Towards integration: Navigating the complexities of health system management

The West Australian health system stands at a crossroads. Fragmentation has long been a challenge, with local health services operating in silos, often leading to duplication of efforts and gaps in service delivery. 

The recent appointment of a new Minister and Director General has sparked a renewed focus on assertive health system management, aiming to foster collaboration and integration across the board. This shift is not just a bureaucratic adjustment but a fundamental rethinking of ways to improve health care systems, so services can work together to better serve the wider community.

The need for a unified vision and strong leadership

A shared vision is at the heart of effective health system management. WA’s health system has not always demonstrated a cohesive strategic direction. As a result, there is an opportunity to develop a new comprehensive strategy that not only outlines the goals of the health system but also actively involves consumers and the community in its formulation. This participatory approach ensures that the system remains consumer-focused and community-centred, aligning services with the actual needs of the population.

Leadership plays a pivotal role in steering the health system towards integration. WA Health’s leaders must be prepared to provide centralised direction, a skill that requires both expertise and readiness. This involves establishing clear performance agreements and key performance indicators (KPIs) that hold health services accountable. From my own experiences in New South Wales Health, I know that focusing on a small set of KPIs can help ensure that accountability is not just a buzzword but a tangible practice.

Evidence-based decision making

A cornerstone of effective health system management is the use of evidence-based decision making. This approach ensures that decisions are grounded in data, quality, and safety, fostering continuous improvement across the system. Rather than allowing individual clinical teams and services to independently determine best practices, a system-wide agreement on evidence-based approaches can lead to more consistent and effective outcomes. This collective commitment to evidence-based practices not only enhances service delivery but also builds trust within the community.

Ways to improve health care systems

One of the most challenging aspects of health system management is achieving integration and coordination among health service providers (HSPs). In WA, the shift from competition to cooperation is crucial. In NSW, tools like role delineation frameworks have been instrumental in clarifying the roles of different health services, ensuring that not every service attempts to do everything. This systems approach requires HSPs to collaborate and refer patients as needed, rather than competing for resources and recognition. Such coordination mechanisms are essential, especially in times of pressure, to ensure resilience and continuity of care.

Strategic commissioning is another vital component of an integrated health system. It involves a clear delineation of roles among HSPs and a commitment to working together as a cohesive unit. The new leadership in WA is tasked with fostering this systems-thinking, creating enablers and infrastructure that support collaboration rather than individualistic approaches. My observations, over many years indicate that this requires a cultural shift towards system-level enablers and infrastructure, moving away from the traditional model of individual health services operating independently.

Finally, a truly integrated health system must reflect and embed the voices of its consumers. Engaging with the community and incorporating their feedback into the planning and delivery of services ensures that the system remains relevant and responsive. This consumer-centric approach not only improves service delivery but also enhances the trust and satisfaction of the community.

Looking ahead: Challenges and opportunities

As WA embarks on this journey toward assertive health system management, several questions remain. How will the new leadership measure success in the coming years? What mechanisms will ensure accountability and continuous improvement? These are the questions that Minister Hammett and her team must address as they navigate the complexities of health system integration.

The path toward a more integrated and collaborative health system in WA is fraught with challenges but full of opportunities. By embracing a clear, shared vision, the state’s health system can transition from fragmentation to cohesion. Collaboration and innovation will be central to this effort. While the challenges ahead are significant, the potential for positive change is immense.