Vicki Tse’s scream of delight when she found she’d passed. Because of my direct involvement with the Candidates in those early years I came to know them quite well – in contrast to those who had just become Fellows the year before I came – many of those it took me years to meet. Today it is others in the Office who come to know the Candidates well as I have had to step back to do other things. I recall how exhausting it was when I alone supported  the exams, organising the BOC and Board meetings and the conferment ceremony back to back was exhausting. In 2006 RACMA held a joint conference with ACHSM and integrated its conferment ceremony, Langford Oration and two Board meetings with the Annual Scientific Meeting (ASM).  Today we have more resources on hand to assist with all this activity; and in fact the Pre-Fellowship Examinations have been separated from the ASM activities for several years now.  

First tasks

A primary responsibility when I came to RACMA was to ensure the College was accredited by the Australian Medical Council (AMC).  By 2008 we submitted our report and opened the doors to the accrediting team. It was a very large piece of work to prepare the College. We launched from a base of  history and much good will but not a lot of documentation and standardised process. A team of Fellows assisted with this project and drafted policies, competency charts, terms of reference for committees, etc. We made it, we were accredited; it still remains a memorable achievement. Since then I have written annual reports on the College’s progress to improve and consolidate.

The legacy of that work laid a solid foundation on which to continue development and improvements in the FTP. The AMC accreditation standards then, and now, continue to provide the basis for change and development. Not only has the College response to these standards underpinned a solid development of the education and training program of the College, but the standards themselves regularly change. As a consequence of AMC accreditation we have more structured  formative assessment, a Research Training Program  (RTP), stronger national training frameworks aligned with Jurisdictional Committee programs, Interacts and other e-delivered training, a documented curriculum and now we contemplate programmatic training and assessment. While we do have more committees to support better governance of the training there remains some distance to go. Faculty, as we now call our training and assessment Fellows,  are engaging in strong numbers. It is no longer the job of the Censor in Chief to “do the lot”, let alone is it possible any more.

In 2018 RACMA is up for reaccreditation and while we go into that process much better prepared there remains work to be done as the AMC adds more hurdles within the standard. The accreditation system today is shaping up to be much more of a compliance system than a continuous improvement system.

As always RACMA remains ‘different’ and because of this difference we advocate and justify always to have this difference respected and accepted. RACMA’s difference will continue to be a challenge to some and an opportunity to others. I prefer the latter because if used carefully this difference grants advantage.

Governance

Working with the RACMA Board has been a privilege. My Presidents have, in addition to Gavin Frost, included David Rankin, Roger Boyd, Lee Gruner and Michael Cleary. I remember each of them for different reasons. The Board had 22 members when first I came and only just fitted in the meeting room up stairs at Drummond Street. I enjoyed doing the washing up after those meetings! The Board met quarterly. Early Board agendas show that discussing the last quarter’s correspondence was an important item, together with reports from the committees. The Board agendas have changed somewhat as I took to writing papers, finance reports and policies, training programs and projects to advance the College strategically, financially and operationally. Accreditation continued to provide the framework for continuous improvement and change.

The Presidents and I have valued the networks created through our membership of the Committee of Presidents of Medical Colleges (CPMC) and the New Zealand Council of Medical Colleges (CMC).  I have been pleased to chair the Australian CEOs Meeting for several years, and wish to record the strength of support I have received from this group of CEOs. The collective experience of this group and the access - there at a call or email - shields one from the professional isolation which can be felt at times in the medical college culture. I have also been welcomed at the NZ CMC meetings which I have attended a couple of times each year. Meeting our New Zealand counterparts is always enlightening and there is much to learn from our colleagues there. There have been numbers of occasions when I have combined such visits to New Zealand with accreditation visits and meetings with the NZ Committee and NZ Members.

The Board has always created a sense of ‘journey’. I have been the beneficiary of Boards and Presidents who have largely permitted me to get on with the business of running the College; but most have been accessible to provide advice. Gavin was a great support in the early years and would ring weekly to see how things were going and how I was ‘travelling’. I have appreciated this and will remain most respectful of Gavin’s sage advice and reliable support. Lee and I developed a close working relationship as much due to our mutual interest in education and training; Lee’s passion to be involved and to help, remains tireless.  Roger was the font of all detailed knowledge about the College and trained me well to prioritise accuracy. I accompanied three Presidents – Gavin, Roger and Lee –on trips to Hong Kong and to World Federation of Medical Managers (WFMM) events. Roger and I went to WFMM events in Rome and Vancouver. Roger is the best bloke a girl can go shopping with - and he owes me for a purchase in Rome that should have been mine! Ever the diplomat Roger helped lead the process of gluing together the WFMM group in its most formative period.

Gavin made it a priority to introduce me to the Hong Kong College of Community Medicine (HKCCM) and this relationship between the two colleges continues to strengthen. In 2018 RACMA will collaborate with the HKCCM to hold a joint ASM in Hong Kong – some eight years after the initiative to form the WFMM.

 

In 2008/09 I had the privilege to work with Heather Wellington to redesign the RACMA Constitution. We did this to reflect more contemporary governance and to better align all the earlier amendments into a framework which would be more coherent and helpful. It took two AGMs and a strong communications strategy to bring in the new Constitution. I recall the jurisdictional agitations and the Queensland lobbying which first time round saw the motion to support the new constitution fail, and the second time saw another ‘quiet” deal for a ‘cap’ to be retained and positional elections for national senior officers. The most significant change was to reduce the Board size to 10 including an external member. It has generally worked well – and created fewer dishes to wash up!

While the College had taken the initiative to include an elected Candidate on the College Council it was in February 2009 that Terms of Reference were approved by the Council for a Candidate Advisory Committee (CAC). For the first few years the CAC was chaired by the Candidate Board Director. It was then decided to separate the directorship from the CAC to provide for a better governance arrangement. While today the Candidate Board Director attends the CAC meetings he/she report ‘independently’ to the Board. Over this eight years I have had the pleasure to work with various CAC Chairs and most particularly recall some of the challenges address by Erwin Low, Leah Barrett-Beck and Paul Eleftheriou during their terms. I have been pleased also to see Elizabeth West take up the idea of an open forum session and I sense this is strengthening Candidate participation.

At its meeting in February 2008 the Council agreed to establish a Finance and Audit Committee (F&AC) chaired by the then Honorary Treasurer Peter Bradford. I developed terms of reference for this committee which were subsequently adopted. This Committee has made a significant contribution over the past 10 years to monitor the College’s finances and support the Chief Executive to grow a wider range of financial sources which in turn have enhanced the provision of services, grow the College’s asset base and place the College is a more sustainable financial position.

In earlier days I gained approval from the then RACMA Councils to undertake a few consulting projects. The payment I received for this work contributed to build the RACMA accounts. I enjoyed both aspects of this work because I was enabled to utilise skills not necessarily required in small office management and to contribute further to RACMA’s brand positioning. .I participated as a RACMA employee and contributed all such funds to the RACMA accounts.

The most significant initiatives were to push RACMA forward for Specialist Training Program (STP) funding. It had been a mystery to me why other colleges secured grants to supplement training development and delivery, but it seemed, apart from SSRS, RACMA had limited history with this source of funding. When the opportunity came to submit for training post funding under a new and integrated STP funding stream, I seized it. In the first year we were unsuccessful but in year two we secured a few funded posts and a significant sum for projects, governance and administration. There began our STP and PICS funded programs; and a most constructive and positive relationship with the Australian Government Department of Health. Over several years of relationship with the Commonwealth, officers there have been receptive to our consultations with them and better understand the RACMA “differenced”. It is not uncommon to be asked for our views and to give presentations when implementation policy is being considered.

Nonetheless there is a continuing strong need to build these alternative sources of income. In 2017/2018 it would appear at least fortunate the Board will not need to seek members’ financial support to fund the re-accreditation program.

 

Education and Training

I have been pleased to bring my education and management experience and studies to College activities. I have enjoyed reminding some of you that education is ‘my special field’ and my lens is valid! Lee Gruner, Lyn Lee and others have always been passionate about RACMA and we have shared many discussions about the education and training programs, about management, leadership and the medical lens through which you view aspects of the same world I see differently. 

We average about 25 new Candidates annually and Gabrielle was a great one for bringing in the Queenslanders – because Queensland Health funded 10-12 posts in those days. This Queensland Registrar Training Program, as it was then known, was much envied by other jurisdictions. Gabrielle was an excellent shepherd for all those young trainees. The steady flow from Queensland was our staple. Despite this the majority of Candidates were practitioners in substantive roles who had, or were moving into medical management positions across Australia. They easily met the ‘credibility’ standard and had hugely busy jobs to also be taking on more study. Our Candidate intakes peaked in the 2010/2012 period with the Medical Executive and new accelerated pathways.

RACMA has developed the most customised/contextualised training program arrangements to enable the fellowship training program to ‘work’ for busy people. In the National Office we learned to be flexible with timelines and adaptable.  It must also be the medical in the College Fellows to ‘adjust’  the training service so much to suit the individual (It was not like that in any higher education institution I previously worked in). No wonder the AMC survey group was challenged to understand  how each Jurisdiction’s program integrated with the national program; and recommended we better ‘glue’ these to a College standard to benefit all trainees ‘equitably’. 

I recall a Board meeting during which John Menzies suggested that a new training program be developed as a pre-requisite for MRACMAs to join the College (MRACMAs changed to AFRACMAs in the new Constitution). The Board set me this task and a new training program was developed and implemented. The program comprised a 2 day workshop. Today we have a splendid and more rigorous Leadership for Clinicians training program led nationally by Liz Mullins and Donna O’Sullivan in Queensland. 

Contracts with the Queensland Rural Generalist Pathway Program and Safer Care Victoria stand as testimony to the quality of this new program. I believe it will begin to re-shape the FTP. The growth in AFRACMA memberships exceeds that of Fellows now and is testimony to the interest in leadership and management amongst specialists and generalists. It’s just such a pity the Colleges find it hard to collaborate (on an official/formal level) because RACMA has much to contribute.

Most of our Fellows come from  other Colleges and when they join RACMA’s training programs they  find what we have to offer just incredibly amazing. The Board’s recent initiative to establish a Learning and Teaching Centre (LTC) will in the future I envisage provide an opportunity for inter-college collaboration. The LTC is home to the Clinical Leadership and Management for Clinicians Programs. It is also developing as the organisation’s service arm for delivering relevant and rigorous RACMA CPD through multiple PD Forums annually. At least one of these forums will ‘wrap around’ the ASM.

The latest RACMA Strategy Plan will highlight the work which might be undertaken to strengthen relationships between colleges.  In my formative period at RACMA I was advised by the then Treasurer that the RACMA membership trajectory was downward and caution should be exercised with expenditure and subscription fee increases. Balanced budgets had been the norm. Such restrictions served only to inspire me to  action – some of which I have already commented upon. In this, your 50th year RACMA’s current membership (all categories) has edged over 1000 showing net growth during my time at RACMA.

We have recently completed a diversity analysis of the College using the 2017 Workforce Survey and the average age (based on self-reported data) is 56.2 years. Approximately 16% of the College population is over than 70 and 4% are under 35 years. The next largest group by age are 55-59 years. Victoria has the largest membership followed closely by Queensland and then NSW. Female Members make up 31.3% of College membership and there are more amongst the Candidates and AFRACMA Trainees than who are current Fellows and AFRACMA. The ratio of female College members is reflected in ACT, SA, NZ and Qld has the lowest ratio at 27.6% of jurisdictional membership. Of survey respondents who report being IMG, UK, India and South Africa and the countries where most complete their MBBS. The College will publish the 2017 Workforce Survey later this year.

Small Office

I moved from working in very large non-membership based organisations with hundreds of staff and well developed structures, management and governance processes. These organisations included public sector central agency policy and strategy roles, higher education colleges and universities, and hospitals. It was something of a change to move to a small, professional membership-based organisation but the synergy with my experience in service, education and health services provided some familiarity.    

In a membership based organisation one is very close to one’s ‘clients’. One of the challenges in the small RACMA Office is to meet the expectations of Members. Attracting and retaining good staff who can roll up the sleeves and work on a ‘shoe string” can be hard. Today there are over 20 staff in the National Office and we work within a matrix structure to ensure we have capacity to cover for each other. I well recall the days when there were 2 and then three of us.  I accumulated leave for a long time because I accepted it fell to me to ‘hold the fort’.  This meant that for many years I was across all the College activities in depth and fell into the habit of being ‘too available”.

The demands on staff as we were developing and improving were not insignificant.  The “College should do …”   attitude made the work load seem impossible for those of us who might have worried about this.  I wrote about this in an early issue of The Quarterly. Over time the National Office changed from delivering a largely secretariat function to a professional one providing design and development support services to faculty, submission and project management work  and collaborative consultative work. These later two activities contributed financially to RACMA and enabled subsequent improvement in College bank balances making new property purchases possible, additional staffing, expansion of training and assessment programs,  IT and e-developments, and faculty training – BOC, supervisors, curriculum, CPD. There is no doubt that the Australian Medical Council (AMC) accreditation drove much of this development and growth.  

I wish to acknowledge the staff who have worked in RACMA and today we have several staff who have been with RACMA for 6 years. These people have built a strong knowledge base about their areas of operation and enabled me to step back to do more of the external stakeholder and relationship building, governance and advocacy. However, we all still find reason to wish for additional staff support.  Where project monies are in hand, this can be possible in the shorter term. But such projects still require oversight and so  this resources issue will continue and be  a  vulnerability for the College.

I have long advocated that RACMA must initiate the professionalising of practitioners in medical leadership and management via RACMA training. I continue to be startled by complacency about employer acceptance of practitioners working in your scope of practice without ‘qualification’. I’ve put this to the MBA several times. The regulations are in place; it’s an employer issue – this is the consistent response. I once thought that most of you were line/managers.  I’m not so sure now and rather wonder if medical administrators increasingly occupy ‘staff/advisory/support positions’ rather than line management roles. I am forming a view this may contribute somewhat to the  sense of ‘not being valued’.  

Authority is exercised quite differently outside line management.  Evolution of the practice and positioning of medical administration  is a strategically important issue for the Board.  No  doubt this will  be expressed through RACMA’s training programs as ways are found  to strengthen capability in  ‘general management’ while simultaneously ensuring that specific differentiating  technical expertise is assured.  

Several years back I initiated a biennial RACMA Workforce Survey.  This has been very useful in our advocacy to funding bodies and to promoting the RACMA name. When Health Workforce Australia (HWA) undertook its first round of medical workforce modelling Draginja Kasap helped with modelling shortfalls in trained specialist medical administrators. This enabled us to make a submission to HWA and this was valuable especially since we were considered too small for HWA to prioritise the RACMA medical administration workforce. There will be a further RACMA Workforce Survey Report issued this year and I hope after I am gone this workforce survey will continue to be refreshed. Unless we do it I doubt NMTAN will ever get to us  - there’s something of a misunderstanding re impact.

In this 50th year it has been my pleasure to interview a number of your past Presidents and senior medical leaders. The richness of their stories unfolds with amazing modesty when they talk about their work and their achievements.  So while I will leave the College Members will stay to tell future chapters   in this modern history about the practice of complex health systems management. So with your indulgence I have contributed some reflections on my time at RACMA. My time is up. I welcome Ms Melanie Saba your next Chief Executive. I wish you all the very best and for the next 50 years. 

Cheers

Dr Karen Owen

Chief Executive

May 2006 – November 2017 

Last Updated on Friday, 13 October 2017 12:37