An anaesthetist’s journey through systems level change

“I’ve always been interested in understanding the bigger picture, and this role has unquestionably aligned with that interest. Rather than focusing on what I can do as an anaesthetist for the one patient in front of me, I’ve been able to pull back and work on how we can make things better for everyone.”

Christchurch Anaesthetist, Dr Hamish Gray, is finishing up after three years as a Clinical Chief Advisor at the Ministry of Health – Manatū Hauora. Working within a multidisciplinary team of clinicians who provide clinical input and strategic advice across the Ministry’s priorities and work programmes, and across the wider health sector. “I’ve been able to apply my clinical knowledge and advice across a variety of projects in a completely different context”, says Gray.

Hamish saw the position advertised soon after completing a postgraduate diploma in Bioethics and Health Law from the University of Otago. “It was an opportunity to apply my new diploma and experience I’d gained from a short-term stint as one of two interim Deputy Clinical Directors at Christchurch Hospital’s department of anaesthesia.”

But it’s the translational skills and exposure working in anaesthesia that he’s found uniquely valuable.

“I didn’t expect to become the lead clinical advisor on the development of a Rare Disorders Strategy and was surprised at what I could draw from my clinical work and observing the challenges family and whānau face in the theatre environment, then considered how these may translate into day-to-day life. By no means am I the expert – the patient, family, and whānau are, but I realised just how often anaesthetists interact with people who have rare disorders in our clinical work.”

Hamish has also been involved in the female pelvic mesh restorative justice process and the system safety steps being put in place. “The pause signalled that we’re going to make some clear, patient-focussed steps around use of the product, and being involved in putting those in place was a rewarding outcome”.

He’s also appreciated being able to help individuals or organisations navigate the complexities of government. “When I’ve had the opportunity to support the Minister of Health as an advisor, I’d like to think I’ve also been able to help organisations get the most out of their meetings with him. It was pleasing to see the NZSA gain a commission from his office following their meeting in June.”

Finishing this August, Hamish has worked across two Governments, four Ministers of Health, two Director Generals and reorganisations within the Ministry. Over that time, he’s observed the clinical office becoming more interdisciplinary and integrated in the way the Ministry develops strategy and policy. “A change I view for the better – everything that comes out of that area will have a really strong clinical quality and system safety focus.”

“My role is technically around planned care, but it’s become much broader. I’ve become more involved in the development of and monitoring with Health New Zealand Te Whatu Ora’s (HNZ) health targets, in particular the first specialist assessments and planned care health targets.”

“I’ve worked closely with one of the chief advisors in the nursing team around cardiac surgery, and with a non-clinical colleague who brought structured engineer-like thinking to health quality and system safety policy. There are such benefits in working in that interdisciplinary way, including the opportunity to learn from everyone’s expertise.”

The role has come with some key lessons too.

“We’re used to seeing immediate results at the end of a needle in anaesthesia, and I’ve come to realise that in areas like strategy, policy and legislation, things happen intentionally but slower. You have to get the legislation right, then policy. Then the operational stuff happens down the line.”

“After the Rare Disorders Strategy was published, I couldn’t help but worry it would gather dust on a shelf. Then, in a recent meeting, the Chief Medical Officer at HNZ mentioned they’re [HNZ] looking into how they can operationalise the strategy and the values and principles put into it. That conversation reminded me not to expect the instant results I’m used to in my clinical role. In policy development, change might be incremental, but it is happening.”

“There is genuine value in anaesthetists stepping into roles like this one. Anaesthetists are pragmatic, neutral brokers across the planned and acute care space. We don’t hold a particular angle. We don’t come from a single surgical craft group. We see problems from more than one perspective – how change here could potentially have consequences over there. That perspective is invaluable in shaping high-level policy, strategy and regulation. I encourage others to put themselves out there too, when they see the opportunity. There’s real value for yourself and our health sector.”