December 6, 2011

I had the opportunity to meet with ten senior leaders in the Danish healthcare system for 2 hours. They established a learning and support network 2 years ago, facilitated professionally. The network consists of doctors, nurses, a midwife, a physiotherapist, an economist and a bureaucrat, all of whom had positions of leadership at the region (=state)1 or national level. They meet regularly for an afternoon and dinner and the agenda may include talks by invited speakers or journal articles that lead on to further discussion. I was asked to lead a discussion around leadership stories and what they told us about the way leaders can be developed or supported. While there are many similarities between Denmark and Australia, some of the many differences I heard were:
1) Union membership is very important to Danish people, including the doctors. The unions have a strong role in determining the quality of involvement and the consensus views that are projected from the clinicians.
2) All hospital leadership teams consist of a doctor, nurse +/- an 'economist' as they were referred to. These leaders do not have any clinical work (or very minimal) - the role of leadership is considered too busy and too vital to allow such indulgences! The medical department leaders and the medical and nursing hospital and regional leaders felt that they were recruited for their specific skills to roles that had very clear responsibilities and accountabilities. Their financial and quality goals are both considered to be vital parts of their roles. The average department (eg anaesthetic dept, orthopaedic dept etc) would consist of around 300 people -doctors, nurses, scientists etc.
3) In one of the 5 Regions of Denmark (the Capital region), the executive and the clinical leadership have decided that leadership training is essential for all clinicians. They had developed 5 different leadership courses which lasted between 10-12 days (5-6 x 2 days) and were tailored to the different roles in the system. I was told that almost 70% of clinicians had been trhough this training so far.
4) I asked about the challenge of leading toward goals that were of benefit to the whole population rather than a department or hospital. They agreed that this has been an ongoing discussion but that they were making headway here. In one specialty, a senior leadership group makes decisions about the adoption of new technologies for the country. This takes into account the cost benefit of the intervention within the limits of the prevailing financial context. They will sometimes make decisions about what interventions should stop being delivered, but agreed that this was very difficult. All of them agreed strongly that Denmark has a limited health budget and that they were tasked with getting the best they could for as many people as possible within the budget.

A little observation - this senior leadership meeting was held in a community owned space, a lovely old building with wooden floors and odd shaped rooms that overlooked a central courtyard through huge windows. The rooms occupied by the group contained colourful, mismatched chairs. In one room was a large old wooden table. In the other, chairs were positioned in a chatty circle. On the narrow shelves around the perimeter of the room, and on little low tables, there were candles and tea lights and big bowls of fruit. It was impossible not to feel relaxed and welcome in this space, and this was evident in the warm, open conversation that ensued.