Concepts and Themes that emerged from the DHQ Forum

Throughout the DHQ Forum, a number of key concepts emerged from the many presentations and subsequent discussions between the many key experts in doctors’ health who were present.

• Doctors in all stages of their careers need a safe space to grow.
• Senior doctors may have fewer opportunities to respond to individual workplace problems as their career pathway options may be limited.
• Positive change will not occur simply because people want it, it needs to be championed. Rewards for positive change and recognising the consequences of not changing matter. Political mechanisms and management of power are integral to success.
• Financial support for doctors’ health initiatives needs to be available from the larger organization and NOT taken from tight departmental budgets.
• There is a need to consider all stages of career progression with a doctors’ health lens and enhancing flexibility would be positive.
• Well-being = ‘feeling in control’. More skills = more control and less stress. Support and education are fundamental.
• AHPRA stresses can have a significant impact on a doctor’s health so changing the way in which AHPRA operates with a focus of improving an understanding of doctors’ health.
• In particular, when AHPRA allows scurrilous complaints, this can cause a significant amount of distress to practitioners. The time lag before the claim is dismissed or investigated magnifies that distress.
• Transformational change to enhance doctors’ wellness requires both bottom up and top-down change.
• Doctors’ health and wellness is everyone’s responsibility and starts with supporting medical students – not just in a token way.
• Foster curiosity about other fields has a positive impact on doctors’ health. A better understanding about other’s roles and barriers they are experiencing is also important.
• Social connectedness enables career longevity, so we need to prioritise and enable connectedness.
• Women’s fertility is everyone’s issue not just a female issue.
• If we want to change the culture, then highlighting the economic argument, enables planners and funders to better engage – they love saving money.
• Young doctors often feel they do not have a voice and they can be badly treated by other staff including nursing staff. Young doctors need a safe way to access support in these situations that will not be perceived as impacting their career.
• Younger doctors who become consultants (new Fellows) need support, especially during their first five years of practice.
• We have to start somewhere, waiting while we collect data should not stop us from doing some things that will support doctors’ wellness.
• As health is a complex system, there will always be “Layers of Care” required, but every layer should come from a place of love.
• Passionate advocates will present themselves if they feel supported, they do not need ‘to be found’. They are already there!
• Fatigue remains a significant issue for doctors and needs to be effectively addressed (not just measured) for all stages of the medical career.
• Civility, connectedness, gratitude, and kindness cannot be underestimated in their importance in supporting the health and wellbeing of doctors.
• Principal House Officers (PHOs) often do not have direct mentorship as they are not situated within the college training support and therefore, they are a vulnerable group. It is difficult for them to speak up as they often want to get onto a training programme.
• Sharing a time for lunch and team meetings weekly will build better team dynamics.
• Enabling support for diversity, inclusiveness and team building through education will support the well-being of health teams.
• Suicide of doctors needs to be examined in more detail and we need to develop compassion around mental health.
• Think BIG – but tailor it in so you can start. Ask: What will make a difference? Even changing one thing enables organic change.
• Wellbeing and quality improvement projects need to be ‘owned by the people’ with commitment and support from above. Not pushed onto a group from the hierarchy with no ownership at the level it is being rolled out.
• Doing something – anything! – is better than doing nothing. Staff notice and appreciate that ‘someone is doing something’.

What is Already Happening?

During the DHQ Forum, working groups discussed interventions that they knew were already happening at the coalface across different work environments. These ideas are captured here to inspire others to consider what they could do to enable doctors’ health and wellbeing.

• Use of social media enables connectedness e.g., Facebook groups (junior doctors, mothers, GPs etc) serve as important sources of communication and information sharing, particularly for young doctors and medical students.
• Team feedback and problem-solving sessions enhance connectedness and enable the voice of all members of the team.
• Mentoring of medical students, junior staff and specialists by senior members of the profession can be an important support e.g., SWIM- Supporting Women in Medicine group
• GP training programs: During training, both trainee and mentors are surveyed, problems are identified and there is an opportunity to have the difficult conversations that need to be had at times. GP training programs employ two pastoral care officers, who contact the GP registrars, especially when they are working away from home and provide family and practical support.
• Being a kind and compassionate professional, including self-care and wellbeing, is being included as a specific domain within the new University of Qld MD course. Teaching how to negotiate and develop a framework for self -assertiveness will be included in the medical school curriculum.
• Chief Medical Wellness Officer is a specific position for a medical practitioner that currently exists in one NSW hospital district. It is a position that is funded as a half-time specialist position and it is supported by a funded team to enable the implementation of a range of initiatives.
• Measurement tools for wellbeing exist e.g., Mayo Wellbeing Index. The MWI is an evidence-based tool that has been used effectively in some organisations to support the implementation of wellness initiatives.
• The tearoom/break room/safe space away from the emergency department exists in some organisations. The benefits of this space are that everyone gathers there because it is pleasant. It is easier to facilitate interdepartmental referrals through informal networking. It fosters better cooperation between teams because of the greater social connection created by the communal space. It makes for a more collaborative workplace.
• Regular social gatherings dinners/sporting activities are promoted in some workplaces. These can be started by small groups. With each successive social gathering each person must invited another member of staff. These activities can lead to better social connection and cooperation in the workplace and improve staff satisfaction.
• Morning teas across disciplines: this has been done by the emergency department at QE2 and the QCH
• The “Qantas Club” tearoom was built at RBWH, and provides a safe space for junior doctors, and promotes a collegial atmosphere across the ranks from juniors to SMOs. It has a coffee machine, designated quiet pods and workspaces.
• “Mid- winter madness” (ED at QCH aims to invite other specialties)
• Paediatric Surgery template at QCH has a weekly education and Multidisciplinary Team (MDT) meeting to question/discuss any issues of concern that have arisen over the week.
• Additional informal time made on a team’s weekly meeting enables further discussion of selected clinical conundrums chosen by the registrars.
• RBWH has a Wellbeing Committee with executive buy in.
• College of pathologists oversees 700 trainees, with 2 dedicated staff for pastoral care and if needed, 3 College funded sessions with a psychiatrist available for any trainee.
• JMO Medical Education Units tend to provide some pastoral care to interns and residents and training boards/supervisors of training. Acknowledgement that PHOs sometimes fall between the cracks.
• Support group at QCH after the loss of a colleague to suicide. This is an intimate group, people keep coming, supporting our colleagues, courage to step into the space, peer to peer support.
• Balint group, a GP-facilitated, safe space, structured group, regularly run within a general practice enables GP wellbeing – noted that the attendance goes up and down depending on what is happening, but people know that it is there for them, and the connectedness is important.

What do you want in your workplace?

Later in the DHQ Forum, working groups discussed interventions that they felt should be incorporated into the medical work environment to enhance the health and wellbeing of doctors. These ideas address the needs that the experts had identified and considered as important to enabling doctors’ health and wellbeing. Some of these ideas reflect interventions that others had already instituted in other spaces, as described above.

• Mindfulness training for all medical students
• Education about normalising conversations about doctors’ health – informal and formal.
• Socialising in a variety of ways and a variety of spaces e.g., exercise in groups, shared morning tea, cross discipline social gatherings, regular celebrations, conversations on WhatsApp.
• FOOD, staff need access to food whenever they are at work (all hours). There is a need for hospital employees to have access to healthy hot food and beverages especially after hours when cafeteria is closed e. g., healthy vending machines. Provide food at education and departmental meetings. These are often held during lunch time, and it is an ideal time to promote healthy habits/healthy eating.
• Review how buildings are constructed – at the planning phase – We want our tearoom back, and space to store personal stuff, and somewhere to have some timeout.
• Education is a vital aspect of a doctors’ wellbeing. Build fun into education, education for everyone, education about what to do if there is a complaint against you.
• Enable the establishment of peer support groups, Schwartz rounds, Balint groups – anything that creates a sense of connection and a safe space to openly discuss sensitive issues.
• Provide more protected time for doctors including lunch breaks, team time, time for health and wellbeing, time to attend medical appointments, parental leave, recreation leave -without guilt about burdening colleagues. Backfill is essential – it needs to be available and provided, not contested.
• Flexible training, flexible workforce and flexible hours that address the needs of parents to enable timeout for child rearing – for both male and female doctors.
• Enable every doctor to have a GP e.g., including a private (independent) General Practice available at hospitals for staff and reducing work constraints so that doctors can access medical care and preventive health.
• Promoting the option of telehealth for doctors to enable connection with their personal GP.
• Staff psychiatrists, staff psychologists, pastoral care and wellbeing officer provided for doctors at all levels of their career.
• Increased availability of professional mentoring to doctors.
• Increased availability of coaching programs e.g., to support doctors sitting exams, tips on dealing with their training organisation, managing communication with other medical team members e.g., registrars and consultants.
• Career counselling enabling better career choice and the consideration of creative career change.
• Instigate an annual Doctors’ Day to increase passion from people on the floor.
• Encourage Colleges and Hospital Services to engage with the Doctors’ Wellbeing Charter, considering how this can enable/leverage change.
• Educate Junior doctors about how to influence organisational change, understanding where their power lies and how to use this e.g., through DIT organisations, AMA, colleges.
• Increase the length of Junior doctor contracts for 2-3yrs to provide more certainty and stability so they can plan their careers and lives.
• Develop a national work plan for PHOs and unaccredited registrars, including enabling Medical Education Units to take PHOs into account.
• Leading a culture change that calls out bad behaviour that is unacceptable, as it emerges.
• Designated regular time for departmental meetings for consultants and junior doctors. Include registrars in consultant meetings to make them feel included.
• Have a team approach to mid-year reviews. Hold an interview with Director of Medical Training (DMT) every term with feedback provided. Fortify the DMT position to enable this.
• Offers opt in anonymous feedback e.g., this could be done using SurveyMonkey and collated by one independent person. Ensure that this feedback is delivered in a confidential manner with the intern’s concerns being heard in a safe way and ensuring that the department and staff receive this feedback.
• Support new consultants, ensuring that new Fellows are well prepared for the transition. Give them leadership training. • Planned Leadership courses: consultants would benefit from ‘leadership’ training – increasing their capacity to lead and also to manage the system – including doctors’ health and wellness understandings in this training.
• Networks across hospitals to reduce tribalism and create a sense of connectedness, leading to understanding, kindness and tolerance and a sense of a ‘work family’.
• GPs and hospital doctors currently get to see the worst in each other. GPs and hospitals work in silos so there is a need to increased awareness to bridge that space and foster support. Enhancing the opportunity for each to understand the other’s perspective would improve primary/tertiary collaboration. Enabling local GPs to come into their local hospital for a meet and greet could help broker this collegiality.
• Establish a wellbeing committee with good visibility/high profile at every workplace.
• Colleges and departments that are further along the wellness program journey provide support and sharing of wellness ideas. Acknowledging that different specialties have different needs – so one size will not fit all.
• Commitment from leadership/executives for increased time and financial resources for health and wellbeing activities.
• Leading change at work: find a champion in your organisation. Talk to them and get them to gather a group of interested individuals. Many administrators have training and skills in doctors’ wellness so approach them.
• Legislation/Regulation creating KPIs around doctors’ health and well-being support.