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Fostering a culture of safety during COVID-19

Dr. Diana Badcock, Chief Medical Officer and Executive Director of CLinical Governance at Bendigo Health describes the steps they are taking to encourage a positive workplace culture in a stressful and volatile working environment and why this is important for safe and quality patient care. 

Disclaimer

The Challenge:

Knowing that people's attitudes, moods and behaviours are influenced by the situations they are in, the challenge was to guide clinicians through the uncertain, ever-changing and stressful environment they are now working in to ensure it doesn't affect patient safety and quality care. (00:01:14) 

The Solution:

  • Working to improve medical workforce rostering
  • Adding additional leaders to support clinicians, particulary junior doctors
  • Developing a framework that ensures two-way feedback and self-reflection to help clinical directors manage their technical and non-technical staff members (00:04:51)

The Impact:

Staff members have reported they are enjoying the new framework as they feel like they have a voice and that their needs are heard by the relevant people. (00:07:35)

Stephen Warrillow

Dr. Diana Badcock

Diana was born in Cambridge and qualified as a doctor in 1986 at Charing Cross Medical School, after a brief stint doing medical publishing in Honk Kong and a year working in Vietnamese refugee camps. She began working at Bendigo Health in the mid-1990s, where she trained part-time as an Emergency Medicine Specialist, FACEM, and became Director of Emergency Medical Training.

Diana gained recognition as an Associate Professor with Monash Medical School from leadership in establishing Emergency Medical Education Training Hub for Primary Care Physicians providing emergency care rurally and regionally, and promoting EM as a specialty for the Loddon Mallee region. She achieved a Rural Doctor Award in 2011.

She has held a number of roles during 25 years at Bendigo Health. Clinical Director of the Emergency Department, Chief Medical Informatics Officer and Clinical Director of Acute Ambulatory and Critical Care. Her current role encompasses Chief Medical Officer, Executive Director of Clinical Governance and Executive Director of the recently established Public Health Unit in Bendigo.

Diana won the ACEM 2019 John Gilroy Potts Award as co-author in BMJ publication on Scribe research. She is passionate about delivering realistic healthcare that adds value to the patient’s quality of life.

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Video transcript

Melanie Hay:

Welcome to another episode of Connecting Clinicians. Today, we'll be speaking with Diana Badcock from Bendigo Health, who is not only the Chief Medical Officer there, but also the Executive Director of Clinical Governance. Today, Diana will be sharing with us the work that Bendigo Health have been doing in providing a culture of safety during this particular time with COVID. So Diana, welcome today and I look forward to hearing what you have to share with us.

Diana Badcock:

Thank you very much, Mel. My name is Diana Badcock. I am, as has been said, the Executive Director of Clinical Governance and I'm the Chief Medical Officer. My background is in the emergency department. So I've been the director of the emergency department for some years. And for most clinicians, what matters most to us is the safety of our staff and our patients, and delivering quality care. So we've tried really hard to move on that notion of what matters to me.

(00:01:14)What we know about safety in a very global way is that people get very affected by the mood around them, the behaviour they witness. And so if you see someone smile, chances are you smile. If you see somebody belittling and bemoaning, chances are you do the same thing. So our attitudes, our beliefs, our behaviour, they have a background, but then they also are fine-tuned by the situation we find ourselves in.

What we then know is that the quality of care I can deliver is very much then affected by how I feel. And the bad behaviour I might have witnessed, but I don't need to have it directly affected me. And yet, it will affect my ability to perform. In the same way as someone I might not see that day might be very happy, they've projected some happiness onto somebody else. And that also affects me. So it's this ripple effect, like throwing a pebble into the ocean and it just ripples out.

And so that background of you being the best that you can be, has never been more important than in this very uncertain, challenging time that we're calling COVID, where people need to be adaptable and agile of thought and behaviour. They have to be happy to sit with a level of uncertainty because one day the message is no masks, and then the next day the message is masks. So for people, this polarity of advice is conflicting and it causes discomfort and stress, above and beyond the level that they would normally have.

They'd normally have quite a clear role. They would normally have quite clear directions. People who work and live in environments that are a little bit more random and ad hoc, they tend to attract people who can live with that uncertainty. So the emergency department, one day you go in and it runs fairly predictably, and then another day there's a bush fire or thunderstorm asthma, or something that changes. And you've got to change direction on a dime.

So I think what we've done at Bendigo Health is the culture of the actual organisation for a long time has been looking at leadership. There's been management programs, we've had the Studer way of thinking and doing things, really trying to hone in on those softer skills, which works well for the nursing and allied staff who are within the organisation and they're employed that way. But for the doctors, they're employed in a different way and so you have to tackle that slightly differently.

(00:04:51) So the simple things we tried to do early were putting in recharge stations. Are you hungry, angry, late or tired? Here we go. Here's a basket of apples and some muesli bars. There we go. These things around the organisation that really try and help to make a difference. But really, if your roster is shit and everything around you is not looking like it's reinforcing that we're trying to make you the best that you can be, then that doesn't help. So we've put a lot of time looking at medical workforce rostering, how we support people with additional leaders to go to, especially for the junior medical staff.

And then in the clinical director's realm, we've put a lot of time developing an excellent doctor framework, which goes alongside of what we're expecting when we do our performance reviews. So looking at the doctor as a healer, as a teacher and a learner and a manager, leader and innovator. But then within that, looking at self and doing a lot around what's your purpose here? Is the things that you're doing and the stuff that we're supplying you with to help you, is that working? Now, people can hone in on the technical stuff very quickly, but the non-technical stuff, what is it that we need to do to make sure you are working to your strengths? We need people to be working in their area of strengths and somebody else should be picking up the slack in their areas of weakness.

We all have things we're good at. We all have things we're good and not so good at. When I was doing the ED rostering, I used to talk about, you need a hare and a tortoise. You need a hare who's on the roster, who's working through flow. At the same time, you need a tortoise who's going around, methodically ensuring that their medical students know what they're doing, that the patient's relations are happy. So it has to be a two pronged method of then giving everybody a hug because that's what they need. And they never have needed it more than now. We can only do that if we're the best that we can be. So a lot of time, trying to ask people to self-reflect.

(00:07:35) We've started doing Wednesday weekly webinars, and look, we're getting some great feedback on people loving that, getting feedback, again, not hard, measurable stuff, but people who are feeding back loving what it is that we're doing for people who felt like a bit of an imposter, like their voice hasn't been heard to this point. We've got WhatsApp groups happening where people are chatting. The trouble with social media is sometimes we all get it a bit wrong. You don't mean to upset people, but there will be unintended consequences when you're just pushing the boundary of what people normally don't do. So expect that, but I think together, we can grow stronger.

We must be really respectful of people's attitudes, beliefs, behaviours, and allow them to get it wrong. Learn forgiveness, learn actually to try and push towards a blameless culture. And actually, the only way that happens is when they're looking at you. So we're doing a lot of self-reflection and trying to drive the leaders, the clinical leaders to do 360s and to sign up with their CME because they can't travel overseas with the COVID, but to look at leadership and personal development as their number one priority. Thank you. I hope that's been helpful.

Melanie Hay:

Thanks so much, Diana. That's fantastic. Thanks for sharing that with us today. I'd also just like to take a moment to thank you for all the hard work that we know has been going on at Bendigo Health, and just for yourself and your team. So just a very big appreciation and thank you from us.

Diana Badcock:

Thank you. I would like to say just as a last parting gesture, we have really tried to support our regions. This is a very difficult time for the rural and regional communities, and just really saying to our regional partners, please, if you're unsure, if you're unclear, we are here to be the safety valve in anything that you're not happy with.

So again, that will ebb and flow depending on the people, the person, the place and the position in time, but allowing them the forgiveness of not necessarily following the policy or the process as per usual, because it doesn't sit well with them for the day. So really, just trying to do this all for one and for all kind of approach.

Melanie Hay:

Thank you. So in closing, I'd just also like to welcome anyone else to come forward if they'd like to share a similar story of how their organisation has been, not only facing these challenges during COVID, but overcoming them. If you'd like to connect in, please email us info@aicg.edu.au. So until next time, stay safe and kia kaha.