1MAY 2017MELBOURNE HEALTH STAFF NEWSLETTER

TRANSFORMING OUR CULTURESPECIAL EDITION

Speaking Up helps combat compassion fatigue in ICUCompassion fatigue and burnout can be a dangerous occupational hazard for staff working in the high-stress environment of the Intensive Care Unit. As ICU NUM Michelle Spence describes it, working in ICU is a privilege, but also a very emotional challenge. So after this was identified as an issue in the 2015 Speaking Up for Safety survey, the ICU team worked with Health and Wellbeing Coordinator, Stephen Whittaker, to create a one-day Compassion Fatigue workshop which gives staff the perspective and skills to regroup, de-stress and find their equilibrium again.

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IN THIS ISSUE• Working together to deliver a

great outcome for Outpatients

• Meet our new Safety Champions

• Because weCare, we Speak Up for Safety

• Because weCare, we hold each other accountable

• What do our values mean for you?

• MH performance results

• Professional accountability taken seriously

• People Matter Survey

• When the going gets tough, let us help

My commitment to culture changeThis is my first MH Connect Special Edition, dedicated to our cultural change program across Melbourne Health.

While it is still very early days for me as Chief Executive, I would like to assure you that our Board is clear about our priorities, one being the Cultural Transformation Program.

I believe positive, well-directed culture change will deliver tremendous benefits for our patients, consumers and particularly our staff. I urge you to embrace this program, take the lead or influence where you can and drive change even in small ways. We can all help move our culture from good to great and work toward achieving our vision to be First in Care, Research and Learning.

CHRISTINE KILPATRICK Chief Executive

2MELBOURNE HEALTH CONNECTTRANSFORMING OUR CULTURE

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“This is the best thing that ever happened to this Unit,” said Michelle. “We’ve had nurses who’ve decided to stay on here, and not resign, as a result of doing this one day course.”

One of the nice things to come out of this approach was the simple idea of a short soothing massage — so the ICU launched “Ten Minutes for Ten Bucks”, with professional masseuse Jane Shearwood (pictured on page 1) coming in regularly to ease away some of the tensions.

This year’s Speaking Up for Safety survey has recently closed — thank you to all those who took the time to Speak Up. We had a 61% response rate this year, so well done! The results are now being processed, and in June, each work setting will be involved in discussions about their results, and changes or improvements which can be considered as a result of the survey data.

Watch: You can learn more about the ICU initiatives which came as a result of their Speaking Up for Safety via this short clip http://bit.ly/2nCJmLJ

Working together to deliver a great outcome for OutpatientsA staggering 33,351 appointments were not attended in Outpatients in the past financial year. This equated to 16.5% of all appointments, at an estimated value of $11.8 million…and growing each year. With statistics like that, it was clear something needed to be done to reduce the Did Not Attend (DNA) rate where patients miss Outpatient appointments without notifying RMH.

Outpatient Did Not Attend rates clearly have a significant impact and cost to our Outpatients services and increase the length of Outpatient waitlists. This directly impacts the patient experience due to long waiting times for a new appointment and during clinic visits.

A patient focused marketing campaign run by the Outpatient Transformation Team and Outpatients is aimed at addressing and reducing the high DNA rates through a multi-pronged approach.

As a result of the initiatives in place since 2016, there has been a steady reduction in DNAs, currently at 14.7%, a reduction already of 2% — a great result!

Read more about this initiative on the intranet.

Meet our new Safety ChampionsWe caught up with our new Safety Champions and asked: “What made you decide to become a Safety Champion?”Watch: Hear more from Ruth Harper and Varnia Muys about why they are passionate Safety Champions http://bit.ly/2o4N4to

“ There’s something really powerful about admitting that I’m going to make mistakes and asking my colleagues to let me know when I do. I often find it really hard to Speak Up. It really is a life skill and it takes practice. I became a Safety Champion because I see that the more we make Speaking Up just a normal part of what we do – the more I will enjoy coming to work.” VARNIA MUYS, Safety Culture Program Lead

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“ The ability to Speak Up when you’re a member of the junior medical staff can be very difficult and often takes years to develop along with seniority, but is something that we desperately need to actively encourage for the benefits of our patients and staff.” DR SIDDHARTH SOOD, Head of Hepatology

“ In my medication safety role, I see incidents where patient harm could have been prevented if someone had spoken up, and as a clinical pharmacist I’ve had first-hand experience raising concern about patient safety and know how important it is to develop these skills.” JO YOUNG, Pharmacist, Quality Use of Medicines

“ Because every single one of our staff and patients matter.” EVAN YANG, Safety Culture Program Consultant

“ I have become a safety champion so I can work with teams to practise the skills of Speaking Up. It isn’t always easy so we all need supportive feedback to improve.” RUTH HARPER, NUM 3SW

“ I am an advocate for Integrity. I want to support our people with the right tools and encouragement so they can Speak Up for Safety effectively.” ELISA BURGESS, Organisational Development Consultant

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The Safety C.O.D.E. in actionCardiac anaesthetist, Michael Kluger, requested femoral vascular access and femoral arterial pressure monitoring lines, as agreed with the cardiologist starting the case, and as per protocol previously agreed to by the Anaesthetic and Cardiology teams. However, the case proceeded without femoral venous access and monitoring for anaesthesia, despite multiple clear requests.

Michael believed that patient safety was being compromised and he was placed in a position where he had to request that the case stop until they had access lines as agreed. This is a great example of our staff Speaking Up for Safety using key steps from the Safety C.O.D.E.. Well done to Michael for Speaking Up!

LIVING OUR VALUES

An excerpt from a letter received by Prof James Tatoulis, Head of Cardiothoracic Surgery

“This is overdue but no less heartfelt. My sister had a quadruple bypass in 2016. I would like to express my deep gratitude to everyone involved. The communication to the patient, her family and loved ones was impeccable. It was clear, professional, and delivered with kindness and compassion. The after care has also been excellent. Please pass on my deep gratitude to the admissions, surgical staff, the trauma unit and the cardiac unit. Also everyone I met, whether they were cleaners, in the shops or in the carpark office, everyone was kind and helpful. Thank you for saving my sister’s life.”

Because weCare, we Speak Up for SafetyWe all make mistakes. Sometimes we see our colleagues do things that might not be as safe as it should be. Speaking Up for Safety gives us a way to raise our concerns in a respectful and effective way.

In the Speaking Up for Safety workshop you will consider the ethical considerations that impact on the decision to Speak Up. You will learn to use the Safety C.O.D.E. — a stepped approach that will help you raise concerns in the moment.

This training is a key part of our cultural transformation. If you haven’t attended a session, book into an open session or email Safety.Culture@mh.org.au to arrange a team session.

I have the skills to Speak Up for Safety: 54% agreed or strongly agreed before the training and 94% agreed or strongly agreed after the training.

Could we just check we are doing this the right way?

CHECKS

OPTIONS

DEMANDS

ELEVATES

I am worried that things seem to be getting worse. Would another pair of hands make a difference?

I am very concerned about this. I know I might be wrong. We need to stop and make sure this is the safest way to do this.

I know we disagree on this but if this was my sister, I would not hesitate to call for assistance and the Safety C.O.D.E. says that I have to do the same for this patient.

C

O

D

E

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Because weCare, we hold each other accountableweCare is a system where we ask for feedback to be given to another member of the Melbourne Health team where we don’t feel able to do so ourselves.

What happens when someone puts in a weCare report about you?• It will be triaged by a group of

senior leaders in the organisation — they will decide if it is appropriate to give the individual feedback based on what has been written (see chart on right).

• If a weCare report has been submitted about you and you have a conversation with a care messenger, your conversation is confidential and safe. It will not be discussed with anyone else unless there is a problem behaviour that needs to be addressed.

• If the Triage team are concerned they are seeing a pattern of behaviour in the reports or it is serious, they may ask your line manager to have a discussion with you. Initially this conversation will be informal — simply providing you feedback. If a pattern continues or it very serious the Triage team may ask for these reports to be escalated to formal HR disciplinary procedures.

When should I use weCare?In most instances it’s best to use the Safety C.O.D.E. to Speak Up or ask your line manager for help.

weCare is a safety net that you can use if you don’t feel safe or you are unable to Speak Up, or don’t feel that your concerns will be taken seriously.

In some instances you need to use Riskman or speak to your line manager or HR if you have identified a risk or behaviour that is impacting on safety (see chart on page 6 for “What should I report where?”).

Are there times when the Triage team won’t arrange a care messenger discussion? Yes. In some instances the Triage team might decide not to respond to a weCare report. The main reasons for this are:

• There wasn’t enough detail about what happened. Reports need to describe a specific incident — an example of a behaviour that the individual can learn from. General statements about their personality will not be acted on.

• We could not identify who the report was about. If you can provide a name that’s a big help!

• A group of staff were reported. Sometimes we pass this onto the line manager but not a care messenger.

The aim is to provide others with an opportunity to gain insight and learn from feedback.

Remember, weCare is a safety net.

ADAPTED FROM VANDERBILT UNIVERSITY ACCOUNTABILITY PYRAMID

HOW THE WECARE SYSTEM WORKS

1. Capture Reporting issue is captured on web based tool (the “weCare” system) and held in a database.

CAPTURE

3. Assign ResponseTriage team assigns intervention: • Care messenger • Line manager and/or

senior manager

ASSIGN

4. RespondProgressive interventions: • Level 0 — Informal

conversation with care messenger

• Level 1 — Informal discussion with manager

• Level 2 — Formal discussion with manager

• Level 3 — Disciplinary intervention

RESPOND

2. TriageTriage team reviews report, collates any historical reports, summarises and makes an assessment about the required response, in-line with MH policies.

TRIAGE

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“ This staff member continues to be undermining on ward rounds. Mannerism with patient is abrupt and disregards concerns raised by the multi-disciplinary team regarding patient care. When approached she is dismissive. This behaviour is not respectful and risks patient care.”

“ I experienced a refusal in Hand Hygiene by a consultant at the bedside. After multiple attempts to engage the consultant, there was still a refusal to perform Hand Hygiene.”

“ Nurse Handover from night shift was not in ISBAR format, missing important clinical information and inclusive of disrespectful personal opinions about the patient. This is not role modelling professional behaviour and upholding the Melbourne Health values.”

HERE ARE SOME EXAMPLES OF THE TYPE OF REPORTS SUBMITTED INTO WECARE:

“ When I approached the staff member later to indicate we should not communicate this way he excused his behaviour and continued to speak rudely towards me. I hope he would not speak to other staff in this way.”

So how is weCare being used?Since we started the system a year ago more than 400 reports have been made. We now receive about 35 reports each month. In most cases a care messenger provided feedback.

More than 80% of weCare reports relate to behaviour that is not aligned to our values. A large proportion of reports mention “disrespectful” or “rude” communication and “aggressive”, “intimidating” or “angry” behaviour.

Depending on the type and severity of the incident, may include: investigation; team-based review; in-depth case review; root cause analysis; risk reduction plan.

Depending on the type of the incident; informal conversation with a MH care messenger; informal or formal conversation with line manager; no investigation and no records.

Performance management or disciplinary action, which may include: Investigation; counselling; performance management; written warning/s; dismissal.

WHAT SHOULD I REPORT WHERE?

Adverse events, hazards or near misses that put people at risk of harm

Behaviour that undermines our culture of safety and accountability

Unacceptable conduct, serious or wilful misconduct

WHAT

EXAMPLES

HOW

RESPONSE

Medication error; patient fall; pressure injury; procedure on wrong patient; needle stick; workplace injury.

Disrespectful communication; disruptive behaviour (including passive); failure to use screening tools; repeated failure to practice Hand Hygiene.

Verbal abuse; sexual harassment; bullying; wilful damage or theft; being under the influence of alcohol.

Riskman and Line Manager

weCare System MH Disciplinary Procedure

RESPONSES TO WECARE REPORTS

Care messenger conversations Line manager conversations Duplicate reports of similar incident

Escalated to line manager with HR support Group of staff, report given to line manager No action

53%

8%

5%

3%

4%

18%

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Trevor CarlisleSocial Worker and winner of the Robyn Humphries Award for Demonstrating Social Work Values in Public Mental Health

“Trevor is person-centred and ensures the voice of some of Australia’s most marginalised individuals is heard. Despite working with complex and difficult to engage consumers, he maintains a non-judgemental and respectful approach to every person in his care. Trevor embodies the values of equality, collaboration and acceptance, which is evident in his clinical work and leadership style. He is approachable, fair minded and inclusive.”

LIVING OUR VALUES

Kate DealePharmacist and You Made a Difference nominee March 2017

“Kate is not only an excellent pharmacist but also a superb communicator and acts as a mentor for not only junior pharmacists but for the junior doctors. Kate is selfless in her endeavours to make sure that patients always have the best outcome. In terms of her mentorship with junior doctors, she is always polite and respectful to doctors. She explains medications to junior doctors and always has a helpful and friendly smile. She is always accurate with her suggestions on the medication management plan and has good ideas for patients that may need additional medications whilst in hospital. There have been many circumstances when she has been called to give advice to junior doctors who are stressed by antibiotic dosing or analgesia needs. In stressful situations for junior doctors, she gives a calm voice of reason. She also helps graduate nurses with administration of subcutaneous medications on the ward.”

What do our values mean for you?You can probably recite the Melbourne Health values, but when was the last time you thought about what they really mean for you? When was the last time you discussed it with your colleagues? Our values are at the heart of our culture, and it’s important that they aren’t just posters on a wall, but are something that guide our actions and decisions every day. There are some practical resources available to help you do this:

• Online training package ‘Living the Values’, available on Training Space. It’s great for new starters, or if you want to refresh your thinking about how the values relate to you and your work.

• A 30 minute face-to-face workshop, at a time and place that suits you can also be delivered. This is a great session to be able to explore our values in more detail, including what you can do as a team to embed the values and bring them alive in your ward or work area.

• Resources on the values intranet page, including videos, poster templates and a manager’s guide to embedding the values.

For more information email Diana McDonald, Program Director, Cultural Transformation via discoverypathways@mh.org.au

77Overall performance score from DHHS — this is the highest score achieved for some time

0.4 Improvements in managing Staphylococcus Aureus Bacteria (SAB) rates

MH PERFORMANCE RESULTS (DHHS PERFORMANCE MONITOR Q2, 2017) — CELEBRATING GREAT RESULTS

Seasonalised elective surgery target achieved

Targets where patients leave ED within four hours (NEAT) and ambulance offload both improved

Operating result positive

0Number of ICU Central Line Associated Blood Stream Infections (CLABSI)

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“Over recent years People Matter Survey has given valuable insights about the experience of the ICU staff, which has given guidance as to how we can direct priorities to best support staff so they can optimally provide care to our patients.” CHRIS MACISAAC, Divisional Director CCIS

Have your say in the People Matter SurveyOur People Matter Survey will be formally launched on 15 May and open until 26 May.

It offers all our people the opportunity to speak out about a range of important issues which aren’t measured by our usual KPIs but have a significant affect on staff experience at work as well as safe and high quality care. Previous survey results led to the development of our Because we Care Cultural Transformation Program.

Why complete this survey?The People Matter Survey:

• Provides us with information on a range of important measures — staff wellbeing, staff engagement, job satisfaction, leadership, change, diversity and patient safety.

• Tells the organisation where initiatives are having a positive impact in the workplace.

• Is an opportunity to shape our future agenda by identifying how Melbourne Health supports its people at an organisational and local level.

The survey is open until 26 May 2017 and results are expected in June 2017.

Professional accountability taken seriously weCare enables us to provide feedback to each other, where we feel unable to do it directly, about behaviours that undermines the safe and respectful culture we want to create. But it does not replace the existing formal processes in place for reporting, investigating and dealing with more serious behaviours. In 2016–17 (up to 31 March), we have seen a drop in the number of bullying complaints compared to last year, but an increase in reports of inappropriate behaviour and harassment. While the numbers are small compared to the size of the organisation, behaviours such as these can have a significant affect on people and create ripple effects for both staff and our patients and consumers.

Mediation and advice or education is being used more often in response to these complaints, reinforcing our aim to help staff reflect and improve. However, the proportion of investigations resulting in a first warning or final warning has also increased on last year, clearly demonstrating our commitment to holding everyone to account for their behaviour.

Professionalism, accountability and civility must be paramount for a people organisation striving to be First in Care. Absolutely everything we do in some way affects the care of our patients and consumers.

# COMPLAINTS RECEIVED

BOTH CHARTS SHOW FIGURES UNTIL 31 MARCH 2017

BULLYING

2015/16  2016/17

DISCRIMINATIONHARASSMENT

48

16

1 1

56

86

2

INAPPROPRIATE BEHAVIOUR

OUTCOME OF INVESTIGATION

Counselling First Warning Final Warning Resignation Termination

Unsubstantiated Mediation Withdrawn Other/Pending Advice/Education

27%

22%7%

1%

4%

3%

7%

1%

13%

15%

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LIVING OUR VALUES

Alex LiaoSocial Worker and Nominee, Social Work Award, NWMH

“Alex has been employed as an entry level social worker at BIPU for the last year. He has shown maturity above his years and experience. He has grasped the essence of social work, has been diligent and respectful in all his dealings with consumers and staff.

He has championed causes at the ward including the use of cue cards to assist CALD patients with simple communication; raising awareness about sensitive and appropriate practice with transgender consumers as well as advocacy for a wheelchair user in her discharge planning. He has also been a valued member of the ROC Portfolio Working Group.”

When the going gets tough, let us helpMost of us use colleagues as an informal sounding board when we are stressed or troubled. The Melbourne Health Peer Support Program simply formalises this process. While Peer Support is not a counselling service, it is a very positive contact, support and referral service with an emphasis on brief, practical interventions. The Melbourne Health Peer Support Program is an avenue of support provided by a trained group of fellow employees who volunteer their time. Support Services Manager, Liz Virtue, is one of the Peer Support volunteers, and has been in that role since the program’s beginning.

“Caring professionals often put themselves last — to their own detriment. It’s understandable, but it’s not healthy,” explains Liz. “Sometimes bad things can happen to good people, through no fault of their own, whether at work or at home. When this happens, they need support and care.”

“I recently experienced a family tragedy myself and needed the sounding board of Peer Support to help me process it. Sometimes you just need the emotional ‘scaffolding’ in life…in other words, the people around you to put up the supports to help you cope. Once the pressure eases, the scaffolding can come down.”

Liz believes initiatives like Peer Support are critical for staff working in the healthcare sector. Melbourne Health is prioritising the mental health and psychological wellbeing of our staff right across the organisation, by implementing an Employee Mental Health and Psychosocial Risk Strategy.

When our workforce is supported and engaged, morale and performance improve…leading to better patient care outcomes. These improvements will, in turn, help make Melbourne Health the best place to work and the best place to be treated and cared for.

For more information visit the Peer Support Program intranet page.

IF YOU FIND YOURSELF GOING THROUGH A DIFFICULT TIME, THERE IS SUPPORT AVAILABLE:

Employee Assistance Program (EAP)The Employee Assistance Program (EAP) is a confidential, short- term, solution-focused counselling and coaching service to assist employees of Melbourne Health with difficult work or personal issues that may occur from time to time. You can access the EAP 24 hours a day, seven days a week by calling 1300 OUR EAP (1300 687 327). Melbourne Health will fund up to three sessions per issue per year.

Peer Support ProgramThe Melbourne Health Peer Support Program is not a counselling service, it is a very positive contact, support and referral service with an emphasis on brief, practical interventions. You can contact a Peer Supporter via the switchboard on 9342 7000.

Send your MH Connect stories, ideas and suggestions to mhconnect@mh.org.au Follow @TheRMH Like us on Facebook Share with your colleagues on Yammer

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LIVING OUR VALUES

Karen BuchananA/NUM 4 South Neurology and You Made a Difference nominee March 2017

“Karen is one of those people within our team that always puts her patients’ safety and her staff members’ safety first. She inspires people to take great pride in what they do and has the utmost respect for everyone she works with.

We recently had a shift where it felt like all hell had broken loose, and if you don’t have a strong backbone within your team, you feel it. Karen didn’t let us feel it; her coordination skills and her ability make sure that everyone in her team and every one of her patients was safe was amazing.

It’s hard to state specific details, how can you comment on someone’s ability to run a shift when it was the whole shift that felt like a spiral of one thing after another thing going wrong. She helped us with difficult discharges and admissions, helped put falls prevention strategies in place for our confused and impulsive patients, and helped with the settling distraught family members.

She is truly making a difference every day. She is the feeling of peace that you have in the back of your mind amongst the chaos.”

LIVING OUR VALUES

Marion ErjavecRN, John Cade 2

“Marion is one of JC2’s long-serving night nurses. She always comes in an hour early so she can touch base with the clients before they go to bed, keeping her therapeutic relationships healthy.”

LIVING OUR VALUES

A post from a patient of The Royal Melbourne HospitalOne of our patients recently left this lovely feedback on the RMH Facebook page: “Following a CT scan I was told I had a mass measuring 3.6cm x 3.2cm on my right lung. My local GP referred me to the RMH. Each and every appointment was just as smooth transition from one to the next with every appointment and department explaining every procedure fully.

Results day…again it was so well thought out, I received the diagnosis of cancer, I left the hospital not with the dread or sorrow of the horrible C word, I left with confidence that this well-oiled machine had my back, knew every step that was in my best interest. Normally I would have a thousand questions but they were so thorough in explaining everything I honestly had nothing to say and felt secure and safe in their hands.

Ten days after results I was booked in for surgery. Recovery, nursing, cleaning, catering, pharmacy, anaesthetics, doctors staff/team and all the staff doing the background works…these beautiful people treated me as if I was family.”

Do you have a story to share from your workplace? Send it to mhconnect@mh.org.au

LIVING OUR VALUES

Helen KellyCNE, John Cade 2

“Helen regularly goes above and beyond to ensure their team is supported. Helen is always available to her colleagues and is frequently found huddled in her office trying to organise staffing at the end of her own shifts.”

LIVING OUR VALUES

Marita GibbsSocial Worker and Nominee, Social Work Award, NWMH

“Marita demonstrates professional and personal dedication to her role as a social worker. In particular, Marita provided an incredible level of support to the family of a consumer who had recently suicided.

This involved advising and supporting several family members in very difficult circumstances.”

What is the one small thing that you can do to help move our culture from good to great?

SAFETY CULTURE KEY STATS TO APRIL 2017

4899 STAFF TRAINED IN SPEAKING UP FOR SAFETY

288 WECARE REPORTS HAVE RESULTED IN A CARE CONVERSATION