Dr Mark O’Brien, International Education Consultant, Cognitive Institute shared his thoughts about culture change in the health sector with RACS, drawing on his extensive experience in clinical leadership, safety and reliability improvement and organisational change.

A growing understanding of the link between non-technical performance and patient safety is shifting the culture of medicine and increasing the value placed on professionalism. The big drivers of future cultural shifts in the Australian healthcare sector will be generational change, closer links between funding and patient outcomes, and the impacts of COVID-19.

Dr Mark O’Brien said, “There’s already really great data to show that professionalism matters a lot…there are more infections, more complications and more re-admissions, because of the impact of unprofessional behaviour on coordination of care.”

Into the future, O’Brien is looking out for the cultural impacts of tighter links between patient outcomes and funding.

“Internationally there is a very significant trend among healthcare funders to move the dial on payment for healthcare services away from ‘process’ to ‘outcome’. The drivers and incentives are changing, and the focus is shifting from doing things, to rewarding the results. This is where the role of professionalism and a healthy culture comes in. The best patient outcomes result from optimal communication, co-ordination, teamwork, professionalism, engagement with your college and professional development – not just whether you did a technically good operation,” he said

Dr O’Brien thinks COVID-19 will accelerate the trend, with the recession increasing pressures on healthcare funding, possibly reducing rates of private health insurance and patients’ capacity to fund out of pocket expenses.

“I’m not sure anyone knows exactly how the dust will settle but I do think there will be significant change in the next 18 months. I suspect these pressures will see a focus by funders on value for money and patient outcomes that we haven’t seen before.”

Another emerging aspect of cultural change is generational, with generations x and y adopting a ‘different model of professionalism’.

“Younger professionals seem more willing to sacrifice some autonomy in exchange for security, access to leave, lifestyle and work conditions. In general, they don’t want to manage the business of being a doctor and are happier being managed than previous generations,” he said.

And then, there is the impact of increased procedural complexity.

“We are doing things now that we wouldn’t have dreamed of doing 30 years ago, and these advances have increased the pressure and stress on doctors.”

But resilience and burnout also affect professionalism, and O’Brien wonders if this is another area in which the impact of COVID-19 will be felt.

“How can surgeons boost resilience and avoid burnout – for themselves and for their teams. If it’s flagging, there will be poor patient outcomes,” he said.

O’Brien’s approach to professionalism is expressed in Cognitive Institute’s Speaking Up for SafetyTM programme and is linked to the Promoting Professional Accountability programme, a partnership between Cognitive Institute and Vanderbilt University Centre for Patient and Professional Advocacy.

He cites Professor Charles Vincent, ‘the Oxford guru on patient safety’, and his conviction that a ‘speaking up’ culture is central to patient safety.

“If you don’t have a speaking up culture, it will undermine everything else you do.”

“We look at everything through a patient safety lens, rather than a clinician behaviour lens.”

When it comes to patient safety and high performance, Dr O’Brien sees bullying and harassment as ‘a microcosm of a bigger picture’.

“Bullying and harassment are a subset of a range of performance disabling issues that can manifest in a team,” he said

Dr O’Brien is positive about RACS leadership in this area and encourages the College to be ‘aspirational around high performance’ and to continue to prioritise professionalism, emotional intelligence and resilience, as well as technical skills in selecting surgical leaders.

He wonders if professionalism holds the key to unlocking exceptional performance more widely in healthcare.

“What mindset, emotions, and environment do you create for superior performance? It’s not just about intelligence and technical ability, but we have yet to identify the systems, teamwork and processes that will create a high safety, high performance culture.”

This article was first published by RACS and is used with permission. RACS is globally recognised for its leadership in implementing a long term program of work to build respect and increase patient safety in surgery.

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