Public health CFO on being a ‘financial steward’
28 Jun 2024
Rachelle Anstey has been part of our Executive Learning sets program since 2019, she has worked in various health services within Victoria as well as in financial management roles in other sectors. Read her insightful perspective on leadership, exploring the delicate balance between financial stewardship, clinical needs, and staff development.
My Role: Empower the team
I see myself as the financial steward of Monash Health, Victoria’s largest public health service, which cares for Melbourne’s south-east with a team of 25,000 employees. We operate with a turnover of about A$3.2 billion a year, so I need a great team working with me. There are about 150 people working in the finance department, which comprises all financial services, payroll and finance projects.
When I arrived in November 2021, I knew that my team needed to have certain freedoms, so they could feel empowered and self-directed. I have three directors in charge of large portions of the budget, but, in truth, they are CFOs in themselves. Each director manages turnover equivalent to that of a small-to-medium company.
I have an allocated budget, with limited opportunities to meet commercial revenues, so I have to stick with what is given. The government provides us with a funding envelope, and I make sure that we stay within that while balancing clinical demand.
With clinical demand and access priorities, even if my budget is running over in the emergency department, I cannot shut that and say, “Sorry guys, I can’t find any more money”. We have to work to find extra funds to support the community members who need care.
Each financial year, we have to make decisions about how to allocate the funding envelope into the major areas within operations while balancing the needs of the other support functions, such as pathology, imaging, IT and finance.
We use trends of the past five years to guide what we think will happen. If we exclude the pandemic era, we think we have a pretty good idea of the trends, although a lot has changed since the pandemic, and we have had to adapt.
There are other factors. For instance, royal commissions into aged care and mental health have led to changes. They usually mean more funding, which means we need to have the right workforce and model to ensure we are up-to-date and compliant.
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Game changers: Shifting gears
During school, I had always intended to become a pharmacist, but when I studied accounting in Year 12, I found I enjoyed it and was good at it. I loved the numbers and the thinking. By the end of Year 12, I knew I would become an accountant.
My work game changer came in 2015, when I changed industries. I had been working for Melbourne Water for close to four years. At the time, the healthcare industry was not recruiting external applicants, but I succeeded in getting a role at Alfred Health because of my teamwork skills. I fell in love with the healthcare sector, and it has opened doors for me.
I am grateful that I have been able to bring the experience I had in other sectors to health. It is a funny coincidence that I am now in something closely related to pharmacy – it may be why I have enjoyed the healthcare sector for so long.
My challenges: A delicate balance
The key challenge in any CFO role is to get people throughout the organisation to understand the financial aspects of their roles. For us, every clinical decision is also a financial decision.
I walk a very fine line to balance financial sustainability and clinical need in my role, because there is a person at the end of every decision.
For example, if a patient who does not have Medicare presents at the emergency department, that affects our budget, because although we are not funded to care for them, we do not turn away those in need.
It is my job to determine the limit, to allow us to operate within our means but still deliver the best care every day.
“I walk a very fine line to balance financial sustainability and clinical need in my role, because there is a person at the end of every decision.”
Rachelle Anstey CPA, Monash Health
Our medical teams rightly advocate for the best and most extensive possible care for our patients, but it must be balanced financially where possible to ensure our health service can operate sustainably and care for everyone in need.
During the pandemic, we needed more money and the government supported us so to provide greater flexibility in the system.
We are not yet back to the position we were in during 2019, before the pandemic, and one of the key reasons is the staff are very tired. Health does not stop. We are seeing sicker people presenting for care now, because they put off surgeries and health problems during the pandemic. Elective surgery backups put pressure on the system.
People also think we are still in a pandemic situation when we are not. It means they have to re-calibrate their thinking as to what is and is not possible.
Lessons learned
Show empathy: This has allowed me to understand and connect with people I work with better and to build strong, trusting relationships both with the team that I lead directly but also the people that I work with. It also allows me to make informed decisions that consider the needs of others.
Treat your team as your greatest asset: I believe that I am only as good as my team. Building strong, cohesive, high performing team has been critical to my success as a leader.
Lead by example: I like to set the example of what behaviours and values I want in the team. I hope this helps inspire, motivate and influence the team around me.
Always empower: I live by this both in my personal and professional life. I love to give others the authority, resources, and opportunities they need to make decisions and achieve their goals. When members of my team have a great idea, I actively encourage them to act on it. The results are usually always brilliant.
