SA MET Newsletter - Spotlight on Workplace Culture

Issue 32 | March 2016

Building the best workplace culture

Working as a junior doctor is an exciting time. After many years of study, you now have the opportunity to put into practice your skills and knowledge. Along with this excitement also comes stress and pressure. SA Health aims to have an environment within the workplace consisting of encouragement, support for training and the promotion of health and well being for all staff members. However, over the last year there have been many negative stories in the press concerning the culture of medicine. Articles reporting the bullying and harassment of junior doctors and in particular the culture of surgeons have been reported. In addition, a program was aired on Four Corners on the ABC in May 2015, titled At their Mercy, which described the culture of surgery as being toxic with many reports of bullying and harassment.

The Royal Australasian College of Surgeons (RACS) established the Expert Advisory Group (EAG) to advise how to deal with bullying, discrimination and sexual harassment. By late November 2015, the College had released their plan in response to the problems identified. We congratulate the College for their response to the reports of bullying and harassment and support their plan to create a workplace culture which does not allow behaviours such as discrimination, bullying and harassment.

SA Health promotes respectful workplaces and all staff should be aware of the policy (Respectful Behaviours policy). In addition all South Australian public servants must adhere of the Code of Ethics document. We all know how we should behave and we all want to be treated with respect. However, how do we ensure that our workplace culture is respectful, caring and free from bullying and harassment? It is important to remember that bullying and harassment occurs across all specialties within medicine and also across all different employer groups. We know that the majority of the time the staff of SA Health act respectfully. The South Australian Medical Education and Training Unit has recently released, on the SA MET website, information on bullying and harassment. The pages include information on bullying, sexual harassment and discrimination, as well tips and resources on the management of issues.

This newsletter will look at how we can all be a part of a caring, respectful work environment. We are all a part of the workplace culture where we can always make a difference and improve the culture. We all want to be part of a great workplace culture that not only benefits us as workers, but also provides a friendly safe environment for all of the public who come into contact with us.

Ronda Bain, Regional Training Manager, SA MET Unit

Recently I met with a senior staff member who was being abusive and disrespectful to other staff. I explained to this individual that such behaviours, whatever the precipitant, are NEVER acceptable. It saddens me that there remains in our health system many who consider that bullying or abusive behaviours to others is somehow acceptable. It is not. It never has been, but some cultural aberration makes some think this is ok. Sadly it is often junior staff who suffer the most abuse, and feel disempowered to respond. My message to such individuals is that you are empowered. There are systems in place in our heath service to protect and support you. Seek advice from the health service managers in your area, your supervisors or others you trust.

Educationally we know that learning is best achieved in an environment of support and collaboration, just the sorts of environments we seek to cultivate in our health services. Working in teams, being respectful of each other and the contribution all can make, recognizing the value that different members of the health care teams brings (so we don’t be disparaging of other health professionals and enhance our own learning and patient outcomes) are all important aspects to consider.

Going back to where I started, my conversation with the abusive staff member, he did not understand that his abuse was having such a negative impact on those around him. He did not seem to recognize that his behaviours were abusive. I was staggered. His calibration systems, understanding the effects he has on others, are clearly dysfunctional. So it is up to all of us to frequently consider if our actions are having unintended negative consequences on others. Seek feedback from those around you and respond to this feedback. Above all, always be courteous and act graciously in all you do.

SA MET Unit update

Associate Professor Alison Jones, Manager,
South Australian Medical Education and Training (SA MET) Unit

The issue of workplace culture has become more high profile in recent years and in terms of our role, in monitoring and accrediting the junior doctor training environment, it is something we pay a lot of attention to. The healthcare system is a complex setting that has to balance patient care needs with providing a quality learning environment for our current and future healthcare workforce.

The work of the Better Placed team looking at SA Health clinical placements for all healthcare students, the Transforming Health Education Experts Group, the various units and staff in the Local Health Networks who oversee and manage the training environments, and the range of accrediting bodies who set the standards and measure against them, all have an important part to play in influencing workplace culture. Through the Women-in-Leadership Steering Committee, I also see a role for tackling complex issues such as unconscious bias and the difficulty of getting complex healthcare systems to truly support initiatives such as flexible work arrangements. As always, the SA MET Unit welcomes feedback on what we can do to support the ongoing development of positive workplace cultures for our stakeholders.

Psychologically Healthy Workplaces
Work plays a significant role in our psychological health and wellbeing. No doubt you have noticed this with your own experiences in ‘good’ and ‘bad’ workplaces and the impact it has had on your own sense of wellbeing. You may have also seen it in friends or family members whose levels of stress rise from their work, while their overall resilience, tolerance and mood levels fall.

You have also likely noticed the impact this can have on relationships and life outside of the workplace. The research supports these observations as there is mounting evidence that work plays a critical role in our psychological health and certain characteristics of our organisation and our work can help to develop and maintain our psychological health or threaten and reduce it.

Organisations now know that workplace stress and psychological distress can dramatically impact on performance and can cost the organisation through reduced productivity, increased absenteeism, psychological injuries and staff turnover. Therefore, organisations have become increasingly interested in supporting the psychological health of employees and since they are ideally placed to do this for the benefit of both the individual and organisation, this is good news!
So what are the elements of a psychologically healthy workplace? Organisational psychology literature has linked a number of workplace conditions with positive psychological health and wellbeing. These include:

Supportive leadership: approachable, responsive, reliable, understanding leaders who treat employees with fairness and respect and provide clear work expectations and frequent feedback
Employee engagement: employees’ feelings of commitment to the organisation and its purpose, enthusiasm for their work and levels of discretionary effort they put into their work
Role clarity: the degree to which employees have a clear understanding of their roles and performance expectations and how they relate to the organisation’s objectives
Learning, development and growth opportunities: professional development and learning opportunities are accessible, supported, valued and encouraged
Performance review and recognition: feedback on performance needs to be frequent, constructive and both formal and informal
Work-life balance: recognition of workers’ needs outside of the organisation and having both the culture and policies that enable workers to achieve a work-life balance

The elements listed here are key ingredients to enabling people to feel valued at work, feel a sense of control over their work situation and have a sense of meaning in what they do – all of which are key contributors to our overall wellbeing.

For more information on strategies to address these elements, you can contact your Organisational Psychologist in your LHN or the SA Health WorkFit Psychologists, Lisa Devine and Caroline Dingle.

Peer to Peer Mentoring Program
A peer mentorship is a voluntary relationship which provides an opportunity for all to develop and grow their interpersonal skills and to share their professional knowledge and experience. In the long-term, peer mentorship programs may have the capability to improve the workplace culture to one that is more supportive, more collaborative, less competitive and more patient-centred.

A critical protective factor in resilience for junior medical officers is the presence of a strong peer support network. Self-care and wellbeing traits are often learned through informal means such as mentoring, professional role-modelling, debriefing and personal reflection, rather than traditional teaching methods. In 2015, Peer to Peer Mentoring programs were undertaken in two hospitals. Both of the pilot programs were a resounding success and will continue in 2016.

The Queen Elizabeth Hospital (TQEH)
The Medical Clinical Education Unit at TQEH undertook a project to trial a peer mentor program for junior medical staff in 2015. The mentors were recruited from the PGY2+ JMOs working within TQEH and the mentees were the new cohort of interns.The program recruited 5 Mentors and 10 Mentees. The aim of the Near Peer Mentoring Program is to help provide additional assistance and support to the intern cohort through what can often be a stressful time.

All participants indicated that they found the experience of being mentors rewarding, and would all consider participating as a mentor again. Evaluation from the mentors and mentee groups provided positive reinforcement that the program continuance is worthwhile, with both groups stating they had benefited from the shared experiences from both a mentor and mentee prospective.

Recruitment and education sessions for the continuance of the program in 2016 was undertaken in late 2015, resulting in 10 mentors being recruited for the 2016 program. An information session was given to the 2016 intern cohort during intern orientation week. Matching of Mentors and Mentees is now underway and was completed in February.
Program Co-ordinator: Lynne Burn (Medical Education Officer)

Flinders Medical Centre (FMC)
Doctors Health SA and Southern Adelaide Local Health Network (SALHN) Trainee Medical Officers Unit education team worked together to initiate a peer mentoring program which commenced in July 2015.
42 mentees (interns) registered and completed an online training session and 30 mentors (PGY2 and PGY3) completed the online training. All participants received a manual. These participants were then matched to their requested criteria (where possible) and 12 mentors agreed to have 2 mentees. To encourage the participants to meet they were offered a two for one coffee voucher twice throughout the program.

A key aim of the program was for junior doctors to have a source of support and avenue for debriefing not directly associated with assessment or employment. Improving these support networks for junior doctors is crucial as this group has recently been shown to have significantly higher levels of substantial psychological distress compared to the Australian population and other professionals. These issues can be addressed more effectively by peer mentoring programs than by traditional methods.

The 2015 program was very successful; the overall feedback from the mentors and mentees was very positive and last year’s mentees have shown enthusiasm to be mentors this year.
Dr Suman Murthy (Medical Education Registrar)

Quality Assurance of Training Settings (QATS)
The Quality Assurance of Training Settings (QATS) project has been designed to offer a confidential platform for trainees to rate and comment on aspects of their workplace learning environment and invites trainees to share their views via anonymous online surveys.

Standards of clinical training are determined to a large extent by the settings in which junior doctors work and learn. By offering trainees a confidential platform to communicate about the educational conditions in their workplace, QATS can gain insight into training experiences that individuals may otherwise be reluctant to share.

The QATS project aims to collect information about learning environments in SA Health workplaces and the information collected is used to shape ongoing improvements to the clinical training of SA’s junior medical workforce. In the next two months the SA MET Unit will be seeking trainees to complete the QATS survey. If you receive an email asking for your feedback, please take the time to complete the survey. It will only take 10-15 minutes and provides an invaluable snap-shot of what is occurring within training in the local health networks.

Bullying and Harassment Awareness
In February 2016, SA MET launched new bullying and harassment pages on the SA MET website.

These pages include information on:

The signs of bullying
Taking control of bullying – what you can do if you are being bullied.
Accused of bullying – what you should do if you are accused of bullying.
Managing reports of bullying – aimed at managers, with information on how to respond to reports of bullying and harassment.
Describe, Express, Specify, Consequences (DESC) script examples – read through some DESC script example conversations about bullying.

View the bullying and harassment pages here.

White Ribbon
Making women’s safety a man’s issue too.

White Ribbon is a national campaign to end men’s violence against women. White Ribbon is a male led campaign, which works through prevention initiatives by raising awareness in youth, schools, workplaces and the community. Held annually on 25 November, White Ribbon day observes the International Day of the Elimination of Violence against Women.

The Department of Health and Ageing (DHA) are proudly working with White Ribbon to create a safer workplace. DHA has established a White Ribbon Accreditation Implementation Working Group. In accordance with White Ribbon Australia standards, this group will undertake work required to achieve the White Ribbon Workplace Accreditation. On 25 November 2015, morning teas were held across DHA to commemorate White Ribbon Day. Approximately 400 staff participated in these morning teas and had the opportunity to discuss this important issue. If you are an SA Health employee, you can view the White Ribbon page on the SA Health Intranet.

How can you get involved?

- Take the White Ribbon oath – stand up, speak out and act.
- Get active – support the campaign by becoming an ambassador, advocate, supporter or partner.
- Host an event – help educate others and change attitudes/behaviours that lead to men’s violence against women.
- Stay updated – sign up for the White Ribbon newsletter, follow the White Ribbon Twitter and like the White Ribbon Facebook page to ensure you don’t miss out on information, events and more.

To get involved, sign up for updates or find out more, visit the White Ribbon website.

Professor Paddy Phillips

Chief Medical Officer & Chief Public Health Officer, SA Health

1. Your role in SA Health is extremely busy; however you manage this very well, what is your best time management tip?
Deal with things as soon as you can – don’t sit on things or batch them. If it’s something you don’t want to do it’s even more important to get it done so it’s not hanging over you. My other tip is do it once, and do it well. That avoids having to re-work things.

2. You’ve worked across many health sites, what do you think makes a good workplace?
Respect, teamwork, humour and talking, talking and more talking.

3. What is one piece of advice for managers to assist them in creating a good workplace culture?
Always treat people with respect even if you don’t like or agree with them.

4. You have a very high pressured position, how do you manage your
well-being during stressful times?
I make sure I have time to myself away from work things through: riding my mountain bike in the hills, exercising in the gym, and walking and chatting with my family. When times are really tough I also meditate which is incredibly relaxing and centring.

Graeme Campbell, RACS
Graeme is the Vice President of the Royal Australasian College of Surgeons (RACS). We congratulate RACS for their willingness and openness in addressing issues of discrimination, bullying and sexual harassment. Ensuring a safe and friendly workplace is the responsibility of not only employers but also employees. Together we can make a change to workplace culture where discrimination, bullying and sexual harassment will no longer be allowed in any workplace.

1. The College has faced intense media scrutiny and has taken decisive action to address issues of discrimination, bullying and sexual harassment. Can you tell us about the role that the College plays in the stopping of these behaviours?
The College is determined to take a lead role in dealing with these behaviours, when perpetrated by surgeons, surgical trainees or IMG surgeons. We are currently developing a suite of educational products and have totally revamped our complaints process. We also need to change the culture in every surgical workplace in Australia & New Zealand. This is a huge task, and can only be achieved by dialogue and partnership with employers, and jurisdictions. We are also looking at ways to improve and foster diversity in the profession.

2. Do you have a tip for someone who is struggling with bullying/harassment within the workplace?
Speak up! If you walk past this type of behaviour, you are condoning it. If you are not confident to deal with the matter directly, talk with a senior surgeon in your hospital who you believe will be sympathetic. If you are anxious about repercussions, contact the RACS complaints line. Your complaint will be taken seriously. Yes, it is possible to remain anonymous. RACSTA is also a valuable resource for trainees.

3. In this newsletter we have been looking at different ways to ensure good workplace culture. What do you think creates a good workplace culture?
The tone is set from the top. However this has to be inculcated, not imposed. There should be good communication between individuals, wherever they sit in the hierarchy, and all feel empowered to speak up. Minor breaches of behaviour are called out and the issue resolved promptly. There is ample evidence that patient safety is optimal when this occurs.

Dr Tara Naige
Tara is currently working as an RMO at the Women’s and Children’s Hospital. She completed her internship at the Lyell McEwin Hospital in 2015 and was a post-graduate medical student at Deakin University, in Victoria. This year, she is chair of the SA Junior Medial Officer (JMO) Forum. She is passionate about rural and remote health, developmental and emergency aid, travelling, rugby, music and getting out and having a good time!

1. We can imagine that during your intern year, there would have been many stressful moments. Do you have a tip on how you managed this?
One of the most stressful things in early internship, that seemed to be felt by every one of my friends, was this overwhelming pressure and self-expectation to know the answers to all questions and that we could help everyone. This can place an enormous amount of stress on individuals, leading to unhealthy and unsafe behaviours and habits. It is imperative to know that it is ok if you do not know all the answers, we are interns and junior doctors, we aren’t supposed to know everything yet and that is ok! The important thing is to recognise your limitations and don't be scared to ask for help.

2. What has a supervisor or team member done that has made you feel particularly welcome in the workplace?
Most people in the hospital understand how hard most interns work, and one thing that really got me through the year was having friends and team members around to help me out when I was struggling or just needed to bounce ideas around; debrief after a tough day, bad outcome or difficult patient; or to make me a piece of Vegemite toast or get me a chocolate bar on those occasions when it was 4pm and I hadn’t been able to stop for lunch.

Internship was one of the best years, while stressful, tiring and at times overwhelming, I learnt so much and worked with such amazing people. When I think back, I have great memories. I think this was primarily due to the incredible people I worked with and the supervisors who provided ongoing support and encouragement throughout the year. My supervisors were all very keen to teach if you showed an interest in their area and I encourage you to make the most of this when you can, it is the best way to learn!

3. What is a piece of advice you can give the new interns on how to manage this year?
I think one of the most important things you can do in the intern year is something other than medicine! Pick up a sport, start a new hobby, play that instrument you haven’t had time to play for years. We need to have time and a life away from the hospital; reconnect with your friends sans medicine; travel somewhere you’ve always wanted to visit; or just sit and home and relax with friends and family. It's easy to become overwhelmed with work and without something to do after hours you find yourself staying late, because there is always another job you could do before you leave. The trick is learning which ones need to be done now, and what can wait until tomorrow.

I started playing rugby with my local team again. Sometimes I didn’t make it to trainings or a game and I was late on many occasions, but I did everything I could to be there! It was great motivation to work a little harder and try and get things done in time to leave for training. Getting outside and having a run around was the best stress relief.

4. Thinking about good workplace culture, is there anything that you always do when supervising junior team members?
As a junior doctor we are often told to just “fake it till you make it”, encouraging confidence is important, however, equally important is to recognise when not to fake it and understand your limitations. When supervising junior team members I try and help junior doctors and students to work out the delicate balance between their confidence and competence, encouraging them to learn new skills while also ensuring they feel supported and able to ask for help. It is important that all members of the team feel that they can contribute, but also that they can safely ask questions and respectful challenge instructions if they are concerned.

Upcoming workshops in 2016

Professional Development Program for Registrars (PDPR)
PDPR aims to improve leadership and management performance in the workplace via a sustainable, national professional development program for Vocational Doctors (Registrars).

11-12 May 2016 – CALHN employees
22-23 September 2016
24-25 November 2016

Register for PDPR through the online registration form available on the SA MET website.

Other SA MET workshops in 2016
Future workshops in 2016 will be scheduled soon, please check the SA MET website for further updates.

Alcohol and Other Drug Use and Intimate Partner Violence workshop
9.00am-4.00pm on 15 April 2016
Clinical Education Centre, The Queen Elizabeth Hospital (TQEH)
Registration via email: Lynne Burn or Natalie Hickman

Sapmea workshops and training
The 2016 sapmea calendar is now available online. The calendar contains various workshops and training. View the sapmea calendar now!

Feedback
What are your thoughts on this edition of the SA MET newsletter? Do you have you an experience you would like to share? Is there a particular theme you would like us to promote?
Provide your feedback, experiences or general comments below.

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