‘Health is a team sport’
Born in a hospital, treated in hospitals, now Fepulea’i Margie Apa tells Kevin Norquay how she’s running them across the whole country.
Imagine overseeing the hospital you were born in; that’s the situation Fepulea’i Margie Apa finds herself in, a half century after her birth at Auckland’s Greenlane Hospital.
Apa is getting used to such connections. As a child growing up in O¯ tara, Middlemore Hospital was her local, with regular visits from her family. She soared over that facility as well, as the first Samoan to lead a District Health Board (DHB), Counties-Manukau.
Now chief executive of Te Whatu Ora (Health NZ), Apa talks to the Sunday Star-Times of the importance of connections, team work and links, of seeing what is working, what is not, and putting all the pieces together.
On July 1, 20 DHBs and a workforce of more than 80,000 became one entity: Health NZ. Apa is integral in ensuring it works efficiently. Given the challenges facing health, it seems a massive job, though Apa does not characterise it that way.
‘‘I see huge opportunity, and that’s one of the advantages of being in leadership roles,’’ she says. ‘‘You can see all the bits that don’t connect or are disconnected, and if they did connect what an amazing experience patients can have.
‘‘I’ve had enough experiences in my career where I’ve seen the magic of when that happens, and I know it’s possible. We have the science to achieve things.’’
She has been deputy directorgeneral of health, and held executive roles at Capital & Coast DHB , the Labour Market Policy Group and the Health Funding Authority.
As well as success, she knows what happens when there are systemic failures. She raises the Cave Creek tragedy, and the death by beating of Hawke’s Bay four-year-old James Whakaruru.
She was working in State Services Commissioner Don Hunn’s office when a review of Cave Creek – the 1995 tragedy that killed 14 – was done. It taught her a great deal. ‘‘All of what unfolded through that review was the part that management environments played on either encouraging or discouraging people’s thinking about doing the right thing,’’ she says .
At Cave Creek, a Department of Conservation (DOC) platform collapsed under the weight of a polytechnic group standing on it. It had not been designed or approved by a qualified engineer, the inquiry found. No-one involved in building it was a qualified engineer, and nails were used to secure it instead of bolts, as the appropriate drill was not taken to the building site.
‘‘The core of that was we had DOC workers who thought they were doing the right thing, but not having the management structures to resource, to set standards, and support them,’’ she says. ‘‘And that’s been a theme of my experience in the public service. I came into health, and it got under my skin and I stayed ever since.’’
Much of her work has been around child health, where the same principles that contributed to Cave Creek applied. James Whakaruru died after his mother’s partner beat him, when the health sector was aware of his situation.
‘‘Cases like James Whakaruru really shook us all. One of the bits that stuck out in my mind is the Health and Disability Commissioner’s review, which basically said that he had something like 55 health sector contacts in 18 months of his life, and nobody made a difference.
‘‘How you set up funding and how you set up contracting have a huge impact on the people at the frontline on what they deliver, how they deliver it, how resourced they are, but also what information do they have to be able to support their clients or communities. We’ve got to simplify the system … it’s the one child at the end of it all.’’
More than two decades after they occurred, those events are still informing the Apa leadership style: ensure systems work, take responsibility if they don’t.
‘‘That’s part of a leadership package, and particularly in the public service. I celebrate those small wins and make sure that the people who delivered them know that they are appreciated and valued.
‘‘I absolutely accept public accountability for explaining why things haven’t gone as well as they should have, and I’ve had a couple of instances where I did
have to front. Probably the bit that sticks in my mind is the two deaths... we had in the very early Covid days.’’
Apa, then the lead of the Northern Region Health Coordination Centre, is talking about two patients who died alone at home with Covid. A review found their deaths were potentially preventable, and Apa at the time accepted they did not have adequate support.
‘‘Our systems didn’t keep up, and I fronted that, because I wanted to kind of acknowledge that, actually, these are the sum efforts of a whole lot of people, and nobody comes to work to do a crappy job.
‘‘Health can be so complex that even when people will do their best, we still don’t quite make the bar. Our job is to build trust and confidence so that New Zealanders are confident we know what we’re doing. We’re doing the best we can with the resources that are given, because we are a taxpayer-funded system.
‘‘You can’t do this job … and impact on human beings without having some emotion invested in it. And actually, the people around me need to see that as well, it’s a business that deals with people every day. We can do this. If we are able to engage our colleagues, our clinical leaders, and make the system simpler, it’s do-able, from what I’ve seen.’’
Fepulea’i is a chiefly title from her father’s village of Sale’aula, on Savai’i. Her parents emigrated in the late 1960s and early 1970s, settling in Clover Park, O¯ tara.
People and community have been at the core of Apa’s life, growing up in a household that was ‘‘technically a bit overcrowded’’ with relatives coming from overseas, staying, then moving through.
Apa played rugby – a Wellington representative lock who fancied herself as a loose forward but says she wasn’t fast enough – and married into a rugby family (All Blacks great Michael Jones is related to her husband Riki).
She volunteers as chair of Presbyterian Support, a charity that supports vulnerable children and their families, and is on the board of World Vision New Zealand, a global Christian relief, development and advocacy organisation.
As well as her two daughters, she supports young people – she calls them ‘‘my children’’ – overseas. There are two in Cambodia, another in Bangladesh and three more in Africa, in Mali and Tanzania. ‘‘Faith is another part of having resilience … things might feel tough now, but actually, there’s always a plan. There’s a higher power.’’
Serving is at her core. Her vision is to make a difference.
If she dies knowing she improved the life expectancy of Ma¯ ori and Pasifika, and the lot of those living with mental illness she will ‘‘feel pretty proud of myself, and also the team’’.
‘‘The job is a privilege. I didn’t grow up thinking I’ll be a CEO. The jobs I’ve taken have all been jobs where I thought, actually, I could make a difference.
‘‘And that’s probably at the core of me being action-oriented. Do something about it … motivate and take people with us, because this is a collective endeavour. Health is a team sport.’’
And family? Growing up with relatives coming from Samoa, and then going from her home and getting on with life, alerted her to the possibilities the world offered.
‘‘A sense of social mobility was possible. That’s the opportunity and the optimism. It seems simple and those who come from the islands work hard, find a partner, go off and buy a house. There’s a lot of resilience and big communal families and communal ways of living.’’
Apa will likely need a dose of resilience as she works to improve health outcomes. Or maybe her infectious optimism could spread as swiftly as … let’s not go there.
She wants to reduce health inequities, to develop a worldleading health system, even as the health sector strains at the seams with stress and overwork. ‘‘We can change some things that will turn it around.’’
‘‘The jobs I’ve taken have all been jobs where I thought, actually, I could make a difference.’’
Fepulea’i Margie Apa