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From a broom cupboard: 20 years of rural health at Monash University

Ch 08. Administration

Flying under the radar

Robert Clough

Culture

The evolution from the Monash University Centre for Rural Health in 1992 to the School of Rural Health of 2012 has been remarkable. Over the journey many staff and students have fulfilled their aspirations during their time with the school. Nevertheless, my introduction and initiation to the centre was difficult. My experience, I came to realise, was shared by countless new appointees. Initial questions of ‘What does the Centre for Rural Health do?’, ‘What roles do people play?’ and ‘Where is everyone?’ were soon followed by ‘What am I supposed to do?’ It took me 12 months to answer most of these questions!

The centre had a very loose structural framework. For those requiring firm boundaries and job descriptions that clearly provided responsibilities and expectations, the lack of direction was stressful. For those able to survive the first 12 months, a career blossomed before them enabling the best use of their skills and interests; a niche within the organisation formed around them. This has been the case for both academic and administrative staff. Although job descriptions and orientation processes provide a much smoother introduction to the school these days, a culture that allows for individual expression and growth still exists.

In the early days the centre’s vision, culture and drive was provided by Professor Roger Strasser. Roger was the only person who knew everything about the centre’s work – how it all fitted together and why. Many individuals represented specific blooms on the bush that was the Centre for Rural Health, but Roger not only represented the trunk and branches, he also provided the soil and the pot in which the bush grew; he had the vision and was the instigator and facilitator of every activity of the centre.

Roger had a unique personal style. He had a tremendous drive and passion for rural health that was obvious and infectious. There seemed little or no distinction between work, family or relaxation for Roger. It was nothing to be welcomed to work on Monday morning by a barrage of emails from Roger sent at 3.30 that morning, or for him, Sarah and their five children to spend the weekend at a rural health conference. Roger worked, nurtured his family and relaxed simultaneously. I’m certain that he had rural health dreams in the few hours of sleep that he did manage!

There was, however, a quirkiness to Roger. We often wondered how seriously he would be received at the faculty meetings when we farewelled him from Traralgon, dressed in his baggy unironed shorts, crinkled, opened-necked, short-sleeved shirt and roman sandals. Would his suit-wearing colleagues take him seriously as he argued the academic virtues of our centre?

Whatever the initial impression made by Roger he had a resilience that was unshakable. Whether it was a severe reprimand from the dean, a dressing down by members of the centre’s executive or a funding application knock back, Roger would invariably brush himself off and redouble his efforts. Such setbacks were only momentary hiccups in the journey towards his desired outcome.

Initially the centre maintained an independence from the faculty and University primarily because the centre was ‘out of sight – out of mind’. This phenomenon proved to be both a virtue and hindrance. The advantages were that we were able to sail under many procedural rules, which enabled us to set up processes and systems best suited to our circumstances. For instance, Joe Hovel, Steve Kirkbright, Dr John Togno and others set up our initial information technology network. The framework, email system, shared-drive structure and hardware were different from those at the major campuses, but were universally agreed to be the best for our requirements. Our network was envied by those in the faculty who ventured beyond the major campus limits to visit us. We were able to build up the network because we did everything. We planned, bought, installed and maintained the hardware and software ourselves. A major reason why our network functioned so well was that everything was scrutinised from a user perspective. The planners, buyers, installers and maintainers were also the users. Of course, we were able to do this because of our small size and the fact that we operated from one primary site in Gippsland.

Similar stories could be told regarding capital works projects, maintenance, human resource and finance management. We posed a difficult problem for the mainstream Monash University administration and, consequently, they were generally happy to let the minnow that was the Centre for Rural Health slip under their guard. If we were challenged later, we would plead ignorance of the rule. Monash had a vast array of policies that we could only consider if we already knew they existed!


A break between sessions in Traralgon 2003: left to right – Julie Luke, Daryl Pedler, Joanna Boast (Latrobe Regional Hospital librarian), Steve Kirkbright.

Steve Kirkbright deserves special acknowledgement. Among his many talents Steve was – and no doubt still is – a very skilled graphic designer. Every publication produced by the centre in the early years had Steve’s touch on it. Whether it was an email newsletter, website, a poster being delivered by a junior academic or a presentation by Roger to government, it was universally lauded for its quality and innovative style. Steve created a ‘look’ for the Centre for Rural Health that was admired and envied. He had the capacity to sit for a short time with authors, then turn their jumble of data and ideas into products that conveyed the message with panache.

The down side of being ‘out of sight – out of mind’ was that there was very little administrative, technical or academic support, and relatively few took us seriously. If many of our new staff had trouble grasping the functions of our centre, how could we really expect those outside the organisation to know why we were there? We sought recognition on many levels for varying reasons. We needed the faculty and University to appreciate our educational and research potential before expecting their support. The communities within which we worked had to be convinced of the value of our work and its potential impact in order to sway the various levels of government towards the importance of improving rural health. We also sought recognition among local, state, national and international rural health academics for our work, in order to raise the profile of issues, and also to attract academics to our organisation. Ironically, it appeared that for some time the greater the distance people were from our centre in Gippsland, the higher our renown. We were often visited by international academics who were highly enthusiastic about our work and influence, while we were virtually unrecognised in the towns within which we operated, and by our own faculty.

Much of the effort to promote the centre involved travelling. Although we quickly became adept at using teleconferencing as a communication tool within the centre, there was little incentive for external groups to use such technology. So we would find ourselves leaving home at 5.30 am to attend an 8.00 am meeting at the metropolitan campus on a regular basis. For many years I would travel to meetings at the Clayton campus once or twice per week with at least a four-hour travel turn-around time. Not to attend the meeting would be to miss the opportunity for representation at these forums. They were opportunities to educate others, not only about our existence, but also about the exciting advances we were making. Unfortunately, time spent travelling – affecting academic and senior administrative staff – was not allowed for in work output expectations. In later years we pioneered videoconferencing as a means of attending meetings without travelling. To the faculty’s credit, they ultimately recognised the value of videoconferencing, setting up a sophisticated system at faculty headquarters and encouraging its use. This has saved significant time and money, and reduced the risk of car accidents.

The evolution of the Centre for Rural Health/School of Rural Health has occurred at arm’s length from the University and, although aspects of their respective visions and objectives are shared, they are not exactly the same. Monash’s objectives revolve around excellence in teaching and research whereas the Centre for Rural Health/School of Rural Health vision is to improve rural health. This vision includes teaching and research, but also covers issues such as rural health workforce development and advocacy. These more applied objectives were amplified when the school received direct ongoing Rural Clinical School Project funding from the Commonwealth. The primary aim of this project is to increase the numbers of medical practitioners in rural Australia – an aim that is reinforced by funding parameters. The variation in emphasis has meant that the school has had to satisfy two requirements: the Commonwealth desire for the program to increase medical practitioners in rural areas; and Monash’s demands for a teaching program that produces excellent graduates. To the school’s credit, both criteria have and are being met.

Finance

Budgeting and finance within the tertiary education sector were completely foreign to me when I commenced at the Centre for Rural Health. Pathology services – which formed my professional background – worked on direct payment for service. The Centre for Rural Health/School of Rural Health funding relied on government grants and Monash/faculty funding policies. I was nervous about relying on another body’s continued generosity for the maintenance of funding. I recall being aghast, on compiling an early budget with Roger, where we listed $2 million worth of expenditure but could only identify $1 million of known income. The $1 million shortfall was made up by what was, at the time, unknown ‘project income’. Roger saw it as his task to attract this project funding over the proceeding months. He never failed.

I soon came to appreciate the logic of this process. The centre needed to successfully complete rural health-related education and research projects, to build a reputation that would assist us in gaining larger and more prestigious projects; we had to build a ‘track record’. However, to take on these projects as they arose unpredictably throughout the year, we required access to staff with the appropriate skills and availability. Roger overcame the potential problem by employing many people across the country on very small fractions. The system appeared to me to work like this: Roger would identify people with relevant skills and a passion for rural health, and would offer them a ‘retainer’ fixed-term contract for a small fraction such as 0.1 or even 0.05 effective full-time. Such contracts amounted to a few hours per week. Roger kept in contact with these staff members, but quite often they did nothing for large periods of time. This would continue until Roger found funding for a project. He would piece together a project team from those available on his list and supplement them with others if required. Quite often people would work many more hours per week than their fraction, but this was offset by the months that they were being paid for being relatively idle. The value of this method was that there was an available talent pool for projects when they arose; it would have been very difficult to piece together a team at short notice otherwise.

This was all manageable while Roger was able to lead each project. The continuity of the system required some projects to subsidise others, some staff salaries to come from projects for which they did no work, and operating expenses to be borne where they could be afforded. We operated very much from hand to mouth. We had to be able to respond to opportunities when they arose and recover from shortfalls when they occurred.

Funding for the Centre for Rural Health/School of Rural Health can be categorised into five broad sources:

  1. state government

  2. Commonwealth Government via Monash University

  3. Commonwealth Government direct

  4. research

  5. other project funding.

The relative proportions from these funding sources have varied greatly over time and in many ways reflect the evolution of the School of Rural Health.

When the Centre for Rural Health was founded its only role was to provide rural placement sites for medical students. As such, its only source of income was Commonwealth funding, provided via Monash University and the faculty. As the centre became established it became involved in many different projects and programs such as vocational training for general practitioners (Victorian Advanced Training for General Practitioners); health career and course information for secondary school students (the Secondary Schools Project); and small local projects such as the Moe After Hours Medical Service. Another phase was reached when rural clinical school funding was received directly from the Commonwealth. This included initial funding for capital works and was followed by ongoing funding for the operating costs of providing clinical medical education in rural locations. Following the establishment of the rural clinical schools, including Monash’s four regional clinical schools, major funding grants have been attracted for the Northern Victoria Regional Medical Education Network – in collaboration with the University of Melbourne – Monash University Department of Rural and Indigenous Health, and the Centre of Research Excellence in Rural and Remote Primary Health Care. All these developments have changed the balance of what we have been paid to do. However, the body of water that is the school has swollen to the point where the addition of new programs now merely creates small waves where tsunamis could have resulted previously.

The growth in the quantum of the School of Rural Health expenditure budget over my years as manager is evidence of the huge expansion of the organisation in that time. Our expenditure budget in 2000 was around $2 million but rose to over $30 million when establishing the regional clinical school sites. With the recent, welcome inclusion of the Gippsland Medical School under the School of Rural Health umbrella, the budget has continued to expand.

Capital works

In 2001 it was announced that Monash’s application for funding to establish a rural clinical school had been successful. Our ambitious plan was to develop regional clinical schools in Mildura, Bendigo and East Gippsland, an office of head of school in Moe, and a rural office on the main metropolitan campus at Clayton. Existing facilities in Traralgon would become a fourth regional clinical school site. State and federal governments initially pledged $4.5 million each – $9 million in total over three years for capital works. This exciting news posed a logistical dilemma: we faced running 13 separate projects across Victoria as well as developing 12 new general practice training locations. Mildura and East Gippsland had to be developed from scratch. Although we had some staff in Bendigo, this site also had to be developed from the ground up. Each site was different with opportunities and circumstances unique to its location.

We applied a few general philosophies as we sought solutions. It was important to forge relationships with health services within the regions, to ensure the ongoing viability of our programs, and to be mindful of our vision to improve rural health. The facilities that we built should provide benefit for the heath service and local community as well as for our students and staff. (What regional health service does not need access to large meeting spaces with state-of-the-art audio visual equipment?) As well as using the capital works to help nurture trusting relationships with the health services, it was important to provide students with comfortable accommodation while on their rural placements.

1998. The new facilities at Latrobe Regional Hospital, Traralgon, popularly referred to as ‘Roger’s ring’.

One director of medical services at a regional health service had formed the following opinion of universities following his time at a metropolitan health service: ‘I regard universities as a boil on the backside of any health service where their students are placed!’ He explained that, in his experience, the universities absorbed all that the health service could give them, but then still took more. We set out to change this mindset, at least in regard to the regional sites from which we operated.

We went to the health services with the following proposal: we wished to establish facilities within their organisation to enable our students to pursue their clinical training. The facilities could be tutorial rooms, a library, office and administrative areas and somewhere for the students to relax. The facilities could be used by the health service. Once the works were completed they would be handed over to the health service to be leased back at a peppercorn rental for a period calculated on the quantity of project funds spent on the capital works.

In some cases there were greenfield sites available on the health service campus; in others existing buildings were renovated, and in some instances land was purchased. The 13 initial capital works projects were:

  1. renovation of a previous ward at the now closed Latrobe Valley Hospital in Moe for an office of head of school

  2. renovation of the former nurses’ home at Latrobe Valley Hospital for student accommodation

  3. construction of new student accommodation on the West Gippsland Healthcare Group hospital campus in Warragul

  4. construction of new clinical school facilities and student accommodation at Mildura Base Hospital

  5. purchase of Lister House in Bendigo (former Central Victorian School of Nursing, then Department of Health regional office) for research and administration offices as well as student accommodation

  6. renovation of Lister House student accommodation

  7. purchase of properties in Mercy Street, Bendigo, to build clinical teaching facilities and library

  8. construction of clinical teaching facilities and a library in Mercy Street, Bendigo

  9. construction of a primary care clinic in Bendigo

  10. renovations at Monash University’s Clayton campus to create a rural health office and facilities for the students’ rural club, Wildfire

  11. renovation of existing buildings at Central Gippsland Hospital in Sale for teaching spaces, library, offices and student accommodation

  12. construction of new clinical school buildings on the Bairnsdale Regional Health hospital campus

  13. construction of student accommodation in Day Street, Bairnsdale.

The school engaged a project officer, Greg Beevor, and a project planning consultant, Raf Dua, to help coordinate these projects and to deal directly with architects and builders. We established project control groups for each project, which included representatives of the health services that were directly impacted. As well as coordinating the projects, we had to provide the regular reports required by the funding bodies. Those were certainly busy and exciting times.

We briefed the Monash University Facility and Services Division on our intentions and plans at a very early stage. After receiving guarantees that they would not become encumbered with responsibilities for building cleaning and maintenance they were happy for us to proceed. The division offered to provide a project manager to attend project control group meetings but his attendance discontinued after a short time due to his other commitments; the division was extremely busy with other major projects within the university. It appeared that we were ‘flying under the radar’ once more.

We embarked on the projects with energetic zeal, ignorant of the myriad policies and regulations that surround Monash University capital works projects. We became aware of procedures sometime after the projects were completed, when the Facilities and Services Division finally caught up with us! Despite this, all the projects were delivered on time and within budget.

Since the initial flurry of capital works, the school has been involved in a number of subsequent projects such as major extensions to the East Gippsland Regional Clinical School, Bendigo Regional Clinical School and Mildura Regional Clinical School. The number of teaching general practices that have benefited from supported capital works has increased from 12 to around 25.

The capital works projects enabled the development of productive, trusting relationships with the health services in the regions in which we operated. We were able to prove that we could deliver on our promises, add value to health services and be trusted not to take advantage of them. We certainly were not ‘a boil on their backside’!

People and relationships

Relationship building has been integral in the evolution of the Centre for Rural Health/School of Rural Health. This has been particularly the case for administrative and professional staff. Relationships have been crucial with local communities and health services, with faculty administrators and with Monash University central services. Maintenance of these relationships has required special effort particularly when distance and remoteness are taken into account. Empathy is required when explaining to local non-university people why certain administrative functions cannot happen instantly, because of the constraints imposed by University policies and procedures. Trips to Clayton were often required to meet personally with faculty and central university staff to discuss unique issues affecting the rural programs. It is too easy to be brushed aside when communicating by telephone to someone buried within a huge bureaucratic maze.

The administrative roles and expectations were different at the School of Rural Health. Administrative positions were decision-making roles imbued with responsibility: quite often the buck stopped with people in these positions because there was no-one else to pass the buck to! We have been asked many times to explain why we had such a high administration to academic staff ratio and to justify administrative positions. The reasons were the high number of fractional-time clinical teachers employed at our regional clinical schools, and our multi-site structure. Due to their high clinical load, teaching clinicians merely arrived at scheduled times to take tutorials, then left. They performed no administrative duties, not even timesheet completion. Even our regional directors were part-time, with full-time clinical roles on top of their Monash University responsibilities. The regional administrators were also responsible for student accommodation and often, by extension, student welfare. And finally, a structure of multiple small sites required much more administration than a few major sites. A gunshot fired through any of our regional sites in the early days would have had little chance of striking an academic! The result was that the rural administrators were responsible for running the operation and played key roles in planning the future.

Along with playing critical roles regionally, administrators also played a crucial cross-school role. A management group was formed that included the key administrators. This group met, and still meets, monthly via videoconference and twice a year, face-to-face. The matters considered by the group include financial and budgetary issues, internal and University human resource policies and procedures, student accommodation and welfare, teaching and learning administrative issues and research administration. The group has provided a reliable communication route for horizontal information transfer throughout the school and is a mechanism for bi-directional vertical interaction with the School of Rural Health executive committee. The management group has been able to share knowledge and expertise in dealing with issues as they have arisen, and has produced policies and procedures that have ensured consistency. In 2008 the School of Rural Health management group received the Vice-Chancellor’s Award for Exceptional Performance by Professional Staff. The group consisted of Graham Allardice, Vicki Dane, Elaine Evans, Jenny Donelly, Michael Elswyk, Marg Bibic, Lisa Lavey, Louise Bassam, Laura Salamone (now Major) and Carolyn Vaughan. This group, individually and collectively, had a massive influence on the successful establishment of the Monash University regional clinical school sites and programs across Victoria.

Another professional staff member to receive recognition via a Vice-Chancellor’s Award for Excellence was long-serving Gippsland stalwart, Julie Luke. Julie started work at the Centre for Rural Health as a shy administrative assistant who blossomed into a key clinical year coordinator, much loved by staff and students alike.

Vice Chancellor's award winners.

Vice-Chancellor’s award for exceptional performance by professional staff 2008: back row left to right – Laura Major, Elaine Evans, Jenny Donelly, Graham Allardice, Lisa Lavey, Marg Bibic; front row left to right – Carolyn Vaughan, Robert Clough, Louise Bassam, Michael Elswyk.

Julie’s colleague in Gippsland, Elaine Evans, is our longest-serving employee. Elaine began work as an administrative assistant with Roger in a small room in Moe, infamously described as a ‘broom closet’, in the very early days of the organisation. Subsequently she has worked as Roger’s personal assistant, as the human resources manager and is currently manager of the Gippsland Regional Clinical School. Along with her expertise and knowledge of the organisation’s history, Elaine’s bubbly nature and good humour have made her a very popular staff member.

Graham Allardice is the current senior operations manager of the School of Rural Health. In the ten years that he has been with the school, Graham has managed the development of the Bendigo Regional Clinical School’s evolution from an office of four staff to a multi-million dollar state-of-the-art clinical school building which accommodates over 45 staff. Graham has managed the complexities of such incredible growth with considerable skill, blended with his unique empathy for those around him. In 2006 Graham’s work was formally recognised when he received the Dean’s Award for Excellence in Administration.

Others who deserve individual acknowledgement are Vicki Dane, Mildura Regional Clinical School, and Jenny Donelly, East Gippsland Regional Clinical School. Vicki and Jenny have overcome the problems associated with establishing regional clinical schools in the most remote corners of Victoria. They have done so with a mixture of skill, patience, devotion and a large dose of determination! The two regional clinical schools have developed into jewels in the Centre for Rural Health/School of Rural Health crown that provides students with idiosyncratic, quality, medical training.


Meeting in Melbourne at a strategic planning exercise 2004: left to right – Cheryl Sutherland, Vicki Dane, Megan McNair.

There have been many more professional staff who have provided dedicated and devoted service over the years. The combined contributions made by professional staff have built and maintained the foundations upon which a highly regarded academic institution has flourished.

Leadership

I have had the pleasure of working with a number of heads of school, each of whom has added a unique and valuable character and emphasis to the organisation. I have written of Roger and his vision and passion previously. Roger’s positive influence is still felt within the organisation he founded as well as nationally and internationally. Following Roger’s departure for Canada the school was in a state of flux for the best part of two years as a successor was sought. During that time several senior staff members attempted to ‘keep the balls in the air’, taking on the role of acting head of school while continuing to perform their substantive roles. These were Associate Professor (now Professor) Elaine Duffy, Professor John Humphreys, Professor Gordon Whyte, and lastly the dean, Professor Nick Saunders. In truth it was a difficult time. Finally Professor Geoff Solarsh was recruited from South Africa. What Geoff lacked in local knowledge was made up for by his strategic approach and attention to detail. Geoff took the school from a band of dedicated and effective amateurs to a group of academic units, depending less on enthusiasm and more on best practice academic methods. His support for research positions resulted in the recruitment of some excellent researchers and increased research output. Geoff’s meticulous attention to budgetary issues was instrumental in negotiating some difficult financial times. With Geoff’s decision to concentrate on the leadership of the Northern Victoria Regional Medical Education Network, Professor Gordon Whyte took over the role of head of school. Gordon had the task of recruiting a new head of school while providing leadership in times when the north-western regional clinical schools were heading in one direction (via the Northern Victoria Regional Medical Education Network) and the south-eastern regional clinical schools were heading in another (via the Gippsland Medical School); the research unit and Monash University Department of Rural and Indigenous Health were caught somewhere in between. Gordon did well with both areas, resulting in the excellent appointment of Professor Judi Walker as head of school and passing over to her a healthy and vibrant institution.

We have been led by an active and diverse executive committee which has reflected the school’s diverse interests including medical education, research, multidiscipline health, workforce, Aboriginal health, gender and administration. It can be difficult to operate a democratic model within a largely authoritarian structure such as a university; however, this committee has managed to do so. Many of the meetings have featured fiercely fought debates, but all have been respectful and sincere in the objective of honouring our vision: to improve rural health.

It has been a privilege to work for the Monash University School of Rural Health and a delight to be involved in the evolution of what has become an outstanding organisation.


Current head of school, Judi Walker, 2011. Photo: Monash University Gippsland

Clough, Robert. 2012. ‘Administration: Flying under the radar’, in From a Broom Cupboard: 20 Years of Rural Health at Monash University, edited by Clough, Robert. Melbourne: Monash University Publishing. Pp. 121–135.

From a broom cupboard: 20 years of rural health at Monash University

   by Robert Clough, editor