achse.au/frameset.html ACHSE Victoria Branch

Residential Conference 2003 3 and 4 April Facilitator: Associate Professor Jeffrey Braithwaite Centre for Clinical Governance Research in Health, University of NSW www.achse.org.au/frameset.html ACHSE Victoria Branch

Day 1: Thursday 3 April 2003

Day 2: Friday 4 April 2003

KEH: key barriers to change • Reluctance to admit errors and flaws. • Reluctance to adopt a ‘beyond blame’ culture. • Reluctance to acknowledge that clinicians are accountable.

1. Reluctance to admit errors and flaws • review of 372 high risk obstetric cases • 47% - one or more clinical errors

2. Reluctance to adopt a‘beyond blame’ culture Perinatal Mortality Committee meetings • ‘witch hunts’ • ‘finger pointing exercises’ • ‘blame culture’ • ‘intimidating’ • ‘denigrating’ • ‘vindictive’

3. Reluctance to acknowledge that clinicians are accountable ‘Peering in from outside’ Poor incident reporting andmanagement • ‘Doctor’s Alert’ • No patient information to ‘management’ without written authority from the patient • No answers to management questions without prior written notice of question.

Management Significance of management: • management is crucial to delivery of health care • management affects all aspects of the quality of health care. Who should manage? • the best doctors are not necessarily the bestmanagers • the best managers are not necessarily doctors • doctors can’t be in two places and do twojobs at the same time.

Above the waterline lie the observable workplace behaviours, practices and discourse: this is ‘the way we do things round here’. Figure 1: the iceberg model of culture Below the waterline lie the underlying beliefs, attitudes, values, philosophies and taken-for-granted aspects of workplace life: ‘why we do the things we do round here’. Day 2: Friday 4 April 2003

achse.au/frameset.html ACHSE Victoria Branch