Home The Quarterly 2017 Monash Doctors – A Case Study on Medical Engagement at a Large Public Health Network

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Monash Doctors – A Case Study on Medical Engagement at a Large Public Health Network Print E-mail
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"Not surprising, the highest engagement (top 1/5th of scores) was found with full-time senior medical staff, and also with our Fellows, Interns and Dentists. Also interestingly, the highest engagement was found in Monash Doctors “with a position of managerial responsibility” (top 1/5th of all health services), essentially our Program Directors and Unit Heads (n=127) which is also a great testament to the engagement work carried out with our medical leaders"
 
  

Monash Health (1) is Victoria’s largest public health service, providing healthcare across south eastern Melbourne, uniquely integrating primary, secondary and tertiary health services, and covering medical specialties ranging from obstetrics and neonatology, paediatrics through Monash Children’s Hospital (third busiest paediatric centre in Australia), all the way to geriatrics and mental health services. Over 16,000 staff work at six major hospitals and over 40 community health sites. Because of the size and breadth of the health service, with medical staff working across multiple campuses and specialties, medical engagement has been a challenge.

I commenced in a medical leadership role at Monash Health in late 2008, and became the organisation’s Chief Medical Officer in 2012. I distinctly remember a surgical unit head telling me very early on about how he never felt any affiliation to the health network (known as Southern Health at the time), and how he had a stronger affinity to the hospital he worked at, Dandenong Hospital. A medical engagement strategy was developed to change this culture of disconnection and lack of belonging.

The first step of the strategy was a baseline measure of medical engagement. A safety climate survey of all medical staff in the organisation was carried out in November 2011 and January 2012 using an external agency based on the University of Texas Safety Attitudes Questionnaire (2), a validated tool. The total number of surveys distributed was 863, out of a total of around 1,500 medical staff at the time, with 293 responses, making it a total response rate of 34%.

This survey was used at the time as a de-facto proxy measure of medical engagement, and showed an average raw score of 3.36 out of 5. Compared to our peers, this showed the organisation to be in the bottom quartile for safety attitudes. In particular, the safety climate survey’s key indicator, “I would feel safe being treated here as a patient” gave a result of 3.57 out of 5 for senior medical staff, and 3.76 for junior medical staff members. On further examination of the data, we found that the lowest score in the survey was for the question: “Health service management supports my daily efforts” – 2.66 for senior medical staff, and 3.13 for junior medical staff. This was considered a reasonable proxy indicator for engagement with the organisation by medical staff, and confirmed the need for action.

The second step in the strategy was to create clear sense of identity and community that medical staff could attach themselves to. In October 2012, Southern Health launched Monash Doctors, the new name for the Southern Health Medical Community. Open forums were held at each of the major hospitals of the health network, where senior and junior medical staff came together for a formal launch of the Monash Doctors community. Included in the launch was the use of the Monash Doctors logo on posters, mugs, badges and lanyards, with every doctor given a Monash Doctor lanyard and name badge. This created a sense that every doctor in the organisation belonged to the Monash Doctor community, no matter where they worked.

In addition, a Monash Doctors website (3) was launched that provided links to all medical policies and procedures, e-forms and other relevant documents. A companion Monash Doctors smartphone app was also created with an external vendor, and used as a communication tool. In addition, the author started a weekly electronic newsletter, which continues to this day, the main method of communicating to all 2,500 Monash Doctor.

The medical workforce and medical education units were rebranded to Monash Doctors Workforce and Monash Doctors Education respectively. Quarterly open forums with all Monash Doctors at all sites were commenced to facilitate two-way face-to-face communication. An annual Monash Doctors career expo was also started, together with end-of-year Christmas barbecue events for all doctors at each site.

A formal two-day biannual clinical leadership workshop was developed and implemented, for all medical unit heads and potential medical leaders (initially in partnership with Monash University in the first year in 2012, and then run solely by Monash Doctors Education moving forward), delivered by key leaders in the organisation, with practical modules covering clinical leadership, change leadership, effective meetings, understanding finances and writing business cases, quality and safety, performance management and training and supervision.

One year after initial launch, the author started an annual Monash Doctors Leadership Retreat in 2013 for the most senior Monash Doctors (the ten or so Program Directors), a one and a half day away in an external location facilitated by an expert leadership consultant to build up the executive medical leadership team.

In March 2013, 5 months after Monash Doctors was launched, Southern Health was officially renamed Monash Health, by an Act of Parliament through an amendment in the Victorian Health Services Act (4).

In October 2014, the Hon Jeff Kennett AC, Chairman of BeyondBlue at the time, launched Monash Care at Monash Health, the Monash Doctor’s Mental Health and Wellbeing Strategy (5). This was a piece of work championed by Dr Anjali Dhulia, Director Medical Services at Monash Health.

In December 2014, the climate safety survey using the same validated tool was repeated, with a very similar response rate. By 2014, the average raw score had improved from 3.36 to 3.49 (from 51% to 57%), which showed that we had moved from the bottom quartile to the average middle quartile on benchmarking. Interestingly, on further examination, the average raw score for senior medical staff had improved, more than junior medical staff, which was the opposite trend in 2012.

In June 2015, The Hon Jill Hennessy, Victorian Minister for Health, launched the Monash Health Women in Medicine Program, the Monash Doctor strategy to inspire, encourage and support women in medicine to achieve their full potential at Monash Health (6). This leadership program for female Monash Doctors continues to this day, again led by Dr Anjali Dhulia.

At the third annual Monash Doctors Leadership Retreat in 2015, a High Performance Team Assessment spider chart showed improvements in the team assessment on all 7 elements by 1 to 2 scores from the same assessment made in 2013 (the elements being: bold aspiration and direction, living the values, trust/real dialogue, coaching, people development, delivering performance, collaboration, and creating breakout), which suggested a maturation of the Program Directors working together as a leadership team.

With the improvement in engagement of the Program Directors, I felt it was time to focus on the next level of medical leadership, the Unit Heads, or the middle managers of medical leaders – the level of leadership that sits between the medical executive and the clinical frontline. To that end, the Monash Doctors Council was formed in 2015, consisting of all the nearly 100 medical and surgical Unit Heads of Monash Health. This Council commenced meeting on a quarterly basis at a half-day workshop held externally, and has continued meeting since, recently for the 8th time. This Council provides the Chief Executive and Chief Medical Officer with an avenue to engage the Unit Heads, and offers a direct channel of communication with this very crucial leadership level.

In April 2016, Monash Health was the first health service in Australia to sign the Memorandum of Understanding with the Royal Australasian College of Surgeons on Building Respect and Improving Patient Safety, as part of a commitment to work together to deal more effectively with discrimination, bullying and sexual harassment in the medical workforce (7).

In December 2016 and January 2017, Monash Doctors implemented the Medical Engagement Scale, a validated tool (8) implemented in the National Health Service (NHS) UK and other states in Australia, that received 912 responses. The Medical Engagement Scale showed that after 4 years of implementing targeted medical engagement strategies, Monash Health showed High Relative Engagement (in the 2nd highest 1/5 of all health services internationally). Pleasingly, Monash Doctors showed the Highest Relative Engagement (top 1/5th of health services) for “Appraisals and Rewards Effectively Aligned”.

Not surprising, the highest engagement (top 1/5th of scores) was found with full-time senior medical staff, and also with our Fellows, Interns and Dentists. Also interestingly, the highest engagement was found in Monash Doctors “with a position of managerial responsibility” (top 1/5th of all health services), essentially our Program Directors and Unit Heads (n=127) which is also a great testament to the engagement work carried out with our medical leaders. In addition, the Medical Engagement Scale results showed lots of opportunities for improvement and Monash Health is by no means the leading health service with the highest engagement scores. An ongoing piece of work to develop findings, recommendations and an action plan using an external consultant is currently underway.

I hope that this summary of the medical engagement strategy and evaluation results at various steps at Monash Health provides an interesting case study of how medical engagement can be implemented and evaluated at a large, tertiary, metropolitan public health network.

 

Professor Erwin Loh
FRACMA

 

References:

1. http://www.monashhealth.org/page/About_Us

2. https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-6-44

3. http://monashdoctors.org/

4. http://www.gazette.vic.gov.au/gazette/Gazettes2013/GG2013S191.pdf

5. http://monashdoctors.org/monash-care/

6. http://monashdoctors.org/women-in-medicine/

7. https://www.surgeons.org/media/media-releases/racs-signs-mou-with-monash-health-on-building-respect,-improving-patient-safety/

8. https://www.researchgate.net/publication/233654235_Developing_a_medical_engagement_scale_MES

Last Updated on Friday, 15 September 2017 12:29