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Changing the culture in healthcare - part 2

By Brian Holden - posted Wednesday, 24 October 2007

Too many staff are agreeing that the only way to emotionally survive as an employee in the public health system is to give up caring and learn to live with the mess. This must be of concern to all of us.

Coexisting are the doctors’ and nurses’ world of blood and vomit and dangerous short-cuts and the ministers’ and area executives’ world of reorganising and then reorganising the reorganised. As the problems become more overwhelming, the world of the decision-makers keeps moving towards the stratosphere.

Typical of any organisation staring collapse in the face, there is unethical damage control on the one hand and an escape into fantasising about better days ahead on the other.


This silencing [public discussion, doctors who speak out] has been balanced by numerous high profile consultant-led inquiries into the future of health where day-long seminars of contrived public consultation in expensive hotels achieve predictable outcomes.

The “predictable outcomes” Professor Steven Leeder refers to are feel-good delusions. What is the “contrived public consultation” the professor mentions?

The policy from high which failed on the ground

From about the mid-90s, public sector executives everywhere have been trumpeting their wholehearted acceptance of the citizen’s right to play a role in public policy.

In public health some recommendations were astonishing. In 1996 the Australian Health Ministers’ Advisory Council was even recommending that consumer representatives should participate in quality management. The 2000 Health Council Report commissioned by the New South Wales Government stated that a health service has no real legitimacy without consumers being involved in the planning of services.

Participating in quality management and the planning of services! That’s a big step up from putting ticks in boxes in a consumer survey. We had been promoted from the bilge to the captain’s cabin.

Riding on the surge of a brainwave, any prior research was seen as being unnecessary. A bit of probing would have revealed that two criteria had to be met if the grand idea was to be more than pie-in-the-sky:

  • the staff had to accept the idea and not have it thrust upon them; and
  • community representatives had to be both capable and fearlessly independent of the public health service.

Neither criteria were met.

The busy health care employees resented the intrusion of political correctness. They resented being required to listen to every ding-a-ling consumer opinion. There was a fear of becoming hostage to articulate minorities and an awareness of a rising culture of complaint. The prospect of close engagement with the community made many in the industry feel very uncomfortable.

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About the Author

Brian Holden has been retired since 1988. He advises that if you can keep physically and mentally active, retirement can be the best time of your life.

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