RACGP CEO will likely go, but what then?

It feels like the long term CEO of the RACGP will leave the organisation soon, but then the real issues of what has gone wrong in the last 10 years will need to be addressed

---

It feels like the long term CEO of the RACGP will likely leave the organisation soon, but then the real issues of what has gone wrong in the last 10 years will need to be addressed.

I’m often asked what I think of the RACGP’s CEO Zena Burgess. My answer is always the same. I’ve only ever met her once, but in my professional career as a journalist and a business person (in which at one point I managed a company larger than the RACGP for 12 years) I’ve never had a stranger meeting with a CEO, or indeed any senior management, of such a large and powerful company.

At the time I was perplexed as to why someone of that stature would treat our group and other medical media (The Australian Doctor Group) with such contempt, and in my view, incompetence. The meeting was organised by the RACGP on the premise of brokering a better working relationship between the College and the medical media. But it turned out to be a “command and control mission” on the part of the College, which abandoned the idea when both Australian Doctor and The Medical Republic worked out that we were there to be told, not to be listened to in any way.

Soon after, the College started an unofficial war against the medical media. In any CEO’s book, even the smartest and most powerful, that isn’t a game you’ll ever win in the long term. Sometimes it’s a tactic, but for ever?  It’s a bit like invading Afghanistan.

That’s not to say that you have to get on great with the media all the time. But declaring war and thinking you will just go around them by doing your own media? That was always going to be a dumb strategy, and a bad investment, no matter how bad or good the media servicing your sector actually is.

That was three years ago. At that time the MBS freeze was really starting to bite and GP working conditions were under stress. At that time, there maybe was a chance for the RACGP board and executive to address this one key expanding threat to members, with some smart and well-financed lobbying and strategies. But that never happened.

Today we are in a situation which is described in detail in the report we wrote earlier this week on the RACGP and the performance of its board and its executive.

In case you haven’t read that, the executive summary would be as follows:

The College has grown spectacularly in membership and financial wealth, but the reality is:

• That growth and money has come from a virtual monopoly created by the accreditation power granted to the College by the Australian Medical Council and the natural growth in graduating doctors feeding into the system.
• While the College has delivered reasonably well on the objectives it once would have been measured solely on: better education, training and knowledge acquisition, and the governance surrounding that, it has failed very seriously on what most members would think should be their main priority in the last five years or more, which is ensuring that the GP profession is recognised by all governments as the crux of our healthcare system, and rewarded and treated accordingly.
• The growth in membership, the wealth and the delivery of education and training has for some reason been enough to mask what many would feel is now the most important objective for the College The latest annual report, like the eight annual reports before it, sings the praises of the performance of the executive and the board, and fails to address reporting on this key objective, or even measure it
• Most members of the College feel disconnected and disaffected.
• While members should be at least happy that the College isn’t in the shape of some other colleges which are racked by politics, board infighting and scandal, why should they on the other hand think that because the College is financially stable and governed reasonably, all is OK? It isn’t.
• The executive has failed spectacularly in some key sets of performance.
• The scoreboard for success is not just money and membership numbers.
• The future is starting to look bleak. Graduating doctors are abandoning general practice in droves.
• If general practice continues on its current trajectory and place in the minds of our key politicians, then it will start dying, and the health of the whole country will be put at risk.

If you accept all of the above, or even some of it, you’d think that now might it a good time for the current CEO to politely announce that her work is done here and she has new and bigger challenges she wants to take up.

Even if you don’t accept the above arguments, some telling numbers in the latest annual report suggest now is a good time to leave the organisation. The CEO would have an argument that things were left in great shape and from a financial perspective that might be true. The College is very rich at the moment and its membership is double what it was nine years ago.

But from a membership perspective the numbers are turning against the current CEO. The most telling number is a 37% drop in the last three years of doctors choosing to train as a GP. If not already, soon, the number of GPs servicing every 100,000 of population is going to start going backwards and an already downtrodden GP community will be faced with a shortage that is likely to amplify the stress of their current working conditions.

So we believe that the current CEO will likely announce soon that she is going at the end of her current contract. She will probably do that at GP19 next week.  If she does that,  it will give everyone time for a smooth changeover. It’s always good to have a smooth parting with a long term CEO.

Then, eventually, history will judge the reign of Zena Burgess.

But if any members think the CEO has been the major problem and swapping folks at the top of the executive will solve a lot of problems they will need to think a bit more deeply.

A CEO who has been there so long and has failed for so many years on a key objective of the company’s constitution is a symptom, not a disease or condition of an organisation.

The disease for the RACGP is it’s constitution and it’s governance, particularly the governance and operation of its board.

The performance, management and review of a CEO is one of the three major functions of a board. The others are setting and reviewing strategy, and governance.

When I was perplexed about how the media was being handled three years ago by the CEO, I wasn’t the only one in the sector wondering about the approach. I’ve spoken to many people who have similarly been perplexed at their treatment at the hands of the College in some way or another, based on some fairly simple rules of stakeholder management.

The RACGP board had, and still has, a responsibility to have a CEO that is meeting the organisation’s objectives, to measure that CEO against those objectives and to fire that CEO if it consistently doesn’t meet those objectives. It has that duty to its members, who you might think of as a proxy for its shareholders.

So if the current CEO does announce she is moving on, what will change?

Potentially not much if nothing else changes.

The College board is not constructed or governed in a manner that makes it workable for its modern operational objectives. But maybe this has been recognised, and there is  alignment at the board level about what is going wrong and how it should be fixed.

If that is the case, the current board should immediately consider how they are never going to get into a situation ever again where the executive of the organisation becomes the main driving force behind the  strategy.

But how do you do that when:

• No board member of the RACGP has to have any business, governance, directorship or real board experience or skills.
• The board members of the RACGP are technically being chosen at random. That is, most of the board is comprised of state-based chair persons, and to become a state based chair you aren’t required to have the skills you would normally need on a company board the size, power and influence of the RACGP board.
• The governance of the current board and executive provides for very little ability for there to be continuity conducting the three most important functions: developing and reviewing strategy and objectives, picking and managing an appropriate executive team (including a good CEO), and governance.

While I’m no expert, there are plenty of people around who could help the RACGP board sort this issue out if they are up for it.

The RACGP has changed fundamentally in the last 10 years in that it has gone from being an organisation almost solely focused on education, training and governance to an organisation that has taken up the cudgels on defending and championing the vital role of general practice. But taking on this big new objective was not just a matter of writing it into the constitution. Structural governance change was required to get the right company set up to achieve this new objective.

As a side note, the new objective we are talking about here, was  once the sole domain of the AMA. But the AMA has very few GP members these days, and as a lobbying organisation for doctors overall, they do an average job for specialists maybe. As far as GPs are concerned, they have failed miserably, and if you consider that GPs are about half the population of doctors, that says everything about the organisation these days.

The RACGP had to adopt this new role and objectives.

So the constitution and governance of the RACGP did not change to suit its new responsibilities. The current (and old) governance is one of a very traditional medical college. If you want to become a lobby group, a political force and influential, you need a very different approach and skill set at your board level. You have to have a very clever and functional board and you need mechanisms for continuity of that purpose.

Such a board would:

• Have chairperson that was highly skilled and experienced in running a company board, has experience in the very technical game of political lobbying and influence, is up to speed and immersed in the  College’s strategic objectives, is  able to serve mid to long term, is  strong, charismatic, empathetic, very smart and, ideally, is a GP. The chair of a board is the most important part of a good company’s governance.
• Be able to pick presidents that align in many ways to the above skills. Presidents are important and it’s possibly important to change them over regularly. But that means they are ephemeral and not able to do what a chair does.
• Have members that are GPs but who are purpose picked to make the board highly competent and functional in normal board tasks. They should at least be trained as directors, ideally have some board experience, and have experience in some part of the RACGP business (eg. education, lobbying, training, finance etc). Then, they  should come from each state to get some representation in the board, which is also important. But that would not be the number one choice criteria in a modern RACGP board.
• Have a governance structure that included well regimented and transparent reporting, first from the executive to the board, and then from the board to the members. Such reporting would be against the key objectives of the College and against a well understood and shared strategy. Most members would be aghast at what some board member say about being informed a long time after the fact of major decision made by the executive without any recourse to the board. That just does not happen within a well-governed company with a good governance framework and clear rules about operational priorities and reporting.

Virtually none of this seems to occur with the current RACGP board.

Just read the annual reports for the last 10 years. There’s virtually no measurement against objectives, not much transparency, no clear measurement against strategy and some very bad examples over the years of huge investment failures being hidden within a set of numbers that can’t be easily dissected.

Such failures have been very easy to wash in the annual reports because each year the College makes more and more money. But it’s virtually impossible to determine what return on investment all this extra wealth is actually achieving for the College and its members.

More money and a good balance sheet is simply not a good measuring stick of a member organisation executive performance because in many instances, the money is being generated in a near monopolistic manner.

The RACGP would not be alone being a member organisation where the money is rolling in, and that is used as a measure of success, but certain settings by either government or standards bodies, and the need for efficiency mean that a member organisation is going to get money no matter what.

The pattern of the RACGP’s long list of investment failures we reported earlier this week is that they don’t tend to feature much in annual reports at all and they are often not on strategy or objective at all. That potentially adds up to huge waste. Waste that an appropriately structured and governed board would probably identify and  address.

If you are reading this and thinking the assessment of the board and the executive is way too harsh, that there is a lot of good done by the RACGP for members, it’s at least stable and wealthy, then as someone looking from the outside in I’d say you might be suffering from Stockholm syndrome.

Of course, the sorts of problems the RACGP has as a membership organisation are very common. Just look over the fence at the RACP, or much worse, at the once highly thought of CPA organisation, which in a similar manner to the RACGP got carried away with a very secure income stream and came to think that was great management.

The RACGP has done a lot of good, is a relatively stable organisation, with great objectives and good people.

Obviously there are also people there in the organisation who are agitating for the necessary changes that will expedite the ability of the organisation to address the major challenges facing the GP profession.

As my best boss ever said to me whenever I thought I was going very well, or very badly. Everything is relative.

In relative terms, the RACGP has done very well, and very badly. Time to fix up the bad side of things with a change in how the organisation operates at the very top.