Dr Shirley Bowen took over the role of Department of Health Director General five months ago. She shares with Medical Forum some of her visions for the sector and answers some key questions that her department faces in the coming years.
My passion for person-centred care has inspired and motivated me every day of my 30-plus years in medicine. Excellent and compassionate healthcare should be available to everyone.
I started my career in sexual health medicine at the peak of the HIV epidemic in Sydney. This led to me training as a physician focusing on infectious diseases.
Caring for those with HIV both in Australia and in Africa was very formative for me in terms of understanding cutting-edge medicine, shared and cooperative care with those affected and, sadly, a significant experience in palliative medicine. Once through those years, I became committed to public health and the many opportunities to prevent illness across the population.
Now five months into this role as Director General, I am taking a global view on how we can work together to achieve excellence in prevention and management of acute and chronic disease across the entire age spectrum.
I will share some statistics to put this into perspective. These won’t surprise medical practitioners, but they are a reminder of the scale of Western Australia.
WA Health proudly services all 2.5million square kilometres of our great State, the largest area in the world covered by a single health system. We are also the largest public sector agency, with a budget of almost $13 billion and a workforce of more than 57,000 people.
In one year, we have up to one million attendances at our emergency departments, perform more than 90,000 elective surgeries and deliver more than 30,000 babies.
Leading this system is a great privilege and a great responsibility, and I am extremely proud of the care that our dedicated health professionals provide.
Health is forever-changing – the advent and pace of new technologies and treatments is breath-taking. We stand on the brink of one of the great industrial revolutions of our time. The innovation and improvement that digital transformation can bring us is incredible, and in the end will support our medical workforce into a different but more precise and personal way of working.
We all want a healthier future for West Australians and now is the time to consider how we can embrace these new frontiers deftly and responsibly to deliver the best care for our patients.
There are some exciting opportunities – electronic medical records, wearable technology – which will help us work smarter and make things easier for our staff.
We also need to look at how we create opportunities for people to access healthcare closer to home.
With the scale of the work at hand, I have embarked on an organisational review of the Department of Health to better align its functions to deliver these important reforms with a keen eye on patient-centred care at the heart.
This is about how we best use the expertise and skills of our dedicated staff to further improve healthcare for the people of Western Australia.
MF: The role of Director General of Health has been described in the past as a ‘poisoned chalice’ because of the demands it entails. Have your first few months been challenging and in what ways?
SB: Every role comes with its challenges and certainly the role of Director General has many! However, I could not resist an opportunity to try and improve the health of our community and hopefully improve the experience of our staff.
The span of control of the role does make it both challenging and interesting. WA is diverse due to its geographical size and providing care to the rural and remote communities is an area of interest of mine. I am driven by a passion for excellent healthcare, and I love to solve big complex problems, so the role is a career goal despite its reputation!
This winter has presented some unusual challenges as it has been the ‘winter of older people’ needing care. It appears the ageing of the population has finally arrived, and all sectors need to adapt to ensure we help people to age gracefully and with excellent care.
MF: If you had to pick a few key areas of focus for you and the department, at the moment, what would they be?
SB: Access to care (emergency, surgery, outpatients), caring for our ageing population, growing and sustaining our workforce, renewing infrastructure and technology, digital transformation and ensuring the sustainability of our health system.
Additionally, there are some emerging areas where prevention is key including family and domestic violence, mental health and supporting our neurodiverse population.
The further rise of genomics and precision medicine will bring opportunities for more rapid diagnoses for patients and increase chances to tailor care.
I want to create the conditions to enable our health system to remain responsive and capable of meeting the growing demands of our diverse population.
I am also committed to our ambitious health and medical research agenda, positioning Western Australia at the forefront and bringing home our clinician researchers from overseas. I am also keen to see further progress in translational research initiatives, taking scientific discovery through to practical application, enhancing care for our patients.
MF: You have extensive experience in both the public and private health sectors, including a long association with SJOG Subiaco Hospital. How has that helped equip you for your current role?
SB: I have a unique perspective having worked in almost all sectors of health care. The private system focuses you on both the consumer and doctor experience and I think that has assisted me to understand what patients value in their admission.
Quite importantly, the current challenges for the private sector mean I understand their fiscal outlook and I hope to make working together easier in the future given their important contribution to healthcare in WA.
I also believe that my financial training with St John of God has equipped me to manage the WA Health budget responsibly. I always say that I am ‘financially diligent’, always a doctor and not an expert, but I will do my best to ensure we manage responsibly into the future.
MF: Following on from that question, the Federal Government is currently doing a financial health check of Australia’s private hospital sector amid concerns about its viability and future. How important is the private hospital system in terms of supporting the public system – i.e. their symbiotic relationship?
SB: A sustainable WA health system is a priority. For our system to work, we need both public and private services running effectively. The private sector operates a large number of beds in Western Australia, and it is essential that those beds operate successfully.
A significant amount of elective surgical work is done by the private sector, while the public system clearly does both elective and a large amount of emergency surgery.
With the volumes of surgery needed post the COVID pause, we need to ensure that work that can be done in private is done in private so that others can access timely surgery in the public system.
The Federal Government review I hope will recommend some viability options for both the insured, the insurer and the hospital operators.
MF: WA public hospitals remain very busy, from their EDs to their wards. Are there still issues with good access to primary health care that are adding to the pressure on the public system? What can we do better?
SB: Health systems around the world are under pressure mostly due to the ageing of populations and the fact that if people live longer, inevitably you will see more chronic conditions including dementia. This is compounded by a relative shortage of workforce in key areas, which does make digital support and transformation a burning platform.
Those medical shortages include primary care. Unfortunately, primary care is just like our hospitals: busier than ever. My ideal world would see more general practitioners and a different type of access to primary care. A world where everyone is triaged to the right type of care, closest and available.
I doubt that the Australian health system can flex this far but hopefully we can create more options for care to assist those living with chronic conditions in the community which mean they don’t have to come through the ED.
We are doing everything we can to address these challenges in the Western Australian context. Our major reforms underway include the State Health Operations Centre (SHOC) and its initiatives, the Patient Transport Coordination Hub, WA Virtual Emergency Department and System Flow Centre.
Through SHOC, we are working closely with our partner agencies with the shared goal of helping patients to get the right care in the right place at the right time. It is exciting to see this central coordination of patient ambulance and transfer access coming to fruition.
MF: There have been concerns in the past about families and parents feeling they are not always listened to when seeking out emergency care, with one resulting change being the setting up of the Aishwarya’s CARE Call process in all WA public hospitals. Has this helped bridge the gap between families and clinicians/admin?
SB: Listening to patients and families is critically important and the introduction of Aishwarya’s CARE Call across emergency departments was a very important initiative and was introduced as a priority in 2021.
It has seen families with concerns call for assistance. However, it does not take the place of active listening. All our medical students are taught the importance of active listening and shared decision making and this education is key.
The Clinical Senate will consider the important topic of ‘listening’ at its meeting later this year. I look forward to hearing some more suggestions to hard-wire this important skill into our medical consultations.
MF: The AMA’s recent doctors-in-training surveys have again identified instances of bullying, harassment and discrimination experienced by junior doctors. How can hospitals do better, and how much of that behaviour is ingrained in medical practice?
SB: Supporting and developing our doctors in training (DiTs) is vital to the future of our health system. Hearing from our DiTs about their experiences is how we drive change.
Everyone deserves a workplace without harassment of any type. Medicine is a hierarchical career pathway and when I was a young doctor this type of thinking was well ingrained in our training. Everyone has a role in stopping bullying and harassment. Speak up and call it out when it occurs. That doesn’t need to be a shouting match but a calm and clear conversation with appropriate support.
Through the years, I have experienced most forms of discrimination in the workplace. I encourage DiTs to speak up and tell a colleague who can assist with seeking support and an intervention.
There were some encouraging signs in the most recent AMA survey. It was reassuring to hear junior doctors feel safe coming to work – 81% reported they feel safety is always or often a priority at their workplace. This was a significant improvement from previously.
Our health services providers are hearing DiTs and supporting them in innovative ways including North Metropolitan Health Service’s Junior Doctors Manifesto and South Metropolitan Health Service’s Junior Doctor Support Unit which launched earlier this year.
When it comes to culture, I strongly believe that leaders should set the tone and demonstrate kindness and support so it flows through the organisation.
MF: What lessons have been learnt from the COVID pandemic experience in terms of systems needing to be nimble/flexible in responses?
SB: The pandemic showed that we can adapt very quickly to a changing health landscape. WA did something incredibly unique during COVID and that was to create the ‘cordon sanitaire’ around WA. Usually in public health, such acts are done to keep disease in but
WA kept disease out.
I am not sure if the community realises that this was one of the great public health actions of our time and will be recorded very positively by history.
I also think the pandemic showed our isolation in the supply chain for many goods including antibiotics and medical products. We need to remedy this situation with local production to ensure we have a more resilient supply chain for
the future.