My commentary on the state of play for Discrimination, Bullying and Sexual Harassment in the Medical Profession.
Part 4 – Where to from here?
I would suggest the following recommendations:
1. Empower junior (and senior) doctors
This is a broad and ambitious goal. It includes:
- Work to shift the frame away from ‘supporting those who are struggling’ and rather toward ‘a collective culture of positive growth – nurturing our doctors so that everyone can thrive’
- Widespread access to programs to build resilience (e.g. Resilience on the Run piloted by AMAQ in 2015)
- Peer support groups: informal settings: give permission to struggle and permission to seek help
- Teach junior and senior doctors strategies to deescalate conflict and tension
- Within organisations, ensure a strict distinction between a mentor and a supervisor/assessor; between an advocate and an employer. In addition, a mentor should be familiar and visible in the immediate work area.
- Start all of this learning in medical school. Some university courses eg Notre Dame WA, Griffith University Qld hold dedicated lectures on Mindfulness.
It is important to note that increasing resilience in workers is not a substitute for correcting deficits in culture, systems or processes. However, it is still a meritorious aspiration in its own right.
2. Organisational commitment to cultural change
A real and meaningful one, not just a strategy or a document. This will likely take the form of a generic template but adapted to local issues and contexts.
It includes:
- Organisational culture whereby Professional Development Plans (for senior and junior doctors) include discussion on non-technical skills – perhaps using 360 degree or a mini-PAT (mini-Peer Assessment Tool) assessment styles.
It has been suggested at leaders within health organisations should report Key Performance Indicators (KPIs) that relate to staff satisfaction with their leadership, and held accountable for deficits in this sphere. Read more about this by downloading the following document:
Nine Organizational Strategies to Promote Engagement and Reduce Burnout (PDF)
- Breaking down the military-style hierarchy and culture that exists for hospital doctors: Unit directors need to take ownership of unit culture – prompt supervisors to seek out junior doctors who may appear to need extra support; have the courage to counsel senior colleagues who model undesirable and unprofessional behaviour and attitudes.
- Robust process for how a complaint will be handled including protection of the complainant, fair exploration of the issue (ensure “accused” is treated justly), meaningful action and response that leads to a visible/palpable change in the situation, and ensuring that the perpetrator is supported to change behaviour*
*In my experience, when you tell a doctor (junior or senior) “This is how your behaviour is affecting those around you/This is how you are perceived”, the majority (perhaps 80%) will respond with “Thank you for telling me. I wasn’t aware. I will be mindful of this” and the issue resolves. Very few come to work each day with the intent of making a colleague unhappy.
Summary
In summary, this is simply asking a group of educated and talented people to be civil/kind/compassionate towards each other. If we are in the business of caring for the community, we should be able to care for each other.
