The LEGS issue
One of the outcomes from the settlement of the 28 March 2011 – 31 March 2012 MECA was the set-up of LEGs or Local Engagement Groups. The purpose of the LEGs was to improve engagement between RMOs and DHBs and address issues that may have arisen. As we are in the midst of bargaining for the next MECA, now is the best time to review the LEGs. What works, what doesn’t, why are some more successful than others and why have some not even begun and, perhaps most importantly, what can we do to get the most from LEGs?
Where are the LEGs now?
The LEGs can be divided into three broad groups:-
“Our LEGs are up and running”
The LEGs that are the most successful are in the smaller provincial DHBs. This may be because with a smaller number of participants the logistics and administration around setting up and maintaining a LEG is more manageable. When the interaction between RMOs and DHB management is more direct and face-to-face it is easier to organise meetings. Obviously the LEGs are also more efficacious when all the parties involved are enthusiastic and driven towards achieving positive outcomes.
“Our LEGs are running in circles and getting nowhere”
A number of LEGs have had one or two meetings but have then lost impetus or have had sufficient meetings but are not achieving anything. Again the LEGs will only be as effective as those involved make them. If it becomes apparent that actions that were allocated and agreed to during previous meetings were not carried out, then “buy in” into the process dwindles.
“We don’t have a LEG to stand on”
For various reason some DHBs have not started LEGs at all. For some of the larger DHBs this was as a result of sheer size, for others lack of trust or faith in the DHBs on the part of RMOs meant they were not willing to take part.
What makes a LEG good or bad?
Attendance: this applies to both parties.
There have to be RMOs prepared to attend and DHBs doing all they can to enable them to attend. There has to be sufficiently senior management from the DHB attending. Leadership in the process needs to come from the top.
Safety: RMOs need to feel that the LEG is a safe environment in order for open communication and constructive discussion to take place. There may be times when the proposed attendance by various SMOs for example is not ideal given the topic of the discussion and this needs to be addressed prior to the meeting.
Right people: There has to be a level of commitment from the DHB such that decisions can be made. There is no point in voicing a concern if the right person is not there to hear it and act upon it.
Right time: The meetings need to be scheduled at the right time and well enough in advance to enable sufficient turn out. Those LEGs that scheduled meetings for the next 12 months and then adhered to the schedule were more effective.
Validation: Progress and accountability needs to be apparent and transparent. If the LEG is going nowhere fast then why keep going? This also means minute taking must be objective and agreed to by both sides.
Topics of discussion: Some DHBs are under the impression that only those items listed in MECA can be discussed at LEGS (physical facilities, orientation, engagement in local initiatives, NEG activities including best rostering practices and RMO support services); however this was an indicative list only. However all agendas need to be forwarded to the NZRDA at least a week in advance and need to be of sufficient detail so it is clear what is going to be discussed and who will be attending. This means no-one’s time is wasted and all groups are prepared before entering the meeting. A few DHBs have expressed the view that only “trivial” concerns are being raised however if these concerns have been dealt with then the LEG can move onto weightier topics.
What can we do to get the most mileage from our LEGs? If no LEG has taken place contact your delegate to find out why not. If a meeting has not been scheduled for a while likewise contact your delegate and ask when the next meeting is, then turn up and take your colleagues with you. Ask to have the agenda well in advance and make sure your concerns are included in the agenda or if you have any queries about an agenda item then raise them with NZRDA. Feel free to ask for further information or resources prior to the meeting if you need.
Remember this is your opportunity to get your voice heard and whilst the DHB may consider the matter trivial it may not be trivial to you.
Take the minutes from the previous meeting with you and ensure the tasks agreed to were carried out and, if not, ask why not? All minutes are available from the NZRDA office. Also make sure someone is delegated to take the minutes during the meeting but also take your own notes. Once the minutes are distributed check them.
Remember the LEG is not there to interpret the MECA and if you have any concerns the NZRDA is here to help you.
MECA bargaining
Bargaining for our MECA commenced in March and is continuing on 15 and 16 May. Key issues for NZRDA include:
Valuing Senior Registrars: Whilst the definition of a senior registrar may vary between specialties, we all know who we mean – the go-to guys when all else fails. DHBs get an immense value out of these senior members of our ranks also; fresh with up to date knowledge post exams and almost an SMO.
A number of concerns around their terms and conditions of employment have arisen including additional duties rates, conference leave and expenses, and steps on the salary scale. Thanks to all those who have given us further feedback on the issues. This conversation will continue on May 15.
Parental Leave: A subject that ignited debate earlier this year when we asked what we thought was a simple question, a reminder here never to assume anything! A reminder here to never assume anything! However the ability for members to choose which type of parental leave support best suits their individual circumstances is a matter we have been discussing directly with our employers.
Keeping the value of our pay: An ongoing challenge
Better Rostering Practices: especially those around our busy night shifts that are still 7 days long. It would be fair to say that the DHBs lack of commitment to this health and safety issue is deeply concerning.
Training: Why should first years not get access to MEL if appropriate for their career progression? And what of our protected training time – when will it be protected and for our training? The DHBs are concerned about the Auckland 1 month notice period, better use of relievers, the better provision some DHBs have of 1:3 weekends (rather than 1:2 weekends), regionalisation and the approval of costs of training. For a full recap on where we are at, check out our MECA newsletter on the website.
Delegate’s Column: LEG Workshop April 23/24
How do you get multiple groups of people, who differ in age, demographics, job descriptions and goals to sit together in a room and engage in a meaningful way? How do you get the right people at the right time, in an environment where everyone feels safe to express their views? Where they feel their concerns will be listened to and acted upon? The RDA and DHB representatives attempted just that at the LEG workshop April 23/24.
We began with trying to imagine interactions between RMOs and DHBs but from the other’s point of view, something the RMOs seemed better at than the DHBs. RMOs are very aware of the power imbalances when dealing with higher management. We are younger, more transient, more clinically orientated and used to operating and being judged within a hierarchical structure.
RMOs felt that DHB reactions to housekeeping issues tended to trivialise their importance, but by the end of the two days it was commonly understood that:
- Not having ink in the printer makes our jobs harder and our days longer.
- Not having a microwave that works makes us hungry.
And these things impact on our job performance, satisfaction and willingness to engage. Once our daily needs are met we can engage on wider issues.
By day two RMO frustrations drove many members to vocalise their concerns more forcefully, and it was amazing to see how surprised DHB reps were at some of the issues expressed. Many were under the impression that we didn’t speak up as we had nothing to contribute, which we all know is not the case. There is no holy grail of how to run a LEG but hopefully the workshops afforded a little more understanding as to how to communicate effectively in the future.
– Dr Felicity Williamson
What is productivity in health?
A good question indeed as certainly Treasury have asserted that productivity in public hospitals is decreasing based on a very narrow approach. Ironically perhaps they see patient deaths in hospitals soon after admission as improving productivity! You just have to love the economists!!
On 1 May however Victoria University made the following media statement (reprinted in part only – for the full statement see our website under media): Hospital productivity in NZ bucks the Trend
Victoria University health researchers say hospital productivity in New Zealand rose by more than three to five percent in the period between 2007 and 2009, challenging perceptions that productivity rates in the sector are declining.
A study led by Dr Jaikishan Desai from Victoria’s Health Services Research Centre in the School of Government analysed hospital productivity over the three years by looking at the number of people treated as inpatients, outpatients or in emergency departments, for each dollar of expenditure incurred by district health boards.
Dr Desai says that importantly, the study also shows increases in hospital efficiency in the same period.
He says researchers looked at three different measures of efficiency, covering technology change, technical efficiency and allocation of staff and resources, and all showed an improvement between 2007 and 2009.
The team was surprised by the findings, says Dr Desai, and checked the analysis using three different methods, all of which showed significant improvements in productivity and efficiency.
He says there is already international interest in the findings because they run counter to widely held views that hospital productivity is falling in developed countries.
The research also shows that the length of inpatient stays is dropping and more people are instead attending outpatient clinics. “Hospitals clearly are trying to shift towards lower cost treatments,” says Dr Desai.
The study did not look at how this move is impacting on patient outcomes…..”
Know your rights: Annual leave
Did you know that when you move between DHBs that you’re able to take your annual leave with you? Clause 20.2.5 allows for any annual leave (to a maximum of 6 weeks) untaken at the time you resign from one DHB to be transferred to another DHB. You must be commencing with your new DHB within one month and the payment responsibility will remain with the original DHB. This is optional, so if you’d prefer to have your annual leave paid out to you, you can do this, too.
What have we been up to?
During March we have asked some or all of you for input into the following issues: MECA Bargaining and in particular:-
- the notice period at Auckland
- Counties Manukau and Waitemata
- parental leave
- overseas conferences for senior registrars
- MCNZ and BPac – thanks to all of you that have provided feedback.
Did you know?
You can pay for your annual membership on line using a credit card? Just visit the website.
* Please note that we are having difficulties with credit card payments on the site. The issue is being dealt with and should hopefully be resolved soon.
Download: RDA News Issue 4
