Health Minister Mark Butler released the National H&MR Strategy for the next decade last week. It is a colourful and inclusive document that says all the right things to every stakeholder.
It is ‘ambitious’ – lofty goals, focus areas and a long list of higher-level actions.
If we assessed the NHMRS from a commercial perspective, how would it rate?
- A strategy is defined by the choices that it makes – what it chooses to do and not to do. The NHMRS covers everything. It makes no choices.
- Every strategy operates in a context. It must identify current state – its good features, weak features and gaps – then proceeds to articulate what must be done to achieve the goals the strategy is designed to meet, and what challenges / bottlenecks need to be resolved to enable success.
- A good strategy synthesises this analysis thematically into focal points and prioritises actions based on their contribution to enable success. Every focus area and action is not equal.
- A good strategy priorities resources and budget to fund the things that can really shift the dial. This process is typically ruthless.
- A great strategy establishes the criteria and measurements for success and the timeline and budget to match.
- A superior strategy can be easily communicated to all stakeholders so that each stakeholder can understand it and explain it to others in 60 seconds.
How does the NHMR Strategy perform against these criteria scored out of 50?
- The Strategy is comprehensive in reach and inclusion of all stakeholders. There is something for everyone, but no suggestion as to what choices exist or the order in which they should be made choices. The Strategy also fails to identify principles the Minister could apply to make and priorities choices. Score 1/10. (1 for trying.)
- The Strategy does not provide a current state context and omits analysis of what works and does not work. Although it identifies some gaps and challenges / bottlenecks, it provides explanation about those challenges / bottlenecks or how they might be resolved. Score 3/10.
- The Strategy identifies focus areas and actions but fails to prioritise focus areas or focus area actions. It presumes each focus area, and its associated actions, are equally important – this is never the case. It does not identify which actions could be pursued concurrently and which should be pursued sequentially. It promotes a free for all among stakeholders to advocate for what they want. It fragments rather than aligns stakeholders. It drives stakeholders to compete for funds, rather than cooperate to improve the system. Score 1/10.
- Prioritisation drives resource and budget allocation to ‘no regret’ actions that can shift the dial or enable other actions. The Strategy does not identify what funding would be needed to execute the strategy or recognise that Budget allocation is always constrained and what priorities should be implemented first if the Budget is constrained. Score 0/10.
- The Strategy identifies formidable goals, yet they are not linked to the focus areas. Some of these goals are economic (a sustainable system), some social (healthier Australians) etc but there are no measures of success. The Strategy goals are not SMART. The sense is that whilst the goals exist there is no understanding of how to get there. Score 0/10.
- This Strategy is a wish list. It cannot be communicated to stakeholders in the system easily. Really who knows what it means. Score 0/10.
Total Score: 5/50.
Is this fair?
In one sense no. Business is more rigorous than Government in developing strategies because it spends scarce Founder or shareholder capital and is accountable to achieve outcomes. Governments spend taxpayer money and are not specifically accountable for how it is spent. Business operates to make money and provide value to its customers. Businesses operate in the real economy. Governments focus on doing enough good things for the largest number of voters to win re-election. Governments play only in the political economy.
In another sense yes. The Strategy does not identify the budget needed to implement it in an environment where Federal and State HMR Budgets are under increasing pressure. And so are Federal and State Budgets generally. Everyone knows that there is not enough funding, even over 10 years, to deliver the goals set for this Strategy. The Strategy allows Governments to pick and choose which parts of the Strategy they want to implement. This abandons strategic coherence. It increases the probability that we will not see a significant improvement in the NHMR System by 2036.