by Lawrence Donaldson

Let’s get the overarching commissioning strategy right!

PHN Boards and executive teams have a critical role in setting the overarching commissioning strategy for their regions.  We know that context is paramount, so your strategy needs to be tailored if you want your commissioning initiatives to work.

While no doubt every Board wants their PHN to be considered a national leader, it is important that Directors and Executives acknowledge the realities of their situation.  PHNs should be ambitious and highly aspirational in meeting the needs of the community, but this should be tempered with a thoughtful consideration of what is in fact possible.  This is vital if we want to manage both external and internal expectations.

Each PHN has unique advantages and challenges, so the overarching strategy set by the Board and Executives needs to reflect:

The Commonwealth’s priorities– as set out in your funding Deed

The regional HNA priorities– identified through your Health Needs Assessments (HNAs)

Real-time commissioning imperatives– e.g., COVID-19, disaster relief, disease outbreak response, etc.

Time constraints– especially funders expectations as to how quickly funds are to be deployed

Size and geography– metro, regional, rural, remote … or most likely a mix!

Social demography– population distribution, economy, employment, education, income, ethnic mix, indigeneity, culture, politics, etc.

Number of LHNs– Local Hospital and Health Districts

Status of sub-regional health systems– esp. workforce levels in rural and remote areas, local service gaps, etc.

Status of relationships with strategic partners and influencers– may vary across sub-regions and groups

Status of relationship with indigenous communities– and their leaders

Level of $fund holding– is the PHN a significant player in the regional health economies?  The answer may vary from program to program and change over time based on funding decisions of the Commonwealth

Internal capacity of the PHN– staffing levels, access to specialised expertise including program subject matter experts (SMEs)

Level of access to data and evidence – will vary across program areas and sub-regions

The Board’s strategy should consider:

  • Internal capabilities of the PHN – ‘we can’t be all things to everyone at all times’
  • External reform and change readiness of strategic partners – e.g.  LHNs, GPs, key service providers, State Health, ACCHOs, communities, etc.
  • The level of maturity of the PHN – how many contracts can teams reasonably manage?
  • The Board’s Reform/ Risk Appetite – is the job to just “fill the gaps” or is it about being a strategic system integrator leading to whole-of-system effectiveness and sustainability?   Or does it need to be a mix?

It is a key responsibility of the Board and Executives to weigh ‘regional needs against the PHN capabilities’ including an assessment of the real prospects of success, given the prevailing circumstances.   This is when the collective wisdom of the Board needs to come to the fore.

Ideally, the Board and executive will develop and update its overarching commissioning strategy and provide this in a practically useful form to help guide day-to-day decisions in the program teams.  In my unhappy experience, the absence of an overarching strategy will result in confusion among staff and stakeholders and result in a lot of re-work.   We can and need to get smarter!