Issue 28 / 1 August 2011

COMPLAINTS by public hospital doctors that they had been bullied or disciplined for speaking up about the needs of patients were recently in the news.

In an article published in the Sydney Morning Herald, one doctor said he was facing disciplinary action for raising concerns about mental health services.

Commenting on the emergency department doctor’s predicament, Professor John Dwyer, of the University of NSW, told the newspaper there had been a culture of administrators bullying hospital staff, forcing them to compromise on standards of care. “[Chief executives] and senior executives were bullying in the sense that they were unreasonably demanding that people save money”, he said.

This led me to think about the relationship between large government departments and bureaucracies and the staff who work within their institutions.

Staff members see themselves at the front line, actually providing the service to the public. However, it seems some layers of management, separated from the coal face, become obsessed by complaints and start to see the staff as a liability rather than an asset.

Broadly, there are two main approaches to people management in high-risk work environments.

The first is to see staff as the generators of risk, and to seek to restrict people making individual decisions and judgements. The second approach is to see skilled staff as the solvers of risk, and foster them to make informed judgements.

In his book The Human Contribution, Emeritus Professor James Reason, a UK psychologist, looks at how people contribute to the reliability and resilience of complex systems. Reason says that in most large organisations the predominant attitude “is to consider the human as a hazard, a system component whose unsafe acts are implicated in the majority of catastrophic breakdowns”.

“But there is another perspective, one that has been relatively little studied in its own right — the human as hero, a system element whose adaptations and compensations have brought troubled systems back from the brink of disaster on a significant number of occasions.”

Perhaps it is time for management within health departments to recognise its heroes.

The heroes are not those who win the largest research grants, perform the most impressive procedures, use the newest technology, or publish the most papers. The heroes are the coal-face clinicians and support staff, who keep the health care system alive and functioning, day after day.

The heroes do their best with their skills and judgement to solve difficult problems within a constrained environment. They struggle to meet the expectations of an ever more demanding and critical society.

These are the people that human resources departments should exist for — the actual human resources of health. They ARE the resources, not the liabilities.

Dr Sue Ieraci is a specialist emergency physician with 25 years’ experience in the public hospital system. Her particular interests include policy development and health system design, and she has held roles in medical regulation and management. She also runs the health system consultancy SI-napse.

Posted 1 August 2011

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