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As another year is drawing to a close, many of us may be feeling burnt out – not least our healthcare professionals, who have continued to soldier on past the COVID-19 lockdowns of 2020 and 2021.  

Despite a parallel pandemic of healthcare worker fatigue, we have yet to see a positive cultural shift towards promoting the health and well-being of health professionals, and in offering ongoing support to an already stretched workforce.  To the contrary, we have recently heard of junior doctors being threatened with negative actions for sleeping during night shifts – including putting strategies in place ‘to increase the night time workload’ and furnishing them with ‘less comfortable chairs.’

The concept of clinical governance includes how we conduct ourselves as individuals – that is, our ‘personal conduct’ in ‘controlling, regulating, directing or overseeing’ the ‘assessment and management of a person’s health to support optimal outcomes’, where ‘outcomes’ includes the ‘experience of care’.

Simulation in healthcare has traditionally been applied in the context of education and training. Whilst robust education and training (which may be achieved through simulation) will ultimately improve safety and quality, simulation can also be used much more broadly - and directly - as a tool in enhancing safety and quality in care delivery.

Continuous improvement is the essence of clinical governance. But continuous improvement requires change, and change can be confronting. As we predictably move towards a more digitised world - including in healthcare, and aged care – change is also inevitable.

As at July 2022, there were in excess of 642,000 health practitioners registered with the Australian Health Practitioner Regulation Agency (AHPRA).  In addition to this cohort, there are also non-registered health professionals who play an essential role in the delivery of care.

How does practitioner burnout impact care, and therefore clinical governance?  As Dr Stephen Parnis put it, from his perspective - and in his words - it “laid siege to my energy and my empathy”; “[D]ecisions and procedures that are usually second nature to me, now require considerable effort and cause more angst than they should”; and “[W]e are less efficient, and we are much more likely to make mistakes.”

The concept of ‘burnout’ was first described in the early 1970s, and has attracted media attention in recent years specifically in the context of healthcare. It is known to be particularly prevalent within certain demographics, compounded by the COVID-19 pandemic.  Burnout is not unique to acute health services, with evidence of its prevalence seen in other care sectors such as aged care and disability.

Compassion is an extension of empathy. It can be defined as ‘the feeling or emotion, when a person is moved by the suffering or distress of another, and by the desire to relieve it’. The desire to help distinguishes compassion from empathy - which, in contrast, may be defined as ‘the ability to imagine and understand the thoughts, perspective and emotions of another person.’

Psychological safety is an important tenet of safe and quality care - as is ‘physical’ safety.  In addition to injury from manual tasks, healthcare workers also face a risk of violence and aggression from patients themselves, particularly in emergency departments, mental health services, drug and alcohol settings, ambulance services and remote clinics.

Negative behaviours between healthcare workers are unfortunately common, and past research has demonstrated high levels of psychological distress amongst Australian doctors - putting their psychological safety at stake. Sadly, bad behaviours tend to cascade down the medical hierarchy, even impacting students.