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Crisis drives change: COVID-19 lessons for better, safer healthcare

Introduction by Croakey: The need for inspired and inspiring leadership, to shift power dynamics, have trauma-informed care, and understand the exhaustion of many health workers and leaders after more than a year of working to address the COVID-19 pandemic – these were among the key takeaways from last week’s #GiantSteps21 conference.

The online conference, hosted by Safer Care Victoria and attended by more than 1,100 people across Victoria and Australia, looked at how to make the healthcare system safer and better for patients and staff, and what lessons were to be drawn on quality and safety from the pandemic.

Guest speakers included Victoria’s Chief Health Officer Professor Brett Sutton, United States patient advocate Tiffany Christensen, US health reform leader Dr Kedar Mate, actor, author and comedian Magda Szubanski and Dr Richard Harris, an anaesthetist who played a key role in the 2018 Thai cave rescue of a young soccer team.

Concurrent sessions then focused on key issues and insights raised by the keynote speakers to examine many different issues at stake for healthcare workers, from leadership and self-care to how best to ensure individuals, families and diverse communities are heard in design and delivery of healthcare.

Participants in one session, reflecting on the lessons of the harsh sudden lockdown of public housing towers in Melbourne in the midst of Victoria’s second wave, heard this quote from Indian author Arundhati Roy:

There’s really no such thing as the voiceless. There are only the deliberately silenced or the preferably unheard.”

Another quoted the call for support from their organisations identified in an international study of health care workers:

Hear me, protect me, prepare me, support me, care for me and honour me.”

The one-day event also featured a playful Great Debate on whether quality went out the door under COVID-19 and a big focus on wellbeing, including via the GiantSteps21 playlist and sessions on meditation, cooking, music making and travel.

Journalist Marie McInerney live-tweeted the event for the Croakey Conference News Story, and compiled the wrap below.

Melbourne-based graphic recorder and illustrator Zahra Zainal turned the spoken content into the compelling illustrations that helped lead discussions and are featured in this post, and many participants joined in with gusto for a #GiantSteps21 selfie competition, to be featured in another post at Croakey.


My bed’s eye view: Tiffany Christensen

US patient advocate Tiffany Christensen is a life-long cystic fibrosis patient who has received two double-lung transplants and is currently receiving hemodialysis while awaiting a donor kidney. An international patient advocate, she is a key figure in the work of the Beryl Institute.

In her opening keynote, she talked about the difference between ‘patient satisfaction’, so often the focus of healthcare surveys, and ‘patient experience’, of what becomes the ‘lasting story’ for patients and families, “all that has been perceived, understood and remembered”.

Christensen talked about the unique perspective of working within the health system as a  patient advocate and advisor, but also how easy it can be to forget what ‘perspective’ you are bringing to daily work.

Despite countless days and nights spent as a patient in hospital, she still found herself at times in her advisor role having “forgotten what it’s like to be a patient”. Different roles are critical in health care, she said, but we need to be aware which lens we are looking through when we are working with people who are worried, scared and in pain.

Work by the Beryl Institute has also shown the different perceptions patients and families have of harm, compared to how the healthcare system sees it. See their White Papers: To care is human: the factors influencing human experience in healthcare today  and The experience of safety in healthcare: a call to expand perceptions & solutions.

See the Croakey Twitter thread of Christensen’s presentation.

As health consumer leader Belinda MacLeod Smith said, in the following concurrent session, a powerful takeaway from Christensen was for better listening to patients and their families, not just by individual healthcare workers and clinicians but the whole health system.


Pain pressure and progress: Professor Brett Sutton

Victoria’s Chief Health Officer Professor Brett Sutton talked about the professional and personal challenges for him and others at the frontline of the COVID-19 crisis, which was “at once transformative and stultifying”.

Sutton traced his journey from the early worrying news out of China in January 2020, through Victoria’s tough 112-day second wave lockdown and into what’s needed now, including for the overworked public health sector.

Talking safety and quality, he described how the Swiss Cheese model (see tweet below) demonstrates a systems approach for managing risk that applies as well to the health sector as much as for the airline industry, and said “hotel quarantine is Swiss Cheese par excellence”.

However, he warned that, in having a systems approach, experts and authorities have to be open to new data and new science, and beware hubris, intransigence, and group think.

“Always reflect, listen to the voices that are contesting your view, and throw yourself into that space of ambiguity and continual reflection, and then be open to saying ‘I’ve got a new view’ or ‘I’ve been wrong previously’, and ‘let’s move forward together’,” he said.

Sutton also reflected on the opportunities for personal growth that the pandemic had opened up for people, including himself, to reflect on where to focus energy and purpose.

See the Croakey Twitter thread of Sutton’s presentation.


Emerging stronger: choosing the path of quality: Kedar Mate

“We need more than a healthcare system. We need a health-creating system.”

That was the key message from Dr Kedar Mate, President and CEO of the Institute for Healthcare Improvement in the US, who said, while parts of the world are still in the throes of the devastating pandemic, health care systems, services and practitioners need to be thinking about how they will emerge.

“Will we be ruled by short-term thinking that might force us to choose austerity, cost cutting and cheap, low quality care? Or … will we turn to quality as the solution for both better care and lower costs,” he asked.

Mate offered five ideas for what a new health system might look like (you can read his blog post on them here), raising the possibility that hospitals as we know them today may be a thing of the past.


The Great Debate: when COVID arrived, quality left

  • For the affirmative: Susan Biggar, National Engagement Advisor at the Australian Health Practitioner Regulation Agency (ahpra) and the South Australian Health and Community Services Complaints Commissioner Grant Davies.
  • For the negative: Adjunct Professor Cathy Balding, Director of Quality Works at La Trobe University, and Felicity Topp, Chief Executive, Peninsula Health.

Biggar said it was not a debate on whether healthcare workers worked hard, were innovative and put their hearts and souls into their work, because they did, nor who was to blame for lost quality.

But she pointed to big waits for treatment and elective surgery, deferred preventive care like dental visits and cancer screening, worrying statistics like a quadrupling of seclusion episodes in child and adolescent mental health services, and inequities and other issues in the delivery of telehealth.

On her side, Topp said quality of care got Victoria and Australia through last year to being now “the envy of the world”, by working differently.

Healthcare modified practices, redesigned care delivery, trusted and used data, updated guidelines, stepped up virtual clinics and outreach, and focused on safety of patients and staff “in a rapid cycle of change”. Leaders were in daily contact, competition was replaced by sharing, and “the power of connecting, planning and responding together allowed the quality of care to remain”.

Moderated by former Safer Care Victoria CEO Euan Wallace, now Secretary of Victoria’s Department of Health, the debate was perhaps more fun than fiery, with plenty of rivalry and some good jabs by both sides, before the verdict came in from participants, in what might be a telling message for health authorities.


Diving deep into leadership: Dr Richard Harris

With Dr Craig Challen, Australian anaesthetist and cave diver Dr Richard Harris was named Australian of the Year and made worldwide headlines in 2018 when they joined an international team that rescued a group of 12 boys and their soccer coach who were trapped three kilometres deep in a flooded cave in Chiang Rai, Thailand.

Harris told #GiantSteps21 about key elements involved in the audacious rescue: the power of the individual, teamwork, expertise, agility, courage, and the importance of community. What he particularly admired, he said, was the capacity and courage to make tough decisions, understanding that “paralysis can be death” in many situations.

Despite the political, logistical, legal, ethical and moral decisions that were in play, Harris said he felt that his role in the rescue brought together his great loves of medicine and caving, made the most of his skills and expertise he had developed over decades, and was ultimately “crafted” for him.

Still, he said, it was a massive challenge and risk, where his first response to the idea of anaesthetising the trapped boys so they could be brought out safely was that it was “preposterous”.


From the heart: Magda Szubanski

Award-winning actor, author and comedian Magda Szubanksi has been subject to mainstream and social media storms in recent years, including during the same sex marriage postal vote campaign, from a recent comment on the Prime Minister and his wife, and as Australia’s favourite netballer Sharon Strzelecki, spreading the COVID-19 social distancing messages.

She talked about the impact at #GiantSteps21, saying it can be terrifying to be in the eye of such storms, which can go to the heart of a person’s fragility, and that people need to make sure they look after themselves. But she also said criticism is often part of being celebrity and it was important not to be inured to it because sometimes it is valid.

Szubanksi traced trauma experienced by both sides of her family, Irish and Polish, through poverty, war, and oppression (outlined in her book Reckoning), which meant she had grown up surrounded by people who had seen the worst of human nature, as well as deep altruism and an inclination towards medicine and the healing arts.

Having worked at a young age in women’s refuges, she said she “fled” into comedy, but always with a focus on social justice. She is now working with Will Connolly, dubbed “Egg Boy” in the media, as ambassadors for Regeneration, a program that helps disaster-affected communities heal through creative arts workshops.

See the Croakey Twitter thread of Szubanski’s presentation.


No such thing as the voiceless, only the silenced or unheard

Across five concurrent sessions, #GiantSteps21 teased out lessons from the keynotes in the work and experiences of participants during the pandemic, particularly in Victoria where the second wave that leaked out of hotel quarantine led to a 112-day lockdown and 810 deaths.

One looked particularly at the issues that arose through harsh and sudden lockdown of public housing towers in Melbourne, which prompted a health and human rights outcry from the community and beyond.

It echoed the earlier presentation of Tiffany Christensen about the challenges and benefits of working on system change from within the system, and the need to change the language and approach away from ‘vulnerable’ communities to recognising the strengths and resilience within them and that they can provide more global answers if they are heard.

Talking about making a difference, Kate Pryde, CEO of Stawell Regional Health, spoke on the importance of agility and partnerships, where a small rural hospital suddenly had access to resources it could not have hoped for before (“being able to pick up the phone and talk to an infectious diseases specialist was amazing”), and whose director of finance led the development of “one of the best respiratory clinics in regional Victoria”.

Professor Shelley Dolan, CEO Peter MacCallum Cancer Centre, who was asked to step in at short notice to set up the Hotels for Heroes program, said she had “lots of preparation in being a leader at times of crisis” from previous roles in the United Kingdom, where she was involved in terrorist incidents and the 2017 Grenfell fire disaster.

But the “massive difference” with pandemic responses was they were not three or four day events but played out over “months and months”.

Another session heard of work investigating frontline healthcare workers’ views on leadership through COVID-19, which Public Health Registrar Dr Tara Purcell said was echoing the powerful reflections in a 2020 study led by Tait Shanafelt of essential requests from health =care professionals to their organisations: “hear me, protect me, prepare me, support me, care for me and honour me”.


Journalist Marie McInerney covered #GiantSteps21 via Twitter and compiled this wrap for the Croakey Conference News Service.

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