Safeguarding Healthcare leads you through the intricate corridors of hospitals, taking you behind closed doors on an extraordinary journey. This is the podcast that holds a stethoscope to the beating heart of hospitals to reveal the reasoning behind the clinical governance decision making process.
Join host, Dr David Rankin, a 35-year veteran of medical administration, as he puts some of Australia’s most senior hospital managers in the hot seat to challenge them with major and often complex hypothetical challenges that reflect some of the most contentious issues facing modern medicine. This podcast offers an unfiltered view of the web of patient safety, medical ethics, and healthcare decision-making.
Discover how these passionate professionals navigate medical minefields, striving to ensure the highest standards of care, all while grappling with a broad and ever-evolving healthcare landscape. Whether you’re a seasoned healthcare practitioner, a patient seeking insight into the system, or simply curious about the inner workings of hospitals, this podcast offers an enlightening perspective on the complexities of modern medicine.
Latest Episode
20 November 2024 – The Incomplete Record
A patient complains, and a second surgeon raises questions about the outcome of an operation, but there’s nothing in the operation notes indicating that there was a theatre mishap or complication. In this episode of ‘Safeguarding Healthcare – the Essentials of Clinical Governance’, Dr David Rankin and Associate Professor Alastair Mah delve into the complexities of handling unrecorded incidents and patient complaints in medical administration. They discuss strategies for navigating this challenging scenario, ensuring patient safety, and maintaining professional integrity. They provide insights and practical solutions and outline how to implement effective quality improvement initiatives in healthcare settings.
DISCLAIMER: The views, thoughts, and opinions expressed in these Podcasts are the speaker’s own and do not represent the views, thoughts, and opinions of the Royal Australasian College of Medical Administrators (RACMA). The material and information presented here is for general information purposes only, and should not be considered health, legal or financial advice. The cases discussed in the Podcast may be specific to the speaker’s organisation or location, and may not be applicable to other organisations, states, territories or countries. RACMA does not endorse, approve, recommend, or certify any information, product, process, service, or organisation presented or mentioned in this Podcast, and information from this Podcast should not be referenced in any way to imply such approval or endorsement. RACMA will not be held responsible for any losses, damages, or liabilities that may arise from the use of this Podcast. The Podcast may contain descriptions of health incidents that may be graphic and triggering for some people, so listener discretion is advised.
All Episodes
A difficult decision for a conflicted family
A family is conflicted over how to care for a critical and deteriorating elderly patient who has prepared an Advanced Care Directive. What should you do? In this episode of ‘Safeguarding Healthcare – the Essentials of Clinical Governance’, Dr David Rankin and Prof George Braitberg AM crunch the complexities of medical administration in this situation. Faced with this challenging scenario, they explore the ethical and practical considerations of end-of-life care. Prof Braitberg discusses the nuances of Advanced Care Directives, the importance of transparent communication, and how to navigate family disharmony while adhering to the patient’s wishes.
The conundrums of clinical registries
What do you do if your hospital CEO questions the value of clinical quality registries? In this episode of ‘Safeguarding Healthcare’, Dr David Rankin tackles the complexities of clinical quality registries with Professor Susannah Ahern from Monash University. Professor Ahern’s work informs national registry policy and practice, including the development and implementation of the National Clinical and Virtual Registry Strategy. It’s a fascinating look at how these vital tools, essential for tracking patient outcomes and improving healthcare quality, are managed and funded. Professor Ahern explains the rigorous processes behind registry data collection, the role of clinician leadership, and how these registries help hospitals deal with the evolving landscape of patient care.
When Graphs Don’t Work
Surgical staff are highly intelligent but may not intuitively understand numbers and graphs. So what do you do if you find the reports you’ve been producing aren’t actually understood by their intended audience? In this episode of ‘Safeguarding Healthcare – the Essentials of Clinical Governance’, host Dr David Rankin is joined by medical administration veteran Dr Craig Margetts, to study the intricacies of data interpretation, clinician engagement, and the delicate balance between individual and group reporting. Dr Margetts provides insights into effective communication strategies and the practical approaches to jumping tricky hurdles.
Confidentiality Conundrums
What actions should a medical administrator take if confidential patient notes are sent to the wrong person? In this episode of ‘Safeguarding Healthcare – the Essentials of Clinical Governance’, host Dr David Rankin presents this challenging hypothetical to Dr Colin Feekery, a former Acting Director of Medical Services at Alfred Health. The pair unravels issues relating to privacy issues, the complexities of handling sensitive patient information and the critical importance of robust training and systems to ensure privacy compliance.
A complication coding conundrum
You are troubled by what may be an increased incidence of a normally routine surgical side effect. Where do you even begin to start troubleshooting? In this episode of ‘Safeguarding Healthcare – the Essentials of Clinical Governance’, host Dr David Rankin guides Dr Paul Tridgell through this challenging scenario. Together they explore the complexities of medical administration and the challenges it faces in measuring hospital-acquired complications. They delve into coding processes, risk adjustments, quality improvement strategies, and key lessons for enhancing quality and safety.
A Director’s Duty
What is Clinical Governance and what is the role of the Director of a healthcare organisation in ensuring the care that is provided is safe?
In this episode, Dr David Rankin takes an unfortunate scenario that is not uncommon in the modern hospital. He explores the meaning of clinical governance with a range of senior medical administrators and then looks at the role of the director. The episode explores ways to determine if your organisation is providing care that is evidence based, creates great patient experience and is delivered in the most efficient way.
To implement effective clinical governance, an organisation needs to move from a focus on compliance with policies and procedures to a culture where all staff are committed to providing safe and effective care through considering their contribution to each patient’s outcomes, experience and the efficiency of the care they provide.
Reference: Download a written summary of the key points of this special episode here.
A Doctor’s Deceit
What would you do if you discovered that one of your gynecologists had lied about their credentials? What are the implications for patients, staff, and the hospital at large? In this episode of ‘Safeguarding Healthcare’, Dr David Rankin discusses this challenging scenario with Dr Simon Fraser, Senior Medical Advisor at Medibank, and a Board member on a Victorian regional health service. The scenario highlights issues of patient safety, recruitment processes, and potential fraudulent behavior. This episode looks at the complexities of the credentialing process, patient care review, external expert engagement, media management, and the broader implications for clinical governance and organisational trust.
Scope of Practice Unbound
Where do you draw the line when assessing if a surgeon is qualified to undertake specific surgery? How do you determine their scope of clinical practice, and what happens if you have doubts? In this episode of ‘Safeguarding Healthcare’, host Dr David Rankin and Dr Leah Barrett-Beck explore a challenging scenario. Learn about the importance of credentialing, ongoing training, and ensuring patient safety in complex medical procedures, and gain insights into the evolving landscape of healthcare delivery while maintaining professional standards and fostering innovation.
Do Not Disturb
A registrar is found asleep with his phone turned off during a serious emergency. In this episode of Safeguarding Healthcare, host Dr David Rankin poses a scenario involving a senior obstetric registrar who fails to respond to urgent calls during a quiet shift. Dr. Rachel Cheong, the Director of Medical Services at Barwon Health in Geelong, responds to the hypothetical, offering insights into the key issues of clinical safety, professional behaviour, and wider organisational implications. The discussion delves into immediate actions, investigations, and support for the staff involved. Dr. Cheong emphasises the importance of maintaining a speaking-up culture and balancing confidentiality with public.
Sharing the Anaesthetic
How do you deal with an anaesthetist who may have been sampling leftover fentanyl? In this episode of “Safeguarding Healthcare – the Essentials of Clinical Governance,” Dr David Rankin explores a complex scenario involving suspected drug misuse, unravelling the intricate threads of patient safety, staff well-being, and organisational culture. Dr Sue Nightingale, a seasoned psychiatrist and former Executive Director Clinical Governance, Education and Research at Sunshine Coast Hospital and Health Service, offers insights into the challenges facing medical administrators when confronted with such issues. From ensuring patient safety and conducting thorough investigations to supporting staff and facilitating rehabilitation, this episode navigates the delicate balance between vigilance and compassion in medical administration.
Learning the Scalpel Arts
In this episode of ‘Safeguarding Healthcare’, Dr David Rankin delves into the complexities of medical administration with guest Dr Bahare Moradi, the Acting Director of Medical Services at the Royal North Shore Hospital in northern Sydney. Together, they dissect a common scenario involving a surgical registrar facing a challenging appendectomy. Dr Moradi highlights the delicate balance between patient safety and providing learning experiences for trainees, emphasising the need for structured support systems within hospitals. They discuss strategies for ensuring young doctors seek help when needed and navigating the dynamics between junior and senior staff.
Compliance Crunch
Compliance issues can be fraught. Engaging senior staff can be more like herding cats. In this episode of ‘Safeguarding Healthcare’, Dr David Rankin highlights the challenges faced by medical administrators focusing on the low compliance rates among hospital staff, especially senior medical professionals, with essential training requirements such as hand hygiene, emergency procedures, and cultural awareness. Dr Mainak Majumdar, the Director of Intensive Care Services at Mercy Hospital, provides insights into the root causes and potential solutions for this issue, emphasising the importance of ensuring communication is patient-centric and that medical staff understand their accountability.
A shocking sterilisation surprise
What would you do if you found surgical instruments not being sterilised? In this episode of ‘Safeguarding Healthcare – the Essentials of Clinical Governance’, Dr David Rankin presents such a scenario to Professor Mary O’Reilly, Chief Medical Officer at Austin Health in Melbourne and an infectious disease specialist. Together, they navigate the aftermath of a potential sterilisation oversight involving endoscopy equipment. From assessing patient risk to addressing system failures and ensuring transparent communication with patients, Professor O’Reilly explains the steps that need to be taken. The discussion highlights the importance of proactive measures, open disclosure, and fostering a supportive, blame-free culture within healthcare teams.
Clashing clinical cultures
In this episode of ‘Safeguarding Healthcare – the Essentials of Clinical Governance’, Dr David Rankin explores the complexities of medical administration with Dr Paul Eleftheriou, Principal at Nous Group and former Chief Medical Officer at Western Health. They discuss a hypothetical scenario where tension between medical and nursing staff has contributed to a patient’s avoidable death, emphasising the pivotal role of culture in clinical governance. Dr Eleftheriou highlights the need for structured approaches, diligent diagnosis of problems, and strategic interventions, whether through internal collaboration or external support. By focusing on motives, implementing clear expectations, and leveraging resources, they conclude that it is possible for medical administrators to navigate and transform challenging organisational cultures to safeguard patient care effectively.
AI deceptions in healthcare
How will artificial intelligence influence healthcare in the near future; what is the potential and what are the pitfalls? In this episode of ‘Safeguarding Healthcare – the Essentials of Clinical Governance’, host Dr David Rankin challenges senior healthcare administrator and healthcare futurist Professor Erwin Loh with a striking scenario. Together they delve into what to do when AI makes a mistake, explores biases, grapple with legal implications, and unravel the potential of AI to revolutionise medical decision-making. And they navigate the ethical and practical concerns that are raised. Listen to gain insights into the evolving landscape of AI in healthcare, and what the near future may hold.
Policeman or coach?
What would you do if a senior psychiatrist was slacking off, and staff had gone behind management’s back to report the matter? In this episode of Safeguarding Healthcare, Dr David Rankin presents Dr Leigh Haysom, the Clinical Director of Adolescent Health and Director of Medical Services for NSW’s Justice Health and Forensic Mental Health Network, with this difficult scenario. Dr Haysom offers insights into the complexities of managing poor performance and navigating potential legal ramifications. From addressing communication breakdowns to restoring trust among staff and executives, this episode explores essential elements of clinical governance.
Improving Quality Improvement
In this episode of ‘Safeguarding Healthcare – the Essentials of Clinical Governance’, host Dr David Rankin interviews Professor Andrew Johnson from James Cook University, a veteran medical administrator now working as a consultant. They dissect the importance of measuring improvement effectively and addressing risk tolerance within the hospital system. Prof. Johnson suggests a shift in focus towards understanding and managing complexity in healthcare systems. The conversation offers practical strategies for enhancing compliance, monitoring care processes, and building resilience to tackle unexpected events.
Culture Eats Strategy for Breakfast
In this episode of “Safeguarding Healthcare – the Essentials of Clinical Governance,” Dr Liz Mullins, the Director of Medical Services for Bega Valley Health Service, discusses engaging surgical staff in quarterly specialist craft group meetings with host Dr David Rankin. They address issues of relevance, consultation and the importance of mutual benefit. Dr Mullins emphasizes the need for proactive engagement, personalized communication, and the role of directors of medical services in fostering a culture of trust and collaboration. The conversation extends to meeting dynamics, system-focused approaches to problem-solving, and practical strategies for improving attendance and measuring medical engagement.
Deciphering Consent
What does a medical administrator do when a patient who suffers complications from surgery complains that they weren’t warned? In this episode of Safeguarding Healthcare, Dr David Rankin delves into the intricate world of informed consent with Dr Tony Sara, who is a Medical Advisor at South Eastern Sydney Local Health District, President of the Australian Salaried Medical Officers’ Federation and a fellow of the Australian Institute of Digital Health. Their discussion explores various aspects of informed consent, from legal principles and nuances to the use of interpreters, consent in emergency situations, and more. Dr Sara highlights the responsibility of medical managers in monitoring complication rates and taking action when necessary.
Pillar of the Community
What does a Medical Administrator do when an aging, small town local doctor, in a region with medical staff shortage, starts to get too tired and makes mistakes? In this episode of Safeguarding Healthcare, host Dr David Rankin is in discussion with Associate Professor Kathleen Atkinson. Kath is a very senior clinician and medical administrator with over 35 years’ experience as a rural generalist. She has held health leadership, medical education and clinical governance roles in Tasmania, New South Wales, Queensland, WA and the Royal Flying Doctor Service. They explore a common scenario of an aging rural GP facing burnout and discuss the implications for patient safety. The podcast delves into the complexities of supporting aging practitioners, managing confidentiality, and the need for a sustainable and attractive career path for the future medical workforce. Join Dr Rankin and Professor Atkinson as they navigate the landscape of rural healthcare, offering solutions.
The Art of Departmental Management
What are the best approaches to being an effective medical department manager — even if you come to the job reluctantly? In this episode of Safeguarding Healthcare, host Dr David Rankin speaks with Dr Simon Collins about the challenges faced by medical department heads, focusing on a hypothetical scenario involving tensions between emergency and anaesthetic departments. The episode covers issues like ensuring safe coverage, managing relationships with other departments, addressing after-hours attendance, and educating junior doctors. Dr Collins, who is the Acting General Manager and director of Medical Services at Bankstown Lidcombe Hospital in the Southwestern Sydney Local Health District, provides insights into building credibility, handling moonlighting, and fostering collaboration between critical care departments.
Treating Tragedy with Restorative Justice
When an inpatient takes his own life, it sparks myriad issues and concerns for any Medical Administrator. In this episode, Dr David Rankin and Dr Nick O’Connor explore the challenges of Medical Administration in this tragic scenario, through the lens of the restorative justice approach. Dr O’Connor is the Clinical Lead of the Mental Health Patient Safety Program for the NSW Clinical Excellence Commission. He is a psychiatrist with more than 25 years’ experience in clinical leadership and assessing medical practitioners for the NSW Medical Council. David and Nick discuss the hypothetical case of Ed, a psychiatric patient who experiences a devastating outcome. This episode emphasizes a shift from blame to systemic understanding, tackling issues like psychological safety and compounded harm.
Keeping sight of patient safety
How would a seasoned Medical Administrator handle a doctor whose eyesight is failing? In this episode of Safeguarding Healthcare Dr David Rankin delves into the complex world of medical administration with the Deputy Chief Medical Officer and Former Head of the Gynaecology Unit at Western Health, Dr Rupert Sherwood. Dr Sherwood is presented with the challenges and dilemmas raised by a scenario involving a seasoned gynaecologist whose deteriorating eyesight raises concerns about patient safety and the potential impact on their clinical practice. Dr Sherwood candidly discusses the sensitive issues surrounding this situation, including the need for a confidential, supportive, and well-documented approach. The conversation offers perspectives on balancing patient care, professional integrity, and the emotional and financial considerations that come into play.
An infant lost: navigating ethical quandaries
In this episode of Safeguarding Healthcare, we look at what would happen in a hospital when a newborn dies after a mother and midwife choose to ignore hospital protocols. Host and veteran medical administrator Dr David Rankin presents a senior NSW Health Ministry medical advisor, Dr Paul Douglas, with this hot-button scenario, in a medical landscape where patients are demanding more say in their care. Dive into the heart of the matter as they discuss patient autonomy, policy adherence, and the profound impacts such cases can have on medical team members — some of whom will be traumatized, while others are left angry. Gain insights into the crucial role of documentation, and the pursuit of a culture that prioritizes patient well-being.
Considering the passioned proposal
In this episode of Safeguarding Healthcare, seasoned medical administrator Professor Gavin Frost and host Dr David Rankin discuss the complex scenario of a young, enthusiastic surgeon who is proposing a novel technique for pediatric diabetes management. They discuss the challenges, considerations, and stakeholder involvement necessary for such a venture, from the importance of research and evidence to engaging with various professionals and organizations. Prof. Frost’s insights and advice on clinical governance provide a perspective on ensuring the safety and success of innovative medical initiatives, and how they might, or might not, be tackled.
Contagious insights – managing worsening infection rates
In this episode, another senior medical administrator is confronted with a challenging scenario: how to address high hospital-acquired infection rates. Clinical governance veteran Dr David Rankin speaks with Dr Peter Lowthian, who has worked as a Director of Medical Services and who currently serves on the boards of a large private hospital and the Australasian Cardiac Surgery Research Institution. The two discuss infection issues, particularly focusing on urinary tract infections in orthopedic wards, emphasizing the importance of data accuracy, involving clinicians in data collection, and individualized data feedback to drive accountability and change.
An auditing avalanche
In this episode of Safeguarding Healthcare, we take a deep dive into the world of healthcare audits, their benefits, and pitfalls. Clinical governance veteran Dr David Rankin speaks with Brigadier Dr Darrell Duncan, a highly experienced administrator who is currently responsible for reviewing the standards of care provided to members of the Australian Defence Force. Dr Duncan emphasizes the need to shift from compliance-focused audits to a patient-centric, continuous quality improvement approach. And he highlights the importance of identifying risks through staff engagement and effective communication, fostering a culture of accountability, involving medical staff in the audit process, and fully integrating quality improvements.
The clinical governance grey zone
Let veteran medical administrator Dr David Rankin be your guide through another minefield, as he challenges a senior hospital medical administrator with a staffing situation that threatens to impact patient safety. Dr Rankin explores a complex scenario involving an aging senior surgeon with Professor Alan Sandford AM, the Director of Medical Academic Development – Regional Medical Pathway, Central Queensland & Wide Bay Hospital and Health Services. Explore the ethical dilemmas surrounding aging medical professionals, the duty of care to patients and colleagues, and the delicate balance of maintaining respect while addressing performance concerns. And learn about the strategies for gracefully transitioning senior staff members, while ensuring patient safety.
Navigating the nightmare of wrong site surgery
What should administrators do and what’s best for the patient and the hospital when a terrible mistake takes place? In this episode of “Safeguarding Healthcare”, Dr. David Rankin hosts Dr. Helen Parsons, the District Director Medical Services for the Nepean Blue Mountains Local Health District, as they delve into a nightmare scenario – a wrong-site surgery. Learn about the protocols, patient safety, ethics and legal consequences that emerge after a patient suffers from this terrible mistake, and explore necessary immediate actions, the formation of review teams, and the importance of a no-blame culture in preventing recurrences.
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