THE QUARTERLY Royal Australasian College of Medical Administrators Q1 2023 2023 RACMAMembership Survey - a summary Page 10 New Era for College with Digital Health Committee Page 14 TowardsBetter:WhyWeNeed to RecultureMedicineNow Page 8 New Era for College with Digital Health Committee
3 2 | THE QUARTERLY Q1 2023 Contents 04 President's Report Dr Helen Parsons makes a call to action on clinical governance in the health systemand the role of RACMA in the space. She also covers off some of the College’s strategic projects in train for this year. 08 Towards Better: Why We Need to Reculture Medicine Now Culture of Medicine Project Manager Dr Jillann Farmer provides an analysis of the latest Medical Training Survey results and the challenges involved in addressing the ongoing bad behaviour across the medical profession. 10 2023 RACMA Membership Survey - a summary Results from the 2023 RACMA Membership Survey have provided a snapshot view of the membership with a lower response rate compared to previous years. 12 Cultural Safety Training for Aotearoa Medical Education ThefirstCultural SafetyTrainingPlanworld-wide tobe implemented into the curriculum of medical specialist training will mark a turning point in New Zealanders experiences with their doctor. 14 NewEra forCollegewithDigital HealthCommittee Dr Monica Trujillo and Dr Oliver Daly have been appointed by the RACMA Board as the inaugural co-Chairs for the College’s Digital Health Policy and Advocacy Committee. 16 AdvancingWomen in Healthcare Leadership Update AWHL continues to expand and grow its reach, continuing with a strong focus on women’s leadership training and progressing on the development of implementation of system-level interventions within the partner organisations. 18 How Accreditation Practices Impact Building a Non-General Practice Rural Specialist Medical Workforce The Accreditation Project was initiated to consult with stakeholders on the impact specialist medical college accreditation systems have on the ability of health care settings to deliver more rural, regional and remote non-GP specialist medical training. 22 Reviewof theRACMAConstitution The College’s multi-year review of the RACMA Constitution is coming to a head with an Extraordinary General Meeting expected in the second half of 2023 to vote on the proposed amendments. The College was founded in 1967 as the Australian College of Medical Administrators and attained its Royal prefix in 1979. In August 1998, when links with New Zealand were formally established, the College changed its name to The Royal Australasian College of Medical Administrators. RACMA is a specialist medical college that provides education, training, knowledge, and advice in medical management. Recognised by the Australian and New Zealand Medical Councils, it delivers programs to medical managers and other medical practitioners who are training for or occupying specialist leadership or administration positions. It is the only recognised way you can become a Fellow in the speciality of Medical Administration. 2023 Office Bearers President: Dr Helen Parsons CSC Vice President: Professor Erwin Loh Chair Continuing Education Program Committee: Dr Greg Watters Chair Education & Training Committee: Associate Professor Pooshan Navathé Chair Finance & Audit Committee: Professor Alan Sandford AM Censor-in-Chief: Dr Darrel Duncan Chief Executive: Mr Cris Massis The Quarterly is the journal of The Royal Australasian College of Medical Administrators (RACMA). It is published quarterly and distributed throughout Australia and New Zealand to approximately 1,000 College Fellows,Associate Fellows, Affiliates and Candidates, as well as selected libraries and other medical colleges. The Quarterly is prepared by staff of the RACMA Secretariat. The Quarterly contents may be reproduced without permission from the Editor providing ‘RACMA Quarterly’ and the issue date are clearly shown; and where relevant, authors or other publishers are cited. Opinions expressed by editorials and articles in The Quarterly are those of individual authors and do not necessarily represent official views or policies of RACMA. ISSN 1325-7579 ROYM 13986 Honorary Editor: Dr Andrew Robertson Publisher: The Royal Australasian College of Medical Administrators 1/20 Cato St Hawthorn East VIC 3123 Australia ABN 004 688 215 Tel: 03 9824 4699 Email: quarterly@racma.edu.au Online: racma.edu.au Connect with Us
4 | THE QUARTERLY Q1 2023 From the President 5 As Medical Leaders there are numerous times in any one day where our decision-making and judgement calls come under fire from various colleagues – no matter the outcome. Our scope of practice, roles and responsibilities are complex and the pressure to ensure the overall quality and effectiveness of healthcare delivery is significant. But no matter the day or the situation, as Medical Administrators and Leaders we must never lose sight of: Leadership and culture Risk management Workforce Clinical practice Consumer partnerships You should recognise these as the five domains of clinical governance. They are the core to underpinning quality and successful Medical Administration and Leadership. It is us, as specialist Medical Administrators and Leaders who are central to upholding clinical governance principles, as we continually drive patient safety, promote quality care, support professional development, manage risks, facilitate stakeholder collaboration, ensure regulatory compliance, develop and implement policies, manage resources and support quality improvement initiatives. The list goes on. But it appears there is a lack of true understanding and appreciation of clinical governance across the health system in Australia and Aotearoa New Zealand. And so, it is up to us to ensure the full breadth of clinical governance remains front of mind for everyone involved in healthcare, every day. Trust in your training, trust in your experience and expertise. Call out system failures and short comings and call on your College peers and colleagues for support. We pride ourselves on our collegiality and tight-knit fraternity – let’s be there for each other when called upon. The College is well aware clinical governance is our space to own and the space within which to be the recognised, respected and trusted voice. We have met with key organisations and authorities including Ahpra, theMedical Board of Australia and the Australian Commission on Safety and Quality in Health Care and I am travelling to Aotearoa New Zealand to meet with the Medical Council of New Zealand, Council of Medical Colleges, Te Tahu Hauora – Health Safety Quality Commission and the HealthMinistry. We will be leading a coordinated approach to develop processes and various guidance materials to support leaders and staff in the health system. To make this work it has to be a collective responsibility of us all, not just the Board or those on College committees. With all of this in mind, it is timely I remind all Members of the RACMA Core values as we go about our everyday duties: Professionalism ((Demonstrating self-governance, high standards and ethical behaviour) Integrity (Doing the right thing in all situations) Excellence (Striving for outstanding achievement despite constraints) Respect (Acknowledging and valuing others’ thoughts, opinions, and feeling) Strategic Projects As we move towards the middle of the year the College has been making much headway on a number of key strategic projects such as the Fellowship Training Program Renewal, the Constitutional Review, the website refresh, establishing a committee dedicated to Digital Health and rolling out a new CPD short course program. Fellowship Training Program (FTP) Renewal Project You would have seen the recent consultation on the draft Curriculum Learning Outcomes for the FTP Renewal Project. I thank all those Members who have provided their valuable feedback – the working group will now evaluate the information. Next steps will involve appointing an Aotearoa New Zealand representative on the project working group, agreement on the workplacebased assessment framework and defining renewed Masters’ program requirements. Constitution Review I am very pleased the proposed changes to the RACMA Constitution have been finalised by the Constitution Working Group and lawyers ClaytonUtz. After much consultation withMembers last year, we will be holding a final TownHall meeting this week, Thursday 25May, where the final proposed amendments will be presented for consultation and feedback. The working group has dedicatedmuch time to fine tune the amendments to reflect the feedback received. The proposed changes are in relation to the following four areas: Objects and purpose Board composition Board subcommittees Jurisdictional committees For more information and details on the Town Hall meeting visit https://racma.edu.au/about-us/governance/racma-constitution/ constitution-review/. We are currently planning an Extraordinary General Meeting towards the end of July or start of August to vote on the Constitutional amendments. See the full article on page 22. Dr Helen Parsons CSC President Website Refresh I would like to congratulate the College Office for all their hard work on delivering a beautifully refreshed website. It is far more user friendly, contemporary, very professional and definitely makes us stand out compared with some other medical college websites. The College team listened to ongoing Member feedback to improve both the site’s navigation and user experience. While the site retains its familiarity for Members, the aesthetic look is better aligned with RACMA branding. The RACMA website is now “persona” driven. This means there are entry points specifically designed for Members, those interested in becoming a Member and those wanting to know more about RACMA’s work, the roles of our Members and the specialty of Medical Administration. If you haven’t had the chance to take a look please do so – RACMA website. Digital Health The establishment of the Digital Health Policy and Advocacy Sub Committee (DHPASC) is a welcome addition to RACMA’s strategic focus. There is much work to be done to assert our presence in the increasingly digital modernisation of healthcare as Medical Leaders are uniquely positioned to lead the digitisation of health. We are fortunate to have the expertise of Dr Monica Trujillo, Chief Health Officer for Telstra Health and Dr Oliver Daly - Digital Transformation and Informatics Lead Obstetrics and Gynaecology at Western Health and Clinical Informatics Associate, Centre for Digital Transformation of Health at University of Melbourne. Dr Trujillo and Dr Daly have been appointed the Inaugural Co-Chairs for the DHPASC and I wish them all the very best as they pave the way for the College in this key area for healthcare delivery. I urge any Members competent in digital health and keen to be involved to email Chief Executive Officer Cris Massis – cmassis@ racma.edu.au. CPD Short Course Program Don’t miss the opportunity to equip yourself with the latest industry trends and best leadership practices through RACMA’s very own, specifically designed CPD Short Course Program. In light of the new CPD changes in Australia and New Zealand, it is imperative to ensure your professional development is on track. Our carefully curated selection of high-calibre courses are tailored to meet your needs and help you stay up to date with the new CPD requirements. Courses cover a number of topics including: managing innovation in healthcare assertive communication authentic leadership looking after yourself conflict resolution coaching skills Registrations are now open for the tailored CPD courses, which are being offered online and face-to-face. The first course is on Friday 16 June - Managing Innovation in HealthCare, delivered by Professor Danny Samson. Click Here to Register. RACMA 2023 Finally, the Conference Committee has been working hard to finalise the program for this year’s event in Auckland, which is also being hosted online. It is exciting to see the calibre of the keynote speakers lined up to date, including Lord Nigel Crisp, Member of the House of Lords of the United Kingdom, and Dr Rawiri McKree-Jansen, Chief Medical Officer Te Akai Whai Ora/Maori Health Authority. And make sure you nominate your colleagues and peers for this year’s Awards. All Members have been sent communications regarding each category, which are: College Medallion Distinguished Fellow Honorary Fellow New Associate Fellow New Fellow Preceptor of the Year Supervisor of the Year This is our chance to recognise and celebrate the dedication, work and achievements of RACMA Members and industry colleagues. For nomination forms visit https://racma.edu.au/about-us/conference/awards/.
As a sub-editor, editor or editor-in-chief, I have been on a variety of different editorial boards for different medical journals over the last 20 years. As these journals have matured, they have all adopted editorial boards to further enhance the scope, reach and value of the journal to their readers. By setting up an editorial board, RACMA is indicating that it wants to further develop ‘The Quarterly’ to ensure that the journal develops a higher level of credibility and attracts top-quality submissions. An editorial board brings together a range of expertise to oversee the content of the journal, ensuring that articles meet the highest standards of quality and relevance. The board will provide guidance on the topics covered, suggest potential authors and reviewers, and provide input on the structure and format of the journal. With their expertise and guidance, the board can help identify emerging trends and hot topics within the medical administration and health management fields, as well as providing insights on the latest research and best practices. They will also provide advice to the RACMACouncil as to how the journal should be further developed to provide optimal value to Fellows, members, registrars, and other readers. The editorial board will also help to further develop relationships between RACMA and other organisations and researchers, including in the universities, working within our field. An increased focus on research and building of the knowledge base can also help to ensure that the journal remains relevant and responsive to the needs of RACMA members. In conclusion, establishing an editorial board is a crucial next step for RACMA tomove its current journal beyond amedical college professional magazine to a peer-reviewed and nationally recognised journal. By providing expert guidance and oversight, the editorial board will help in moving the journal forward to ensure the highest standards of quality and relevance. I would encourage any RACMA members with an interest in medical writing, editing and medical communication to consider nominating for the proposed editorial board. If you are interested in joining the new editorial committee, please submit your Expression of Interest by clicking HERE. Registrations are nowOpen for the 2023 Continuing Professional Development (CPD) Short Course Program Enhance your leadership and management skills through topics including managing innovation in healthcare, assertive communication, authentic leadership, looking after yourself, conflict resolution, coaching and more... REGISTER NOW If you have any questions or for more information, please email us at cpd@racma.edu.au Editorial – Why an Editorial Board? 6 | THE QUARTERLY Q1 2023 Dr Andy Robertson Editor
9 8 | THE QUARTERLY Q1 2023 Towards Better: Why We Need to Reculture Medicine Now The latest Medical Training Survey makes for sobering reading, prompting the need for senior doctors to do more to stop bullying, racism, discrimination and harassment, in the profession, writes Dr Jillann Farmer. The results of the 2022 Medical Training Survey were released in February and paint an increasingly negative story for our earlycareer colleagues. They point to an environment that is repugnant to cultural safety, one that holds an uncomfortable mirror to the profession and details impacts on workforce retention. For RACMA Fellows, there are two perspecives to consider – that through the lens of system leaders and managers, and that of supervisors of our own candidates. Both perspectives warrant further reflection. The headline data are as follows: 30% of prevocational or specialist trainee doctors witnessed bullying, harassment, racism, or discrimination in the workplace in the 12months preceding the survey. For RACMACandidates this percentage was 36%. 22% of the general population and 24% of RACMA Candidates reported experiencing it themselves. The combined overall total of those who experienced or witnessed these adverse behaviours was 34% in the overall survey group. The rates were lower for Trainees in General Practice, with 19% witnessing bad behaviour and 16% experiencing it. For non-GP specialties, 34%had experienced these behaviours and 23% had witnessed it. Breakdown by category Bullying – 12% experienced, 21%witnessed (RACMA – 16%, 24%) Harassment – 8% experienced, 13%witnessed (RACMA 13%, 17%) Discrimination – 9% experienced, 13% witnessed (RACMA 8%, 15%) Racism – 6% experienced, 13%witnessed (RACMA %, 14%) Racism If we look at the data from the 191 respondents who identified as Aboriginal or Torres Strait Islanders, there are some confronting differences. 20% of our Aboriginal and Torres Strait Islander colleagues have directly experienced racism in the workplace. 30% of them have witnessed it. That compares with 6% experiencing racism and 13% witnessing racism for non-Aboriginal and Torres Strait Islander respondents. While 85% of the overall cohort agreed that their workplace did not tolerate racism, only 69% of Aboriginal or Torres Strait Islander respondents agreed. This suggests that we need to ameliorate the way we recognise and acknowledge the lived experience of racism – those who do not experience it are more likely to believe it is not there. So, who is responsible for this bad behavoiur The survey helpfully outlines the answer to this highly pertinent question. 50% of respondents identified senior medical staff 40% identified a patient, family or carer 33% identified nurses or midwives, and 30% identified a registrar or other doctors in training Respondents were able to identify more than one perpetrator, as the report was an aggregate of a year’s experiences. This means that 80% of respondents saw other doctors engage in bullying, harassment, discrimination, or racism. Half of them senior doctors, who should be their role models, engage in these behaviours. 79 respondents were RACMA Candidates. They had negligible levels of reported bullying, harassment, racism or discrimination. However, for the 24% who experienced it, it was perpetrated by their supervisors- likely to be Fellows of this college- 23% of the time. Although these overall numbers are low, this should give us all pause – and a renewed awareness of our impact as role models. The full report can be downloaded here, and you can create a report that details your specified areas of interest by using the website’s interactive features. A culture of bad behaviour The Medical Training Survey produced similar results in 2021, and as a consequence of those results, the Medical Board of Australia convened a “Culture of Medicine Symposium” on 27 May 2022. While the COVID-19 pandemic and its associated workplace stressors may have exacerbated levels of manifest distress in the workplace, it cannot explain the totality (or even the majority) of this picture. The 2019 Survey, collected before the pandemic, showed that 22% of respondents had experienced bullying, harassment or discrimination, and 27% had witnessed it. What can we do? Some key challenges for change include: the complexity of our close working relationship with other stakeholders the split responsibilities between the States (who operate the health services that employ almost all non-GP specialist trainees) and the Colleges (who accredit training positions, set curriculum, conduct training programs and associated assessments, and confer Fellowship), and the finding that non-medical health professionals and patients/ families were identified as a very significant proportion of perpetrators. This is not an exclusively medical problem, but the medical profession must own its slice of this unsavoury pie. We have tolerated egregious behaviours for too long. Some of the Specialist Medical Colleges have taken concrete steps to address these issues, others are still at the policy and discussion stage. Whilst acknowledging our contribution, it is also clear that the Colleges alone cannot fix this and dealing with it as a professional conduct issue dooms us to failure. The Medical Deans Australia and New Zealand Inc have published a series of case studies of their interventions to address these harmful behaviours. These case studies are sobering reading, with several entrenched and recidivist attitudes among senior colleagues who, quite frankly, should know better Psychosocial Hazards Bullying, harassment, discrimination and racism are psychosocial hazards, recognised variously in different state legislation, but nonetheless, they are workplace hazards. As a working GP, I saw many patients whose acute mental health decompensation was directly associated with workplace experiences, and amongst those were medical practitioners, nurses and allied health professionals. The AMA Council of Doctors in Training has published an excellent briefingpaper on this topic, which shouldbe readby all those aspiring to or currently holding leadership roles in healthcare (in medicine or in other disciplines). Whilst Doctor wellbeing and workplace psychosocial hazards are related, they are not the same issue. Poor individual health and wellbeing can be one contributor to adverse workplace behaviours, and psychosocial hazards can (and do) contribute to poor health. These programs of work complement one another, but it is time to move beyond a belief that doctors can fix this by ourselves. Fixing the problem Doctors are, by and large, a privileged group. This contributes to a perception that doctor behaviour will not be addressed. That does not negate our need for safe, healthy workplaces. However, it does mean we have an opportunity to use our privilege to benefit all health workers, to contribute to the creation of better workplaces, better culture, and in turn, better patient care. We need leaders (Health Ministers, Directors General, Commissioners, and consumer advocates) who acknowledge that this is a shared responsibility, with employers having a duty of care to their staff that cannot be abrogated to medical training entities. In return, those leaders need us, as professionals, to step up. They need us to challenge hazardous behaviour, to ensure that those who report it are supported and protected, and to set clear boundaries around what constitutes professionalism in the 21st Century. It is only by harnessing the cohesive efforts of all parties that we will finally create healthy workplaces. The Royal Australasian College of Medical Administrators has started a 2-year project to boost us on this journey. I am privileged to lead that project team, with a firm belief that together, we can reculture medicine. To date, there has been extensive stakeholder liaison with invitations to speak at some College Conferences. Branding and website development will be finalised next month, and a governance structure has been established with the convening of an Advisory Board to commence shortly. Communication around branding and websites will be made available to all RACMA Members in the coming months. There will be ample opportunity for Fellows and Candidates to become involved in this work. There will be working groups to produce content, and these will be supported by an array of reference groups, each one focusing on a different perspective. This will ensure that voices not usually heard at leadership tables in medicine are amplified effectively. These reference groups will be co-chaired by RACMA Candidates and nominees of other colleges. I invite you to connect with the project and join us on this journey towards a better culture. *A version of this article was published in Issue 10 of Insight+ on 27 March 2023
11 10 | THE QUARTERLY Q1 2023 2023 RACMAMembership Survey – a summary Results from the 2023 RACMA Membership Survey have provided a snapshot view of the membership with a lower response rate compared to previous years. The 2023 survey was sent to 1301 active College Members and 207 (16%) responded. Responses were received from 98 Fellows, 77 Associate Fellows and 32 Candidates. The objective of the survey is to better understand the profile of our Members, the challenges they face in providing Medical Leadership and the contribution they make to the health system. It also asks Members about their perception of RACMA, their willingness to contribute and ways the College could improve. More than half of the Fellows who responded indicated they work in either Executive Director of Medical Services (EDMS) and Director of Medical Services (DMS) roles. While 68 per cent of Associate Fellows who answered the survey work as clinical leaders or clinicians with just 24 per cent working as EDMS or DMS. The survey also revealed 49 per cent of respondents (63 per cent of Fellows) work 80 – 100 per cent of their time in Medical Administration roles. When drilling down into the areas of focus within their roles, the Fellows who responded spend most of their time in clinical governance and executive leadership. This is followed by medical workforce, and stakeholder engagement. When it comes to what challenges Fellows most in their roles, it is medical workforce, closely followed by clinical governance and then digital health, medico-legal and executive leadership. The survey also showed Associate Fellows spend more time than Fellows in education and training. Out of the Members who responded, 46 per cent have experienced or witnessed bullying and harassment in the workplace. Responses includedmany observations of not being heard, seeing resignation as the only option or being instructed to not raise the issue. However, 70 per cent of respondents say they are well respected within their organisation, with only three per cent indicating they are ignored. Interestingly, the survey showed the Colleges where most Members have membership with were: RACP – 26% RACGP – 18% ACHSM – 15% ACRRM – 10% RACS – 8% The survey also helps explore ways the College can enhance the value of RACMA to our Members. When it came to uncovering the opinions and perspectives of the College, the survey queried Members on opportunities to improve Member experience and the value to Members, as well as asking their thoughts on significant challenges for the College. Key challenges for the College are seen as: Improving collegiality, mentoring, connections, support; Be acknowledged for health service leadership, advocacy; Expand outside doctors to corporate education etc; Focus on the core (less extraneous stuff); Reduce fees (or enhance value); Enhance knowledge content at Conference (2022 was commented on frequently as being low content); Providing short, practical education resources. Practical instructional videos on common challenges; Partnering with the Australasian College of Health Service Management (ACHSM), Australian Institute of Company Directors (AICD) and other organisations; and Improve availability, answering the phone, responsiveness The most popular College activity amongst those who responded is the monthly CPD webinars. Members provided more than 70 Webinar topics or short courses that they would like to see RACMA provide in the future and the top five topics were: Strategic planning Culture change Corporate Governance Preparing a business case Clinical Informatics Other College activities, events and communications the respondents favoured include jurisdictional events, the conference, the Quarterly, access to the BMJ Leader, the Presidents Member Forum on Wednesdays and the monthly President Newsletter. Looking at the College wholistically and thinking about what we do and offer on all levels, the survey asked Members to rate RACMA against a number of descriptive words, and of those who responded, the majority chose the following to be the most appropriate when thinking about the College and what we do. ANSWER CHOICES RESPONSES <25 0 25 - 45 24.15% 45-65 56.52% >65 19.35% Total Respondents 207 ANSWER CHOICES RESPONSES Metropolitan 68.12% Regional 28.50% Rural 22.22% Remote 8.21% Total Respondents 207 ANSWER CHOICES RESPONSES 1 1.93% 2 3.38% 3 22.22% 4 5.31% 5 8.70% 6 13.53% 7 15.94% 8 25.12% 9 9.66% 10 12.56% Total Respondents 207 Activities Members spend most of their medical leadership time ANSWER CHOICES RESPONSES Strategy, planning and executive leadership 46.38% Departmental oversight/management 21.26% Medical workforce management 49.762% Clinical Governance and Quality 61.35% Advocacy and stakeholder engagement 32.85% Digital Health and Informatics 13.53% Medico-legal issues 15.94% Research and Innovation 14.01% Education and Training 30.92% Other 10.14% Total Respondents 207
12 | THE QUARTERLY Q1 2023 World-first Cultural Safety Training to be embedded in Aotearoa Medical Education The first Cultural Safety Training Plan world-wide to be implemented into the curriculum of medical specialist training will mark a turning point in New Zealanders experiences with their doctor, says Chair of Te Ohu Rata O Aotearoa (Te ORA) Professor David Tipene-Leach, and Council of Medical Colleges Chair, Dr Samantha Murton. “The Cultural Safety Training Plan we are launching today is a key part of the big move toward achieving equity and the aspiration of Mori reaching our full health potential,” Professor Tipene-Leach said. “The Cultural Safety Training Plan provides curricula foundation for medical colleges’ training programmes. We want to support doctors as they train and retrain to undertake culturally safe practice, as defined by the patients and whanau they serve,” Dr Murton said. Cultural Safety for doctors looks like examining the impact of their own culture on their work with patients; a commitment to address any of their own biases, attitudes, assumptions, stereotypes, prejudices that may affect the quality of care provided to patients; and engaging in ongoing self-reflection and self-awareness to hold themselves accountable for providing culturally safe care, as defined by the patient and their communities. This training plan has been designed to reflect the unique context of Aotearoa. Whilst cultural safety is applicable to all cultural, ethnic, religious and other social groups, its focus on Maori health outcomes is immediately obvious and intentional. “This is a significant project, and I want to thank everyone involved from the Council of Medical Colleges, researchers and Te ORA for how we have worked together to develop this Training Plan,” Professor Tipene-Leach said. The Cultural Safety Training Plan responds to the 2019 statement from theMedical Council of NewZealand (MCNZ) that medical education in Aotearoa should include a focus on cultural safety. It builds upon the independent research findings on the current state of cultural safety and health equity delivered by doctors in Aotearoa New Zealand developed by Te ORA and the Medical Council of New Zealand in 2020. Colleges already have Hauora Maori and cultural competence training well embedded in their curricula -cultural safety is in addition to those pieces of work Professor Jenny May University of Newcastle Department of Rural Health Dr Curtis Walker Medical Council of New Zealand Dr Libby Lee Health Bureau, Hong Kong Special Administrative Region Lord Nigel Crisp The House of Lords, United Kingdom Learn, innovate and share with industry colleagues at the 2023 Royal Australasian College of Medical Administrators Conference. Join us online or onsite for what promises to be an engaging and memorable program. We invite you to participate by submitting an abstract for consideration for the 2023 program. Abstracts submissions close 22 May 2023. To submit your abstracts visit racmaconference.com.au/abstract-submission/ Registrations are now open! To stay up to date check out the website and join our mailing list. We are delighted to announce the following as just some of our keynote speakers for 2023
14 | THE QUARTERLY Q1 2023 New Era for College with the introduction of Digital Health Committee 15 How would you describe Digital Health? The enabling of better health outcomes via technology. What does Digital Health mean to you? Why are you so passionate about Digital Health? I am the only Dr in a family of engineers, my daily life and dinner conversations were about system-thinking and process improvement via computing when I was growing up. Fast forward to when I was practicing as a health provider, the role of technology was evident to me pretty early in my career. We rely on a lot of manual processes and repetitive tasks, let alone very old data, to do our jobs and I think this is where technology can really assist all of us across the health and care ecosystem, especially patients and their families. How important is it for RACMA to take the lead in the Digital Health space? When I first started in this role, there were no formal positions and in fact, I was the first CMIOwhen that role didn’t even exist in Australia. As I continued to work in the area it was pretty clear to me that this was an area of more study and skills and RACMA is a clear match for preparing the medical clinical informaticists of the future. What attracted you to take up your role as the inaugural Digital Health Committee co-chair? Well, I think I have been advocating for RACMA to take this on and lead the conversation so as soon as the opportunity arose I thought I better step up and help move the dial. What are some of your initial goals/tasks for the Digital Health Committee? I think the task ahead of us is not a small one. Information technology hasbecomeentrenched inour daily lives and theCOVID19pandemic provided a catalyst for the rapid adoption of technologies. We need to think about what streams of work will enable ALL medical administrators feel confident in managing technology now and in the future and then what sub speciality areas we need to develop so that RACMA can support those seeking to train further in the area. What are the challenges you can see that RACMA, and the field of medical administration in general, will face in the future? And particularly when it comes to Digital Health The WHO released the Global Strategy on Digital Health and adopted in 2020, presenting us all with a roadmap and a challenge to take on digital solutions as key enablers of better outcomes for all. Technology is not an addition, but a must for all strategies, and as it continues to develop in areas such as ML and AI, the challenge will be to ensure that we have a robust clinical and corporate governance framework wrapped around it, particularly data management and governance. In order to achieve this, we need skilled medical administrators leading the conversation and now is the time to do it. I am really looking forward to working with my peers to support RACMA, I can’t wait! Creating a real presence for RACMA in Digital Health The College Board recognises RACMAMembers are uniquely positioned to lead the evolving and increasing digitisation of health, ensuring its effectiveness and efficiency and the quality and safety of health services and patients. After much consultation and discussion, the Board decided the best way forward in this space for the College was to form a Digital Health Policy and Advocacy Sub Committee (DHPASC). To start this process the Board has appointed Dr Monica Trujillo and Dr Oliver Daly as the inaugural co-Chairs for the DHPASC. Dr Monica Trujillo is Chief Health Officer for Telstra Health and Dr Oliver Daly is Digital transformation and informatics lead - Obstetrics and Gynaecology at Western Health and Clinical Informatics Associate, Centre for Digital Transformation of Health at University of Melbourne. Both Dr Trujillo and Dr Daly are active participants in the Australian Institute of Digital Health. An Expression of Interest (EoI) process is currently being undertaken to select inaugural members of the DHPASC. The purpose of DHPASC is to contribute to leadership and vision for achieving accessible, high-quality and safe health services and systems through policy and advocacy initiatives that utilise digital health and the medical leadership and management expertise of RACMA Members to: Improve health outcomes. Influence policy to improve accessible, high-quality and safe health services. Support RACMAMembers to undertake their leadership role. Strengthen the health, well-being and safety of RACMAMembers. Strengthen the health, well-being and safety of the medical profession. Facilitate the medical workforce and health care systems to be supported by the highest standard of qualified medical leadership and management. Contribute to the development andmaintenance of amedical workforce that provides high-quality, safe and equitable care and services. Facilitate and enable development of health services. Ensure that DH is considered in all RACMA committees, policies, procedures and activities. Advice RACMA on DH topics to be considered in RACMA Education and Training programs. How would you describe Digital Health? The goal of Digital Health is to implement technology that improves all aspects of the quadruple aims of health system improvement - the health of the population, the experience of receiving care, the experience of providing care and reduction in the cost of health care. This improvement is a transformation journey not an endpoint, so will continuously evolve with the needs of the health system and community. What does Digital Health mean to you? Why are you so passionate about Digital Health? We are at an exciting point with significant investment and innovation in digital health. While acknowledging the current frustration with user interfaces, data entry and inefficient clinicalEMR workflows, over time there will be more seamless data collection and presentation of clinical information. And this is not just an opportunity to adopt new technology, but one in which we can redesign our clinical care workflows to take advantage of reduced duplicate clinical documentation, increased data sharing and integration between systems, and the collation and analysis of data from a range of information systems to provide individual patient clinical insights and an expanding frontier of big-data, realworld, population-based research. With the addition of predictive, diagnostic and clinical decision support, introduced in an evidencebased manner, this will reinforce the role of clinicians spending their time supporting patients with interpretation of the significant increase in health information available and providing patientcentred care. How important is it for RACMA to take the lead in the Digital Health space? Inmany ways RACMA has been at the forefront of digital health over several decades through the vision and leadership shown by many of our fellows. RACMA has an important role in recognising this wellspring of experience and facilitating professional recognition, ensuring medical leaders are trained in Digital Health principles and practice, and advocating for those medical leaders to be at the table when the health system makes decisions about Digital Health commissioning, design, implementation, and ongoing development. This will ensure technology is introduced that benefits patient care, those providing it and the system at large. What attracted you to take up your role as the inaugural Digital Health Committee co-chair? To have the opportunity to bring RACMA fellows together to establish a shared vision for the professional development and recognition of medical digital health leaders, unitedwith key external stakeholders, is a great honour. I am committed to ensuring that medical leaders are empowered to inform evidence-based investment in Digital Health and that clinicians are supported through the transformation challenges, to best support patients and the health system. What are some of your initial goals/tasks for the Digital Health Committee? The initial goal is to establish a sub-committee of members with experience in Digital health curriculum, training and professional development; professional recognition, credentialing and accreditation; research and clinical informatics, medical informatics leadership, and digital health transformation, implementation and change management. This team will work together to update the RACMA Digital Health position statement, inform the current curriculum review and work with other organisations such as the Australian Institute of Digital Health to develop professional development pathways and establish professional recognition for medical informatics leaders. What are the challenges you can see that RACMA, and the field of medical administration in general, will face in the future? And particularly when it comes to Digital Health Thebiggest challenge is therateof changeacross somanyareasof the health system, the technology andDigital Health options, the scale of investment. To achieve integration within and between institutions, medical leaders need to be aligning their digital strategies with a tenyear horizon to reflect the return on investment. This needs to be informed by knowledge of the technical capacity and limitations of health information systems, how to best use informatics to improve care, understanding the application of Digital Health to quality improvement including clinical decision support, and the change management principles that apply to transforming clinical services to leverage Digital Health. Dr Oliver Daly - Co-chair Digital Health Dr Monica Trujillo - Co-chair Digital Health
AdvancingWomen in Healthcare Leadership Update WHAT WORKS? Organisational leadership commitment & accountability Organisational processes Awareness & engagement Mentoring & networking Leadership development Support tools Start with evidence-based interventions (2) . 5 Lorem ipsum dolor sit amet, consectetur adipiscing elit. Nunc fermentum urna ac dolor aliquam, vitae ultricies diam accumsan. Maecenas porttitor lectus in purus euismod, iaculis dapibus massa hendrerit. Nam vulputate ipsum vel velit sodales tincidunt. Fusce lacus ex, blandit ac sem eu, rutrum dignissim nisi. Advancing women in healthcare leadership Evidence-based Coproduction National partnership & tailored to context Intervention development Implementation & scale up Organisational and systems change A collaborative, partnership approach Healthcare is delivered by women and led by men (1) Leadership does not reflect the community or healthcare workforce. Equity and diversity in leadership leads to improved healthcare, workforce and quality of care outcomes (1) WHY PRIORITISE EQUITY IN HEALTHCARE LEADERSHIP? WHAT IS ALREADY KNOWN? Lorem ipsum dolor sit amet, consectetur adipiscing elit. Nunc fermentum urna ac dolor aliquam, vitae ultricies diam accumsan. Maecenas porttitor lectus in purus euismod, iaculis dapibus massa hendrerit. Nam vulputate ipsum vel velit sodales tincidunt. WHAT IS THE SOLUTION? 1 2 World Health Organization. Delivered by women, led by men: A gender and equity analysis of the global health and social workforce. Geneva; 2019. Mousa, M. et al. Advancing women in healthcare leadership: A systematic review and meta-synthesis of multi-sector evidence on organisational interventions. EClinicalMedicine 39, 101084 (2021). DOI: 10.1016/j.eclinm.2021.101084 Mousa, M. et al. Factors that influence the implementation of organisational interventions for advancing women in healthcare leadership: A meta- ethnographic study. eClinicalMedicine 51, 101514 (2022). DOI: https://doi.org/10.1016/j.eclinm.2022.101514 Mousa, M. et al. Experiences of Organizational Practices That Advance Women in Health Care Leadership. JAMA Netw Open. 2023;6(3):e233532. DOI:10.1001/jamanetworkopen.2023.3532 1. 2. 3. 4. 3 4 Intervention fit & fidelity Leadership commitment & accountability Cultural context & organisational readiness Apply evidence-based implementation approaches (3) Successful implementation needs: Address systemic barriers Challenge gendered assumptions of leadership Provide mentoring opportunities Build practices that foster credibility, collaboration and continuous improvement. Create a workplace culture that supports women's credibility as leaders (4) Inequity & barriers to women's leadership pathway Strategies for women to address barriers Practices, policies, interventions Making the case Fixing the woman Fixing the system © Monash University 16 | THE QUARTERLY Q1 2023 AdvancingWomen in Healthcare Leadership (AWHL) continues to expand and grow its reach. As described in the lastQuarterlyUpdate, AWHL is a national partnership initiative across professional, medical and nursing colleges, industrial bodies, health services and government. It aims to coproduce, implement, evaluate and deliver evidence-based effective systems-level change to improve equity and diversity and advance women in healthcare leadership. Since our last update, the Royal Australian and New Zealand College of Psychiatrists (RANZCP), Australian and New Zealand College of Anaesthetists (ANZCA) and the Australian Federation of Medical Women (AFMW) have joined the partnership. We continue to have a strong focus on women’s leadership training and are progressing on the development of implementation of system-level interventions within the partner organisations. Knowledge Generation We have previously reported on the range of foundational knowledge generation already completed. A systematic review demonstrated the range of organisational interventions which research has shown to be effective in advancing women in leadership; we have demonstrated WHAT works. (1) Subsequent analysis of interviews with organisational leaders has demonstrated the factors that influence implementation of organisational interventions; they focus on HOW actions might work. (2) These have been complemented by a third foundational study looking at the experiences of women in leadership roles, with a view to informing an organisational culture to promote women’s career advancement. (3) These three papers underpin the project’s approach to knowledge gathering from partners both individually and collectively. We congratulate Dr Mariam Mousa who led these three foundational papers as part of her doctoral research, and are excited that she recently received her PhD. Mariam will continue to work on the initiative, in particular in coordinating the Women in Leadership program run by the Monash Centre for Health Research and Implementation. RACMA Progress We conducted a survey in late 2022 to seek the views of RACMA’s membership to contribute to shaping the priorities for RACMA and others. This incorporates consideration of the following three key areas: 1. RACMA leadership roles - to advance women within the college 2. RACMA medical workforce pipeline - training strategies to attract women into medical leadership and support them throughout training 3. RACMA’s influence on the broader medical profession - leveraging RACMA’s influence on health services through its Members. The survey data have been triangulated with data from qualitative interviews of RACMA leaders to better understand what is considered to work to advance women in leadership within RACMA and health services more broadly. Interview and survey data showed that overall, RACMA leaders and members believe that RACMA has a gender equitable leadership culture, demonstrating RACMA’s commitment to improving gender equity and advancing women in leadership. RACMA was seen as being collaborative and consultative in its decision-making. Issues of flexibility in training and career were considered key to effecting change. Data are currently being finalised and a report will be provided to the leadership committees and board overseeing this work. We extend our gratitude to the 184 members of RACMA who completed the survey. We are hoping to explore the issue of your role as medical leaders and members of RACMA in advancing women leadership in greater depth at the RACMA conference in October. Community of Practice Whileeachorganisationfaces itsownspecificchallenges inadvancing women in leadership, it is clear from our knowledge generation that organisations share multiple challenges and issues. We started a Community of Practice in 2022 for member organisations, in particular the Colleges and the Australian Medical Association, to explore common issues and coproduce collective actions that each can implement within their organisations. We will restart the CoP later this year as we move into the intervention generation phase of the initiative. Engagement and Reach We continue to be amazed and grateful for the ongoing enthusiasm partners show for this initiative. Relationships with partners are strong and increasingly deepening as we all work together to understand the issues facing both the organisations and the service system within which health professionals work. Ongoing engagement is vital to create the systemic change this initiative is striving for.Wehavepresentedourwork toProf KathleenRiach from the University of Glasgow Adam Smith Business School, with whom we delved into the sociology of gender inequality. We interrogated the implementation science of this project with Professor Jeremy Grimshaw from the University of Ottawa. All external academics with whom we have interacted have been impressed by the scale of this coproduced, implementation-focused initiative and are keen to remain involved. We thank those of you who have contributed so far to interviews or surveys, and we look forward to seeing you later in the year at your conference to continue this conversation. References ¹ Mousa M, Boyle J, Skouteris H, Mullins AK, Currie G, Riach K, et al. Advancing women in healthcare leadership: A systematic review and meta-synthesis of multi-sector evidence on organisational interventions. EClinicalMedicine. 2021;39:101084. ² Mousa M, Skouteris H, Boyle JA, Currie G, Riach K, Teede HJ. Factors that influence the implementation of organisational interventions for advancing women in healthcare leadership: A meta-ethnographic study. eClinicalMedicine. 2022;51:101514. ³ Mousa M, Garth B, Boyle JA, Riach K, Teede HJ. Experiences of Organizational Practices That Advance Women in Health Care Leadership. JAMA Network Open. 2023;6(3):e233532. ~ By Dr Jenny Proimos MBBS MPH FRACP GAICD, on behalf of the AWHL project team
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