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Honing in on health inequities, addressing institutional racism and training up whanau to fill future health roles. Hauora Tairawhiti chief Jim Green reflects on 20 years of service and the work yet to be done. He talked to Local Democracy Reporter Alice Angeloni.

Hauora Tairawhiti chief executive Jim Green still has a lot on his “to-do list”.

And they're not small tasks, with Mr Green acknowledging institutional racism is an issue within Hauora Tairawhiti that requires more work.

“Because it's Tairawhiti, there's a new challenge, and some old challenges, every day,” he said.

“That's the thing that in my opinion has kept things fresh for me over those 20 years.”

Mr Green marked 20 years as chief executive in December. He is the longest-serving current chief executive of any district health board.

“I won't be here forever obviously and like anybody, you need to be making plans for what you will do around retirement.

“I see that there are always opportunities in terms of how you can move forward and how you can develop.”

Mr Green moved to Gisborne for the role in 2000 following the resignation of the former chief executive. He was previously group manager of women, children and youth health services in Northland.

During his time at Hauora Tairawhiti a number of themes have stood out.

Among them are health equity for Maori, the importance of whanau, the need in the Tairawhiti community to have excellent health services, and the way in which clinicians and whanau could be involved in designing those services.

While he couldn't pin down any one major change, he said he had seen health in Tairawhiti and the body overseeing it evolve.

“I think it's been a cumulative and determined pathway over that period of time.

“The services here within health have grown and there are more people in this organisation and within health in the community.

“There's a much greater emphasis on Maori health outcomes and working with Maori to improve those outcomes.

“We've got a much stronger clinical input into decision-making.” This was about the importance of clinical leadership and making sure clinicians felt empowered and able, he said.

Community-based services had also been developed. “The hospital is important but there's more of an importance around those community-based activities.”

When he started out, the way different organisations within the community interacted looked very different.

“There was virtually no connection when I first came here between people within health, with iwi, with other government agencies, with the council.

“It's much stronger now.”

He described the advent of Manaaki Tairawhiti, a group of local iwi and cross-sector leaders working to improve social outcomes for whanau, as “a whole new era”.

A focus on Maori health and health inequities had been an important theme throughout his two decades.

“There's no advantage whatsoever in some people in the population having poor health outcomes. That doesn't bring any advantage to anybody, clearly not those people experiencing that, but anybody else either.

“That's why it's so important that we change that in Tairawhiti, and Aotearoa as well of course.”

Sustainability of services was another important element.

“In a comparatively smaller community like this, you can have a service today and not tomorrow. So a lot of work that's gone on over the years is making sure we do have a degree of surety.”

Ensuring the sustainability of services included having the numbers of people on the ground, but also the skills and knowledge of people and ways of working.

Employing graduates from the Tairawhiti EIT nursing degree programme was a good example of this, but another important aspect was “growing” staff onwards, Mr Green said.

“We are very intent on growing our own here in Tairawhiti, which I think is a very important strategy, but also growing people on.

“It means that you continue to develop those people.”

Tairawhiti had a high proportion of young people in its population, which meant there was a “huge amount of potential”, he said.

“We need to make sure we're converting that potential into the people that we need within health now and into the future.

“That's not an easy task and there are some difficult things we need to surmount. Often our young people need to leave our district to gain the qualifications or the experience or the knowledge.

“So we need to bring as much of that here as we possibly can . . . but also we need to support young people to go out and get those qualifications and then come home and have the jobs and the life that they want to have here.

“To me, we're not only building a health workforce and a health system that is supportive of people, but also we are building a system where people need less access to the treatment aspects of it and more access to the wellbeing, straight line health aspects of it.

There had been “difficult times”, he said.

“Working in health is challenging. We've got 1000 people working in this organisation who know how challenging it can be . . . the amount of effort that is required and the thoughtfulness that you need to apply to it and the listening.”

Support from family and colleagues had been crucial.

“I've had a family that has been extremely supportive of me. I've spent a lot of time at work and concentrating on work over that period of time.

“I could never have done that without my family.”

The other element was the team at Hauora Tairawhiti.

“I've had a great group of people to work with over that period of time. Over that 20 years people have come, people have gone, but a lot of people are still here as well.

“You couldn't be a chief executive of a district health board for any particular length of time if you didn't have that support from your family and from your team.”

Jim Green