Where Have All The People Gone?

There are around 1300 hospitals, public and private throughout Australia. Collectively these organisations employ around 50,000 people in management roles. (On average, 1 CEO + 3 Directors + 15 middle managers + 20 frontline managers/supervisors). I appreciate this scenario may not accurately reflect your particular hospital. The concept I want to discuss is more important than the actual numbers involved. It is also possible I have underestimated the numbers.

Let's assume 50% of these managers will retire over the next decade. This means at least 5000 senior management roles will need to be replaced and around 15000 middle management roles. The majority of replacements will come from the ranks of 25-35 year olds currently in frontline manager or supervisor roles. Which means hospital will need to develop a further 25,000+ supervisors over the next decade. Were we to add the aged care sector to this then the number swells to around 30,000. Where will those people come from?

This upward movement of people into senior management roles will take place at a time of unprecendented low unemployment and labour shortages throughout Australia. The situation will be compounded by an increasing number of people leaving the sector, the low number of people entering the sector, an upward movement in remuneration, the fact that healthcare is process driven and more flexible working conditions in other sectors. What do health providers need to be doing?


It is likely the sector will have to look at how it goes about its service delivery. A smaller number of people will need to achieve more with less. A significant investment in non-traditional development will be needed - development that develops the ability of people to think, to take personal responsibility, to focus on quality service delivery from a customer perspective. Perhaps more importantly, the sector needs to develop flexible development pathways; that enable people to move in and out of the sector, and develop skills along the way. This will require more flexible learning and education processes, geared to the needs of the health provider rather than the needs of the education provider.

There is no doubt health delivery is process driven, especially inside a hospital or aged care facility. Yet this reliance on the procedures and policy manual creates inflexibilities that do not always benefit the customer and serve to frustrate employees. The end result will likely drive people out of the sector. Hospital management teams will need to develop the ability to drive non-wage related costs ever downwards through more efficient workplace practices. Governments cannot continue to fund a sector where expenses are outstripping the cost of living. It is likely Governments will face reductions in taxation monies as the ageing population goes into retirement. This will be reflected in Government spending on social services.

Technology will continue to make in-roads in every area. While healthcare has always required considerable investment in medical technology; the future may see a greater reliance on combinations of the internet and mobile telephony to reduce wastage, improve communications, speed up analysis, provide information, reduce the amount of face-to-face contact and minimise travel time. This will be made easier as Baby Boomers, reluctant to embrace the possibilities and potential of this technology leave the industry and move into retirement.

Restrictive employment practices may need to become more flexible. For the past three decades the focus of health sector unions has been to preserve jobs and increase benefits. It is likely for the next twenty years or more there will be little need to worry about preserving jobs, they will be abundant and remuneration will be driven upwards by market demand. Restrictive employment practices will serve to drive people out of the sector and into other areas of work.

The perception of working in healthcare will need to change. Younger generations have so many more enjoyable and lucrative options. Nursing in particular continues to revolve around shift work, body fluids, tired, uncooperative patients and medical specialists with poorly developed social skills. Compassion alone will only act as a motivator for so long in the face of other options. Public education programs promoting the sector will continue to be important. More important, health providers will need to develop ways of being seen as employers of choice.

Current Government practice is to throw money at hospital management teams to try and reduce waiting list times. This may have a short term benefit, yet if these other issues are not addressed it is possible there will insufficient people to enable sufficient beds to be available; which may result in even longer waiting times and greater patient inconvenience, regardless of how much money is thrown at the problem!

Let The Journey Continue
John Coxon

Taking You From Frontline Manager to CEO