Resources

We think of consumer safety primarily in terms of physical harm. But consumers often conceptualise safety as ‘feeling safe’, as well as ‘being safe’.  

Violating a consumer’s emotional safety while avoiding physical harm is not yet embedded in consumer safety reporting. We know that consumers can experience emotionally harmful experiences as they navigate health services, such as: disregard for their opinion, not being listened to, rudeness and abuse. Are we doing consumers and families a disservice by ignoring or denying harm that doesn’t fit our organisational definition?

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.’

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.”

Medical error remains rife. The Australian Institute of Health and Welfare reported 26,995 potentially avoidable deaths in 2020 among people under the age of 75 in Australia. While this ‘age-standardised’ rate has been the lowest reported in 10 years, there is clearly room for improvement.

Saying sorry is an important element of open disclosure and psychological safety – and therefore clinical governance. It is also an extremely powerful yet simple way to make people ‘feel better’. Saying sorry conveys empathy, compassion, and respect towards the person receiving the apology, not to mention remorse. It acknowledges an acceptance that your actions (or words) can adversely impact others, and is the opposite of defensiveness (which is counter-productive). Apologising is not taking the blame, nor is it an admission of liability. Saying sorry is about being accountable, accepting responsibility, and restoring trust in a relationship.

It’s not just what we say, it’s how we say it. We know effective communication is key to patient safety and quality, and person-centred care. But it is also crucial to psychological safety and the extent to which we support each other in speaking out, or in asking questions. This in turn will impact patient care.

In childhood, we shun the ‘dibber dobber’, or the ‘tattletale’. As we mature into adulthood, we learn to distinguish ‘dobbing’ from an acceptable calling out of wrongdoing. However, in the context of care giving (whether healthcare or otherwise), speaking up is crucial to safety.

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.

Although boards are ultimately accountable, and responsible for oversight and strategic direction, clinical governance begins and ends with those who deliver clinical care. We have previously suggested that ‘culture impacts how individuals feel in workplace - and in turn the manner in which they conduct themselves.’ Do they feel supported in the workplace - or are they afraid to seek help? Do they feel safe to speak up if they have any concerns? Do they feel free to share their ideas, mistakes, and feedback - fostering a learning and collaborative environment, in a united vision to deliver optimal care?

Governance, leadership and culture together form one pillar of the National Model Clinical Governance Framework.  ‘Culture’ in particular is a somewhat nebulous concept - what does it really mean, and what is its role in clinical governance?