The anonymous administrator. A five-year experience as a medical administrator in Tasmania

The task of reorganizing and modernizing Tasmanian hospital and health services during the past five years is described. It is shown that substantial improvements can be achieved, despite a lack of authority to match responsibility. The keys to achieving these improvements were: a logical development of objectives; a careful documentation of facts; a sense of timing for the introduction of new measures; the use of independent management consultants; above all, ample finance. The major problems were the anonymous nature of the work which prevented adequate consultation with those affected by the changes, and the very adverse effect on incentives caused by poorly informed community groups exerting pressure on governments. Further improvements could be achieved by the establishment of a health commission or board consisting of full and part time members responsible through a minister to Parliament.