The Ethos Program: Re-defining Normal

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1 The Ethos Program: Re-defining Normal Dr Victoria Atkinson Group Chief Medical Officer Group General Manager Clinical Governance Cardiothoracic Surgeon 1

2 1. Background Unprofessional behaviours are creating a culture that is putting staff and patients at risk. 2

3 Vanderbilt version

Poor behaviours affect operational efficiency and revenues Evidence indicates that early intervention can

4 1. Background Poor behaviours increase surgical complications, hospital acquired infections, medication errors and adverse outcomes. Poor behaviours affect operational efficiency and revenues Evidence indicates that early intervention can prevent minor inappropriate behaviours from escalating into bullying and harassment. Cultural change is created through conversations Our aim is a kinder, safer and more reliable healthcare system 4

5 It s all about safety The impacts are felt by: Patients; linked to safety, errors especially in procedural areas and patient complaints Staff; turnover and retention and associated recruitment costs, reduced productivity through poor morale and demands on management time, OH&S, training impact, reset career goals, suppresses ideas, Institutions; stifles potential, significant legal costs and reputational damage, economic cost, propagation of culture 5

6 Policies and Processes Finally the answer 6

7 Or not..no Difference 7

8 Where s the Evidence? Studies across NHS, Canada, USA and Germany including a Joint Commission review in 2008 Worst perpetrators are only 2-3% of staff but their influence casts shroud over entire hospital; directly or through others 2/3 of nurses reported being abused by other nurses or physicians in last 3 months 44% were dissatisfied at work, with 21% planning to leave within 12 months So what is normal professional behaviour for the other 98% of staff? 8

Prevalence of bullying/harassment in the health sector 49% Fellows, trainees and IMGs report being subjected to BHSD 54% trainees and 45% fellows <10 yrs report being bullied 71% of hospitals

9 Prevalence of bullying/harassment in the health sector 49% Fellows, trainees and IMGs report being subjected to BHSD 54% trainees and 45% fellows <10 yrs report being bullied 71% of hospitals reported BHSD within last 5 years, mostly bullying Across all specialities Senior surgeons and consultants the primary source problems Prevalence of bullying/harassment in the health sector not conclusively known Research suggests it is widespread 25% of employees in the health sector have reported experiencing bullying the highest of all Victorian public sector agencies 40% of nurses and 39% of surgeons reported experiencing bullying.

Training Medical Staff Abuse and Discrimination in Medical Registrars (Canada) 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Psychological Gender Discrimination (F) Gender Discrimination (M) Sexual

10 Training Medical Staff Abuse and Discrimination in Medical Registrars (Canada) 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Psychological Gender Discrimination (F) Gender Discrimination (M) Sexual Harrassment (F) Sexual Harrassment (M) Physical assault SMS Peers (incl nursing) Patients Cornelia H.M et al. Discrimination and Abuse in Internal Medicine Residency (1996). J Gen Intern Med 1996; 11:

11 Is Gender Important? 11

12 Genders

13 What about Gender? Women in healthcare are twice as likely to experience all types of bullying and harassment as men 13

14 Gender at SVHA; How do we rate?

15 SVHA Non-Medical Workforce Gender 100% SVHA Non-Medical Workforce Gender 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Executive Senior Mx Middle Mx Clinical (ex. Medical) Admin Other Male Female Column1 15

16 SVHA Medical Workforce Gender: Public Division Proportional Medical Staff Gender Distribution: Public Division 100% 90% 80% 70% 60% 50% SMS 31 % female 40% 30% 20% 10% 0% SMS Registrars / Fellows HMO Interns Medical Students Male Female 16

vs SVHM 47% 50% 40% 30% 20% 65 55 83 57 67 83 72 53 Surgery at SVHS 8% female vs SVHM 22% 10%

17 SVHA Medical Workforce Gender: Speciality Breakdown SMS Gender Breakdown By Speciality Area : Public Division 100% 90% 80% 70% 60% General medicine SVHS 31% female vs SVHM 47% 50% 40% 30% 20% Surgery at SVHS 8% female vs SVHM 22% 10% 0% Anaethesia Emergency Medicine ICU Medicine Radiology Surgery Mental Health Pathology Male Female 17

18 What are the root causes? VAGO report found that across the health sector: poor accountability for inappropriate behaviour a double standard where some individuals are perceived as untouchable widespread under reporting due to: belief that the reported behaviour will not be addressed distrust of human resources departments fear of repercussions normalisation and acceptance of inappropriate behaviour particularly among junior doctors. 18

19 What are the root causes? The health sector has an entrenched clinical hierarchy. Environments can be insular; especially procedural areas. Tradition plays key role in culture. Career still dependent on reputation, references and word of mouth; even as VMO. Clinical prowess still valued much more than behavioural exemplars. 19

20 Promoting Professionalism: Addressing Behaviours that Undermine a Culture of Safety, Reliability and Accountability 20

21 Background Vanderbilt program is built on the premise that most staff are good people, doing the right thing for the right reasons Honours people who are behaving well Based on peer accountability, peer messaging and peer comparison Create micro / macro environments to intervene early & often Data and safety driven interventions These systems enable the right culture 21

22 Patient and staff observations gathered through reporting system Observations are triaged into a tiered accountability model which aligns with human resource processes and laws 22

23 Vanderbilt version

24 Page 24

25 The Ethos Program Redefining Normal

26 The Ethos Program SVHA has a long legacy of living our values through professional practice. We feel safe We feel welcome We feel valued 26

27 The principles of the Ethos Program are: All SVHA staff are entitled to a safe workplace We will encourage, acknowledge and reward behaviours that reflect our values. Our response to behaviour that undermines patient or staff wellbeing will be consistent, transparent and equitable. Our staff are given an opportunity for reflection and self-regulation Particular attention will be paid to vulnerable groups e.g. trainees, junior staff. Diversity and gender balance are central to organisational strength. 27

28 Building Cultural Identity Building Cultural Identity Cultural Training / communicaton Orientation Recruitment Performance management Gender diversity / equality Build external partnerships Accountablility Equitable, consistent and transparent Tiered intervention model Signed behavioural declaration Aligned with internal HR policies / by laws Aligned with laws / legislation Internal Governance Reporting Electronic reporting app / database Positive or negative event report Safe voice; anonymous / confidential Patient observations Staff observations Behavioural and safety events 28

29 Login and report behaviour Can remain anonymous Reports assessed by trained triage team Response determined by Ethos model Dependent on severity of event / number of related reports 29

30 The SVHA Ethos model 30

31 Building external relationships: Creating the Web 31

32 Communication current model Facility Support services Staff member Regulatory board Professional College 32

33 Communication Creating a web Facility Regulatory board Staff member Support services Professional Colleges 33

34 Research and Evaluation Working with Jeffrey Braithwaite and Johanna Westbrook from AIHI Macquarie University on NHMRC partnership proposal Work with Vanderbilt University Medical Centre on collaborative research Explore partnerships with other health services 34

35 35

Our pathway for change: eliminating bullying and harassment in healthcare

Our pathway for change: eliminating bullying and harassment in healthcare Janelle Hearn Principal Project Manager Health Service Programs Department of Health and Human Services 12 October 2016 Addressing