Hello. So I'm going to take about 7 minutes to talk
about what Nelson Marlborough has been doing in terms
of adopting a more relational approach
to when things don't go to plan in health care settings.
I'm going to talk about —
a little bit about why we've embarked on this,
what we've done,
and a few key things that we've learnt.
So first of all, who am I? Well,
I'm Elizabeth Wood and I'm a GP by training.
I've been the clinical director for clinical
governance at Nelson Marlborough Health
for the past seven years.
Nelson Marlborough Health is a small health care system,
a district health board,
or at least it was until the 1st of July
2022 when our system changed. We cover a 160,000 population.
We've got about three and a half thousand staff
and two main hospital sites separated by a mountain range,
both of which have a very extensive rural
hinterland also to cover.
So why did we embark
on this journey?
Well, I'm sure that if you're watching this,
then you will already have multiple reasons of your own
why you think it's a good idea. And I guess for me personally,
my journey started probably in a cupboard in the back
of the Wairau Hospital theatre complex
when I was visiting some five or six years ago.
The charge nurse manager,
on hearing that I was interested in adverse event processes,
basically bundled me into what seemed like a cupboard
and said, "You must talk to — I have a nurse here that,
you must talk to this nurse.
She has a very important
experience to share with you.”
So I waited and then the poor nurse got, you know,
got brought in by the charge nurse manager
and we got talking, and I knew — she was — she was in tears,
basically. It was some five years since there
had been a series of very tragic events
for Wairau Hospital that's public knowledge.
There was a surgeon and some events went wrong.
There were two deaths, and a young —
including a young woman who died following surgery.
And of course, there was a major investigation,
including a police investigation. And
in the course of this investigation,
this particular nurse had felt targeted and blamed
for the series of events that happened.
In her experience,
that was her experience of the review process.
Of course,
there was no way anybody could think that the nurse
had any direct impact on what had happened
or could possibly have done anything to prevent
what had just happened. But, you know, health care workers
often carry a feeling of guilt and blame, you know,
almost on their shoulders. They sort of carry that.
It’s a heavy, heavy burden.
And this had had a major impact on this particular nurse,
and the story, her story, you know,
it had a big impact on me. And so that's — you know,
a personal story is a very,
very powerful way of prompting change. So we —
in 2017, at Nelson Marlborough, we also had a staff survey,
and our learning and development team,
our human resources team also came to the conclusion
that there must be a better way of having more useful,
helpful, thoughtful conversations between staff
to sort things out when things aren't going swimmingly.
And so we had —
some 48 staff across lots of different disciplines
were trained in using the restorative approach
for workplace conversations.
And we have had a partnership with the Health Quality
& Safety Commission and with Vic Uni Department
of Restorative Justice. Thank you both very much.
And we have run five workshops in collaboration
with them using a circle process to really explore
the impact of health care events that don't go to plan
when bad things happen.
We included consumers in the workshops and the whole
multidisciplinary team, including doctors, nurses,
allied health, psychologists, the managers,
and you know,
it's a very powerful process to really understand
just how much an adverse event impacts,
not just the patient and their whānau,
but everybody involved.
And of course even the organisation
itself is impacted,
and also sometimes the population of an area
is impacted by an event that happens.
So we're pretty committed now to taking a more
relational approach, but it's uphill work. It's not,
it's not as easy as just saying, well,
we should just sit down and have a conversation.
It's a piece of work that takes preparation.
It takes skills and knowledge of how to run
a process in a safe way.
And it takes work afterwards as well.
It isn't just, oh,
we'll just all sit and have a nice conversation
and then the job will be done. It's not as simple as that.
So what — what have we learnt? Well, there's been a few —
There's a few key things.
I suppose that one amongst them is that by and large,
you know, our clinicians —
I have immense respect for the clinicians that we have
in our health system.
In terms of how hard they work and how much
they care and the commitment to the roles that they have
and to the safety of their patients, you know,
it's — as I say,
I have a lot of respect for that. And we,
our clinicians are good at handling the open disclosure
concept and also take it very seriously that patients will
want to meet with them afterwards and go
through things and find out more about what happened.
But quite often our clinicians are sort
of really keen to have reviewed what happened
first before they meet families.
So that's been awkward to sort of move over
that little hummock. And it's easy for us,
for clinicians to feel undermined if there's a sort
of parallel process whereby patients and whānau
are offered a conversation with reviewers or with people
like a couple of steps removed from the direct frontline team
so that they can really share their concerns and worries
and difficult questions that they perhaps haven't
been able to raise with their treating clinician. So,
you know, of course,
the last thing we want to do is to undermine our clinicians.
But however,
whenever you try and change something,
there's always —
it's always not as simple as you think.
We've also
learnt that it's really much more,
much more can be learnt by having a review with all
of the frontline clinicians involved in an event together,
rather than interviewing them separately
and getting maybe five different versions
of what happened.
And so I've experienced this on a couple
of occasions now,
and it's really eye opening and heartwarming to see
the unfolding of learning that happens when you put
all the clinicians who were involved together
to relate the story as it unfolded. And in doing so,
of course, other clinicians in the room understand why
this happened and why that happened and how
come this came about and how come that came about.
And the recommendations that result have been so much
more robust and helpful and practical and easy
to implement than are things that are dreamed up by some
external review team, you know, two years down the track,
when everyone's really forgotten what was happening
and everything.
So, I remain convinced that this is —
even though there are wrinkles in the road,
I remain convinced that this is much more
efficient in terms of a time and action-oriented thing to do,
as well as being much more likely to settle and calm
and repair all of the people who have
been impacted by the thing that has happened. Of course,
we can never take back the fact that the thing happened.
But what we can do is stop the review process
from continuing to damage and harm people for years
and years and years afterwards. So,
I'd like to encourage you to take,
to sign up for the micro-credentialing
course run by Vic Uni over the next year
or so and to dip your toe in the water and just
to give it a go.
And be aware that it won't be straightforward, but when,
when we treat everybody
who is impacted
by the event
that has happened
as equal participants
in the subsequent journey to, you know,
put ourselves back together, to pick ourselves up,
to dust ourselves down, to carry on, to keep on living,
keep on working, keep on contributing,
and importantly,
to learn something helpful that would make
whatever happened less likely to happen in the future.
So be encouraged, and I wish you all well.