The blind men and the elephant
BY DR BERNADETTE WILKS, CO-CHAIR, AMA COUNCIL OF DOCTORS IN TRAINING
Within the space of two days I had the pleasure of attending two events: the National Forum (the ‘Forum’) on Doctors’ Wellness held in Melbourne and run by the Australasian Doctors Health Network, and the AMA’s Gender Equity Summit (the ‘Summit’) held in Sydney, which was the brainchild of Council of Doctors in Training (CDT) Chair Dr Tessa Kennedy.
Both the Forum and the Summit were attended by representatives from various Colleges, key industry players, Directors and CEOs of numerous hospitals; and Presidents of Associations.
During the Forum the parable of the blind men and the elephant was raised as a way of conceptualising why doctors’ mental health has taken so long to identify, let alone tackle. Subsequently, during the Summit, I recognised how the parable is equally relevant for the issue of gender equity.
The parable of the blind men and the elephant dates back to 1200BC and has been re-told over the centuries. The crux of the parable is that a group of blind men come to know an elephant by each man touching different parts of the elephant; the tusk, the ears, the hooves. Through this process each man comes to a true conclusion about an aspect of the elephant but a false conclusion of the whole. In some versions of the parable, this leads to violence between the blind men. Attending these conferences enabled me to appreciate the entire elephant that is doctor wellness and gender equity, and not just the parts I knew from my narrow experiences.
I will briefly reflect on the common issues behind, and solutions for, achieving doctor wellness and gender equity that I synthesised from my attendance at the Forum and the Summit.
The Business Case
The business case for improving gender equity and doctors’ mental health is well documented. The quadruple aims of improving the experience of the healthcare provider as they achieve the triple aims of optimal patient experience, improved societal health and reduced healthcare costs is a technical version of putting the oxygen mask on one’s face first.
For example, in companies with gender equity there is improved productivity, less workplace injuries and reduced operating costs. Even workplaces that accommodate pregnant workers experience minimum costs and increased productivity, retention, recruitment and safety. And likewise, the momentous cost of losing a doctor, even temporarily, from the workplace was estimated by the Lancet in 2009 to be between $211,000 and $420,000. Even the Australian Government thought it important enough to publish Presenting the Business Case for Investment in Health and Wellbeing.
Fostering effective leadership helps to redirect and utilise energy otherwise put towards fighting a system. Furthermore, leadership that comes from the top of an organisation is three times as effective. Committed and visible leadership is on par with flexible work models as the most effective means to achieve workplace place equity. And the key barrier to engaging with change is not knowing how to engage, thus leadership is key. But leadership is not only about driving change, it has also been shown to improve employee health and as such should be simultaneously seen as an occupational health factor. Not enough women apply for senior leadership positions and not enough Boards place tangible targets on physician wellness. A tap on the shoulder to encourage a woman to apply can be all that is needed to increase applications. Having a CEO who walks the walk of wellness through wellness KPIs can be all that is needed to reduce burnout.
Flexible participation structures and intelligent rostering are crucial scaffolds for equitable workplace engagement and improved clinician mental health. Interestingly, global companies like Yahoo! and Amazon began scaling back flexible work arrangements in 2012-13, driven by the myth that innovation and successful collaboration were best achieved through face time.
Flexible participation includes the use of web-conferences, consideration of time and location of meetings and events, access to breast feeding rooms and plentiful job-sharing. And despite the myth, work flexibility is desired equally by employees without and with children. Furthermore, men and women equally utilise flexible work options throughout their careers.
Intelligent rostering is mindful of an individual’s life-events, wellness, training needs, career aspirations, and need for compassionate leave. Such rostering is most successful when done within a single department and not en masse by a medical workforce unit, as the number of doctors becomes too many to individually tailor rostering to be dynamic and responsive. In fact, one NICU found not only were trainees more supported through intelligent rostering but were more successful at achieving training targets.
We have progressed past ignoring the elephant in the room; and are now transitioning beyond seeing the parts towards a more complete (from incorrect) interpretation of the whole and thereby removing it from the room completely.
Published: 11 Apr 2019