NSW intern blog

NSW health management interns in the news

NSW interns from the ACHSM Health Management Internship Program made headlines in recent months.

Management Intern Maleeha Altaf joined an International Womens Day Panel at Odyssey House, her placement organisation. Recently Odyssey ran a panel for International Women’s Day, chaired by HMIP graduate Chloe Tadorian with all Odyssey staff, its major stakeholders and Board. Maleeha was invited to speak as one of three panellists and did really well, not an easy task in your first few weeks as an intern!

One of their stakeholders posted about this on LinkedIn, acknowledging the day and the panellists. See below.

Also in the news was Grainne Ducat. A graduate of the NSW HMIP, Grainne was featured in the local Port News for her active frontline role in the fight to stop the spread of COVID-19.

A Jack of all Trades, working to become an expert at something! (Chloe Tadorian)

By Chloe Tadorian

2nd Year Management Intern

Coming to the end of my 2-year HMIP experience allows a great opportunity to reflect on where I started and where I am at now.

Finishing high school in 2012, I graduated with a double Bachelors in 2017. I completed a Bachelor of Science (majoring in Biochemistry and Molecular Biology) and a Bachelor of Business and Commerce (majoring in Management). I wanted to find a place for myself in health and did not know where to start. Finding a starting point in health without formal studies in medicine, at the time I graduated, proved an uncertain realm.

After graduation, I got myself into a highly competitive Graduate program with a private organisation and quickly realised that working purely in business was not for me. I wanted to help people.

Shortly after in 2018, I worked in a health-related industry- I was recruited as a sales representative for a company that manufactured and distributed Assistive Technology for Blindness and Low Vision. This gave me a taste of working with clinicians who supported those disadvantaged by varying disabilities. I loved the work I did and the clients I had - but knew that it wasn’t it just yet.

In 2019, I started the HMIP, having only a mere year in the workforce before returning to study once more. I admit it was intimidating being surrounded by those with lengthy experiences in Health, especially Public Health, but I wanted to learn. And I was lucky enough to be offered an opportunity with the Agency for Clinical Innovation as my first year with the HMIP.

Working in the ACI gave me the grounding and foundational understanding of Health that I needed, and in the space of the work culture, I felt safe to learn, ask questions, get involved and see how things worked from a unique perspective. My rotations were across three areas; from Clinical Networks (Stroke and Rehabilitation), to Finance and Corporate Services and finishing with Clinical Monitoring, Economics and Evaluation. I was involved in various projects, sat in a wide range of meetings, attended events from state-wide health to team specific, and so much more. From sitting in Executive meetings to supporting the facilitation of workshops for clinicians in specialized areas of health, the ACI and ACHSM provided a real-life project, where I had the chance to learn, be immersed in the environment, and get a better idea of what Health is at different levels.

On to my second year in 2020 with Odyssey House NSW. It was a wildly different experience. As a not-for-profit non-government organisation providing tertiary health services, this was the other side of the coin (if that coin had four sides!). It had been described to me as the part of health that works with those who fall through the cracks of the traditional health care system. Working in Alcohol and Drugs presents its own unique challenges but is also the ideal opportunity to learn about the value of health care services within a niche area. Only in a not-for-profit branch of health will you see the level of passion and dedication of clinicians in helping their vulnerable and highly stigmatised clients work through not only surpassing health challenges, but rebuilding their lives for the better. For these clinicians, it wasn’t about just having a job, but the purpose of their work and the lives of the people they are helping to improve.

Appreciative of the foundations I developed in my first year, this second year saw the inception of COVID-19 in all its glory. Initially planning a range of projects to be involved in, I was lucky enough to be given the opportunity to be part of the COVID-19 response team. Even so, I still worked through my rotations; Planning and Development, Community Services, Finance and Commercial Services, and finishing with Programs (Residential Services). From developing protocols for health screening and infection control to developing reports in applications to NSW Health and the ACHS, buying hand sanitiser to tracking data and helping setting up systems for internal contact tracing should it be required, I appreciated the close-knit structure of the organisation in both being able to get involved in high-level activities, further refine my skills in key areas as well as have the support available when needed to tackle each arising challenge.

Odyssey House gave me a wide range of opportunities, allowed me to steer my learning in alignment with the needs of the organisation, and work through challenging times with all the support I could ask for! Workplace culture is vital in aiding one’s work experience, and the unique and supportive culture of Odyssey House, and the ACI, were ideal in guiding my learning, both inside and outside of my formal work responsibilities, and supporting my character development.

Balancing the personal pressures of living through a pandemic, with the continuously evolving challenges within the workplace, and finishing off a degree in the meantime, was the toughest year of my life, but I can honestly say that I have grown so much because of it and I would not take back a second!

It all sounds a little overwhelming, and it honestly can be at times. But as long as you have the right attitude and you seek help when you need it, there are always ways to get through it. This program is designed for those who are seeking to learn, to grow, who are willing to take on a varied range of projects or roles in the hopes of finding where they fit and learn about the ever-complex and growing industry that is Health care.

Anyone can do it if they put their mind to it! I have seen past interns who started straight from their first Bachelors degree, through to a fifteen-year plus career in health. Some had never worked in health and others decided to come back to study later in life. There are no pre-requisites besides being a continuous learner, being open-minded to opportunity and having the ambition to finish. It does not offer an advantage to the most expert, intelligent, most qualified or any other particular character trait -beyond dedication and ambition. This is the value of such a fantastic learning opportunity, and ACHSM work with their partners to provide and support each Intern to see them through to completion and success to each person’s own journey.

I would recommend this program to any person looking to work in Health and looking for growth or, if you’re like me, seeking a beacon in a complex world.

Views are those of the individual authors and not those of ACHSM or management interns’ host organisations or employers.

Juggling motherhood, a new career and a Masters (Grainne Ducat)

Gráinne Ducat
​2nd year ACHSM Intern MNCLHD

Today marks one year since I officially hung up my navy uniform and entered into the corporate side of health, and I reflect on the opportunities, challenges and successes of the past year.

My career to date has been in the field of paediatric and maternal health nursing. I trained as an RN is Belfast in early 2000’s and worked in a range of settings, most recently as a Child and Family Health Nurse. The opportunity to apply for the ACHSM internship came to me in the form of an e-mail from the Director of Nursing, Midwifery and Workforce and encouraged all staff to apply. I have friends that went through the ACHSM Internship program almost 10 years previously and were now enjoying remarkable careers in health. Although I loved my current role, I had already sought out more challenges and felt the current model of practice in health was unsustainable. I wanted to bring my knowledge and experience to decision-making at a higher level.

The biggest challenge for me has been dealing with feelings of inadequacy and ‘imposter syndrome’. Nursing is structured, ordered and supported, whereas the corporate side of health has many unwritten ground rules that need to be followed to succeed. My mentor has been pivotal in helping me identify and understand these behaviors and navigating complex health systems, hierarchies and structures. Over time I have started to feel more comfortable in this role and believe that I may have something of value to contribute to health decision-making and leadership. As well as a fabulously supportive mentor, I have met some inspirational leaders so far on my journey. I am already cherry-picking the very best of their attributes and blending them with my own personality.

They say “you can’t have it all,” but I am here to tell you, you can, you just need to be organised and have the right supports! My husband has been crucial in helping balance the demands of a Masters and working full time (with occasional long days) with my family life. My workplace supervisor has been a wealth of support and information as well as brightening up many a routine day. My fellow ACHSM Interns are a marvelous support network, particularly on the lead up to University submission dates! In the early days, I would have been completely lost without my fellow ACHSM intern here at MNCLHD. We have become very good friends, as we both understand the juggle of parenthood, university work and learning in this role.

I am not sure what the second year of the ACHSM Internship has in store for me, but I already know it is full of potential and I intend to seize every opportunity that comes my way! I know there will be long evenings of university work, so I can enjoy the weekends with my children. I look forward to reuniting with my fellow Interns at the Professional development days and hearing their experiences. And I am excited about the upcoming projects and plans I will be involved with during my rotations and I am keen to take on more responsibility and further develop my leadership skills.

Views are those of the individual authors and not those of ACHSM or management interns’ host organisations or employers.

The fancy office in the BIG smoke (Rachael Stephen)

Author:

Rachael Stephen, Project Officer, Independent Hospital Pricing Authority
1st Year Management Intern

It has now been one year since I committed to change things up from my physiotherapy career and, reflecting back over the past 12 months, I feel extremely grateful for the support I have received from my husband, family, friends, supervisors, colleagues and of course, my fellow interns. 

Although change was always ‘just around the corner’, having worked in eight hospitals in just as many years, I still felt butterflies and doubt about this new chapter.

Would I still be able to strive towards better healthcare for people who are the most vulnerable by pursuing the Health Management Intern Program (HMIP), going back to study, working in this fancy office in the BIG smoke? Instead of running around in my sneakers, doing exercises and feeling the natural happy endorphins, how would I make a positive impact for a person in need when I was sitting behind a desk?  After all, I originally pursued a career in health, in the first instance, because I knew from a very young age that health is invaluable. Health services were there for my brother when he was diagnosed with an intellectual disability, epilepsy and autism spectrum disorder. And again, they were there when my mum had a serious stroke at the tender age of 55 years. Yet, as I worked hard to provide physiotherapy support for my patients and their families, I had the feeling that there was something more that could be done, that I could do, to make it even better than I had experienced before.

Working with the Independent Hospital Pricing Authority (IHPA), I have learnt to flip from my student hat to my leader hat and back again and put myself out of my comfortable clinical zone. No more familiar clinical ward, constant flow of patients, practice of physiotherapy skills and being the expert and teacher to staff and students. Rather each day has brought a new project, approach or stakeholder interaction. I have been involved in designing a fact sheet explaining hospital funding, met with health managers to participate in a national costing study and contributed to the planning and management of an international conference. I am constantly learning of new ways to apply my skills and experiences to influence and shape the way health services are designed, developed and accessed.

And so, 12 months on, I’m still sitting behind the desk, in the fancy office in the BIG smoke. Although the butterflies still visit from time to time, I have the genuine support of my supervisors and peers and the reward of working for an agency that positively contributes to sustainable health care. If I can possibly repay even a fraction of the support received from my personal and professional networks to pursue this new challenge, I would like to begin by supporting any others that go on before and after me.

Perhaps I can put on my ‘physio hat’ and plan an exercise program for interns to do between all of the work and study involved with the HMIP.

But on a serious note, work-life balance is very, very important! Even during a period of change such as joining the HMIP, joining a new workplace or putting your hand up for a project, it is essential to take care of your physical and mental health so that you can undertake the work in health that cares for others. I’d like to also encourage any readers to embrace change as the constant and know that you have the genuine support of even a stranger if you have the passion to make a change in the health world.

Views are those of the individual authors and not those of ACHSM or management interns’ host organisations or employers.

Reflecting on six months of the Health Management Internship Program (Peta Andreone)

Author: Peta Andreone

1st year Management Intern

Applying for the Health Management Internship Program was a leap of faith I made because I am passionate about a career that contributes to improving community wellbeing. The health sector provides the opportunity to contribute directly or indirectly and you don’t have to be a clinician to add value.  Below I have reflected on my first six months of the HMIP program.

Going back to University

I’m not sure what was more difficult to manage; the essays or the essay related anxiety. Okay, so changing jobs, moving house and going back to University within a three month period was not the best way to maintain comfort and stability but when it comes to disruption, go big or go home, right? The Masters workload is not for the faint hearted, but it is manageable and I have found the content is relevant and interesting. Best of all, you are able to apply your learning in real time in your role as a Management Intern.

Starting a new job

This year I am placed at the Clinical Excellence Commission. The CEC is one of the pillars of NSW Health and its primary focus is to promote and support improved clinical care, safety and quality across the NSW public health system. I don’t think of myself as a shy person however I may have been perceived this way in my first couple of months at the Clinical Excellence Commission. Making a step toward my future meant leaving my treasured colleagues behind and adapting to an unfamiliar workplace culture. I found several colleagues who were HMIP graduates and it was great to chat to them about their experience and their subsequent career path. It was inspiring and demonstrated to me the variety of career pathways available for a Health Manager. Six months on and I feel well and truly a part of the Clinical Excellence Commission and the wider NSW Health team.

Feeling uncomfortable

This program takes you on a journey of personal and professional development. Right from the beginning of the selection process you are placed outside your comfort zone, then you commence in a new role in a new workplace, again outside your comfort zone, and then you commence a Master’s program. It’s uncomfortable, it’s scary and it’s challenging but also very rewarding.

Abraham Maslow once said “One can choose to go back toward safety or forward toward growth. Growth must be chosen again and again; fear must be overcome again and again.” As a leader, fear can be your enemy or your ally and through this program I am learning how to embrace the fear in pursuit of my growth as a leader and contributor to community wellbeing.

The HMIP program is the doorway to this future, if you are willing to step through and commit to what it takes to become an emerging Health Manager.

Views are those of the individual authors and not those of ACHSM or management interns’ host organisations or employers.

Transitioning from Clinician to (aspiring) Health Manager (Chad Leeuwenburgh)

Author: Chad Leeuwenburgh
2nd year management intern

Comfortable but unsatisfied. Two words which best described my final two years of my clinical life. After ten years of clinical experience and a couple of post graduate masters, I was becoming that clinician which I warned students about… you know the one, the cynical disengaged one that was edging on toxic. I could see the warning signs, and thank goodness nobody else did, but I knew that my working life wasn’t challenging me in the way I wanted and I NEEDED a change.

Luckily the universe put together some 0s and 1s and dropped an email into my inbox, with a little advertisement for a program for aspiring health managers. As I had nothing really to lose, I sent in my application without any real thought of being fortunate enough to get a response let alone have to make a decision in changing my life.

Fast forward 10 or so months and I was making the decision to be accepted into the program, employed by the Agency for Clinical Innovation (ACI) and for my second year, here at Justice Health and Forensic Mental Health Network (JH&FMHN). I cannot thank both of these organisations and their staff more than enough for what they have provided me with. If you get an opportunity to engage with either of these organisations, I thoroughly recommend them – they do fantastic work.

Instead of detailing what I have achieved or experienced (so much beyond what I had expected), I thought I might give a little snapshot of some of my feelings over the past 18 months.

Daunting, ambiguous, doubt, frustrating, challenging... The polar opposite of my comfortable previous life. These five words pretty much summarise my first few months in this opportunity filled program. Had I made the right decision? I lay awake many nights wondering this, and if it wasn’t for openly discussing and the subsequent support from my family and staff at the ACI, the question may have had merit. I really struggled with the transition from a clinical role, where I was supervisor, comfortable and fully autonomous (and in my own mind - a subject matter expert) to an aspiring health manager, now dependant for instruction, with an unaccustomed low level of subject knowledge.

I felt like I wanted to let everyone know, ‘hey, I was a subject matter expert in my clinical role,’ which in my mind would make an excuse for my lack of knowledge in this new ambiguous field. I totally lacked confidence and felt like I needed to know everything (one thing I have learnt is that nobody knows everything). It took me a while, but letting go and moving away from a specialist to a generalist is all part of the journey. I throw this out there, as if you currently have or had these feelings, you are not alone.

I found this transition from clinician to manager my greatest challenge. The more people I spoke to, the more I came to realise that the strong feelings of uncertainty and doubt that I had, seems to be a pretty much routine within the health management space. As a clinician, things are to a degree ordered and linear – there is cause and effect - disease A causes symptom B – Intervention C treats symptom B and cures disease A.  I found in this new world of management, things are more complex and ambiguous – everything is connected and everything has consequences. It took me a while to truly understand that we never really have all the information and our best judgement is the best we can do.

Now, 18 months into the program, some other words best describe how I feel about this program…

Opportunities, growth, experiences, support and challenges. Half-way through my second year, I reflect on what I have achieved, experienced and how I’ve grown in my professional self. I have undertaken opportunities in performing roles I had never contemplated, have experienced, been exposed and been accepted into unique situations and working environments (Board and Executive meetings) which I otherwise would never get access to (and where colleagues actively seek my input), met with so many different people and visited many different working sites across the state.

Most appreciatively the whole time I have had support from some truly amazing colleagues from the ACI and JH&FMHN. I can honestly say that I have experienced both personal and professional growth and like to think I have provided meaningful contributions along the way.

If you are reading this and contemplating making a move into the program, you need to know that you probably will be uncomfortable and probably lose the authority and/or power which you may be accustomed to. But, you will bring much more to the table than you give yourself credit for. So if you are looking for a challenge which is pretty much governed only by your own drive, I would recommend going outside your comfort zone. Don’t be that cynical one.

Views are those of the individual authors and not those of ACHSM or management interns’ host organisations or employers.

In the eyes of an Intern - Life outside law school

Author: Edward Valenta

Where would I see myself working as a graduate? If you had asked me that question last year, my answer would not have been Long Bay Correctional Centre, working for Justice Health and the Forensic Mental Health Network (Justice Health).

To all the future graduates at university who seek to partake in a graduate program, do not miss the opportunity to apply for the Australasian College of Health Service Management (ACHSM) Health Management Intern Program (HMIP). This two-year program provides great exposure to the health industry in Australia and professional and educational development. ACHSM provide ongoing support over the two years and assist with finding a second-year placement if required.

Last year, I was fortunate enough to complete a Bachelor of Commerce (majoring in management) and a Bachelor of Laws from UNSW and a Graduate Diploma of Legal Practice from ANU. Why the HMIP you ask? I went through the same process last year, applying for different graduate programs hoping to receive an offer. I was fortunate enough to receive several offers but upon weighing up the pros and cons of each offer, I knew Justice Health was the one.

Justice Health were very kind to offer me a one-year contract that would include undertaking several rotations. Before now, I never knew Justice Health existed. Justice Health is a Statutory Health Corporation within NSW Health that provides health care in a complex environment to people in the adult correctional environment, courts, police cells, juvenile detainees and to individuals within the NSW forensic mental health system and in the community.

It is a very interesting and niche area to work in as you witness health and justice entwined together. Justice Health must work closely with several other State Government Departments including NSW Ministry of Health, Corrective Services NSW, Juvenile Justice, Local Health Districts and the NSW Police Force. Justice Health are very supportive of the HMIP and understand the competencies with which the program is designed to furnish interns. These competencies include experience that aligns with the ACHSM Master Health Service Management Competency Framework, the completion of a Master of Health Service Management and attendance at different professional development days that ACHSM coordinate. For example, Interns attend the annual ACHSM Asia-Pacific Health Leadership Congress which will be held in Darwin this year. Other events throughout the year include breakfast and evening forums, online podcasts and a symposium with a range of well-known guest speakers from the Australian health industry.

I have had experience working in Hospitality and Tourism, Corporate, Legal, Non-For-Profit Organisations and the Government. Each experience has been valuable, learning new skills and the operations of different industries. Thus far, I have extremely enjoyed working for both Federal and State Government. The opportunities and projects that come across your desk are quite unique and can potentially affect a substantial portion of the Australian community. The other benefits working for the Government include a work-life balance and further opportunities to attend internal training workshops and development days.

Whilst reading this, you may be thinking, he has no experience in health? Why would he go into a program that is purely health focused? That is true, this is my first time working within the health industry, and it is another benefit of the HMIP. ACHSM and the participating Health organisations are looking for individuals with diverse backgrounds, not just health. Do not let your past persuade you not to apply for the HMIP.

As mentioned, this program offers an array of opportunities and benefits, but most importantly interns will network with a range of people, from Chief Executives to front line staff. Health is an interesting industry to be working in as it will always be required.. It is a challenging industry because much of the workplace involves working in multidisciplinary teams from doctors, nurses and allied health staff to health managers.

Justice Health prepares a rotation plan for the Intern to ensure they can gain valuable experience and improve their professional skills. This year, I will be fortunate enough to work across different teams including; the Communications Unit, Organisational Development Unit, Clinical Business Unit, Allied Health and Corporate Services. Each rotation will vary between four weeks and twelve weeks.

I have undertaken my rotation within the Communications Unit and Organisational Development Unit. Justice Health is holding their first National Custodial Health Conference at the ICC in Sydney 31 May 2018 – 2 June 2018. I had the opportunity to engage with external stakeholders including interstate Health Departments and their pillar agencies advising them of the Conference. I also undertook a review of the wide range of committees within  Justice Health to determine the current governance and reporting structure.

The Organisational Development Unit is responsible for Research and Evaluation, Education and Training and the Practice Development Unit. I have been fortunate enough to take the lead on the next stage of a major project that is in progress. This project relates to the governance of projects throughout Justice Health and involves further developing the Improvement Initiatives Framework, creating a registration process, reporting requirements and online modules. These projects and tasks that I have been assigned have allowed me to gain a better understanding of Justice Health as an organisation, the services provided to patients and further develop my professional skills.   

Despite only being with Justice Health for three months, I have attended three site visits, Metropolitan Special Programs Centre Area 1 at Long Bay Correctional Centre, Metropolitan Remand and Reception Centre at Silverwater Correctional Centre and Cobham Juvenile Justice. These site visits have provided insight into the day-to-day operations and requirements of the frontline. They have been very eye-opening experiences and I now have a greater desire to improve patient care within all facilities. I will also attend high-level meetings including the Justice Health Board, the subcommittees of the Justice Health Board, interagency meetings and coronial inquests. 

It is an experience I recommend embarking on, whether you receive an opportunity to work at Justice Health or another NSW Health organisation. You will not regret the next two years! 

Driving continuous improvement and effective financial management

Author: James Comerford

Date: 4 April, 2018

Now that we are into the New Year, the ACHSM’s Emerging Health Leaders (EHL) events are back up and running. I was fortunate enough to attend the first EHL Breakfast held at NAB House on February 23rd where Jennifer Nobbs, Executive Director of the Independent Hospital Pricing Authority (IHPA) was our guest speaker. The seminar focused on driving continuous improvement and effective financial management throughout our health system, whilst giving a great overview of Activity Based Funding (ABF) and the challenges that may lie ahead. 

I am currently a member of the ACHSM as a part of the Health Management Internship Program (HMIP) run throughout Australia. Having just started my second and final year of the internship, I see these EHL events as valuable opportunities to expand my contextual knowledge, as well as build relationships and network with individuals from other facilities and organisations. This event was particularly important for the new first-year HMIP Interns since it presented an opportunity to mix with other ACHSM members, as well as gain a strong understanding in the role that IHPA plays throughout our health system. 

Whilst taking us back through the somewhat short life of IHPA, as well as giving us a quick overview of Activity Based Funding, Jennifer very quickly highlighted the importance that IHPA plays in the continuous improvement of financial management in health. The main take-home message is that IHPA has achieved its overall goal of slowing down the cost of health service activity (measured in National Weighted Activity Unit, or NWAU) since its introduction in 2011. 

What I found extremely useful throughout the presentation was the clear breakdown of funds that are allocated for events of differing complexity, ranging from a non-admission consultation to a complex hip replacement for a patient with certain comorbidities. This highlights the importance of capturing accurate data to ensure that the correct funds are being allocated to our services. Clearly, coding plays a very important role in this and whilst Jennifer was able to highlight that IHPA has achieved its goal in slowing the cost of NWAU, she also stipulated that there is room for even more improvements in the system that will ultimately lead to more effective and efficient care to a wider population. 

At this stage, Hospital-Acquired Complications (incidents and health complications that are avoidable) are still prevalent in all hospitals around Australia, costing time and money and ultimately leading to a reduction in activity-based funding. Patient falls and infections are the most prevalent examples of the complications that need to be addressed to ensure that hospital facilities are being appropriately compensated for their treatment and care.

Although the current ABF model is succeeding throughout Australia, Jennifer touched on a slightly varied model that has been recently implemented throughout our health system to improve care and strive for better patient outcomes. Funding for some services is now being given based on outcomes rather than just raw activity data. This signifies a change in the overall mindset towards funding in the health sector, in that we should now be looking to focus on value-based care rather than volume based. This will ensure that we continue to strive for the best possible patient outcomes at our facilities and that the funding model can thrive into the future.

It was a great morning and it was great to see such a diverse attendance for the first EHL event of the year. It was also great to see some of the first-year HMIP interns as they begin their journey into health leadership.

Lessons learnt along the way

Author: Katie Lau

Date: 23 March, 2018

On the brink of entering the next quarter of life, with a slighter slower metabolism and decreased resilience to fitness, it was with excitement that compelled me to reflect on my first year in the health management internship programme. I thought about what I could write, could it be the endless learnings that I had the privilege of being exposed to? Trends in healthcare? Big data? No. I resolved that I’d leave that up to the subject matter experts that are in abundance in the college, but perhaps what I could offer was my two cents on what I wish I could tell myself, a year ago today. I knew the programme would teach me a lot in terms of the qualities needed to become an effective health manager/leader into the future, but little did I know that it would crystallise life lessons that I’m learning till this very day. A year isn’t much time in the grand scheme of things, yet you don’t realise how much you’ve grown until you look back and realise how much you’ve overcome. Here it goes…

Fearlessness 

I fondly recall the first time I felt fear, I was 3 and I couldn’t find my mother at the shops. It was a moment of pure despair and fright, but thank goodness, I did find her a few minutes later. Fast forward to twenty years later, primal fear has manifested into other forms – self-doubt, the unknown, the uncertain future and trepidation. Fear is the body’s way of protecting us from danger and in some cases, it’s completely justifiable – I mean, I live in Australia, land of drop bears and spiders. I digress. 

If there’s one thing that I’ve learnt this year, is that being fearless is most rewarding. Fearlessness was what prompted me to take a risk with my physiotherapy career and jump into the wild world that was health management. Fearlessness was what pushed me to complete projects at work that I thought were insurmountable. It was the factor that encouraged me to seek out all the opportunities that the college had to offer – from a stint working with a healthcare consulting company in the Gold Coast and to applying as a subcommittee member in the Emerging Health Leaders of the ACHSM. Personally, fearlessness led me to taking a solo trip across the ditch and see the beauty that was Milford Sound and feel at peace with nature. Being fearless has allowed me to realise my strength, my persistence and admiration for what I could accomplish when I had the conviction and belief. So come on, do something that scares you. If you’ve been waiting for a sign, this is the sign, go beyond and surprise yourself. Let go of your fear and you’ll see how strong you are.

Slow down and meditate

A quick search through the Harvard Business Review for articles on mindfulness/meditation will give you a plethora of results – and for good reason too. At risk of sounding like another person on LinkedIn obsessed with the latest buzzwords in the business/management community, mindfulness and meditation have true benefits in supporting our mental and physical wellbeing.

Research has shown that mindfulness training alters the neural pathways in our brains and how we engage with our surroundings. Mindfulness training grounds you to your environment, encourages one to be more present and can potentially alleviate stresses and anxieties. In an age where emails don’t seem to stop flowing into our inboxes, where trains are perennially late and where we have a million things on our to-do lists, mindfulness helps to ground oneself to be present and assist with relaxing us in our busy lives.

Mindfulness isn’t a huge commitment, embedding 5 minutes into our days practicing this invaluable technique will reap its rewards. Download an app to help and guide you through it. Practicing mindfulness is a skill that needs practice, just like weight training.  Always remember to slow down and be mindful.

Patience and time

Social media these days is proliferated with viral nonsensical memes (of which I have a soft penchant for) and other times, bizarre tweets from official accounts that make you do a double check to ensure its veracity. In the noise of the social media platform, there was one time I fondly remember on LinkedIn when I found a post that strongly resonated with me.

“Obama retired at 55, Trump started at 70. Sydney is 3 hours ahead of Perth, but that doesn't make Perth slow. Someone graduated at the age of 22, but waited 5 years before securing a good job. Someone became a CEO at 25 and died at 50. While another became a CEO at 50 and lived to 90 years. Everyone in this world works based on their time zone. People around you might seem to be ahead of you and some might seem to be behind you. But everyone is running their own race, in their own time. Do not envy them and do not mock them. They are in their time zone, and you are in yours. Life is about waiting for the right moment to act. So relax. You're not early. You're not late. You are very much on time.”

In an age where my generation has been conditioned to constant dopamine hits through instant gratification and transparency of everyone’s ideal lives portrayed on social media, the thoughts of needing to hit a certain milestone at a certain age have been inevitable. But what I’ve come to realise that looking at another’s path, their milestones and comparing it to your own serves no purpose other than to detract you from your goals. All will come in its own time, when the time is right. And what better way than to have this confirmed through the talks we have had with our mentors, the presentations we listened to at Congress and those that have come before us through the college. At the end of the day, everyone has their unique path to follow, no two are the same. But the important point is to keep chugging along, keep going and never give up on your goals. There is no rush.

Self-love

Health is an industry that is very giving, it attracts those that have an undying optimism and drive to change the world, to give back to the people who have given them so much. Yet as we give a little more away daily, you start chipping away at yourself and someday, after a long day at work, it finally creeps up on you that you’re burnt out and have got not much left to give. In health management, the reason for why we’re in our industry mustn’t be forgotten. What we’re all striving for is to improve patient outcomes, enhance health and for some of us, to leave a positive impact on society.

It mustn’t be forgotten that putting ourselves first must be a priority, even when it seems that there are so many things to be completed. After all, if we are not well ourselves, how are expected to help others? Don’t forget to love yourself, seek time out to do things that energise you. 

My first year as a HMIP Intern

Author: Lea Sugay

Date: 11 February, 2018

My first placement for the internship was in the Health Informatics Unit within District Finance Directorate of Western Sydney Local Health District. At this placement, I had the opportunity to work with the various members of the Health Informatics Unit across the district, such as the clinical coding managers, clinical coding educator/auditors, clinical coders, and the medical health records manager. 

The clinical coding team is responsible for coding every patient episode that is discharged from the hospitals in the district. One of the key performance indicators (KPI) of a clinical coder is to code thirty five episodes a day, however this is quite difficult as each episode have different levels of complexity. There are various clinical coding advice and rules that clinical coders must follow to code accurately. The resources used by the clinical coders were stored in various places, therefore searching for the right coding advice could be time consuming, thus preventing the coders from meeting their KPIs. My first project was to put together a Clinical Coding Resource database. The objective of this project was to have one place for the coders to access that would include all the information they need, thereby allowing them to code more efficiently. 

I liaised with the clinical coding team and determined which resources they accessed the most - clinical coding advice/rules, links to websites with coding advice and local coding advice/reminders. I attended a website publishing training session to learn how to use the district's publishing system. I worked with Corporate Communications to design a database that is easy to navigate and user friendly. Privacy was also a factor and we had to ensure that files uploaded onto the database could not be accessed by other staff members in the district. A unique login for the clinical coding team was created to address this issue. Changes to the database can only be made by myself or the District Clinical Coding Operations Manager.

After fixing the privacy issue, it took approximately three weeks to upload all the information onto the database. I then conducted training sessions in different hospitals across the district to teach the clinical coding team how to navigate and use the database. After the database going live, only simple maintenance is needed to keep it going, for example, uploading new coding advice or updating website links. Overall, the project took two months to complete which was much quicker than anticipated in our six month project plan.

I received positive feedback from the clinical coding team and my manager. Some coders have stated that the search functionality of the database has saved them time and helped them work quicker.

Audits are conducted by the clinical coding educator/auditor to keep track of the coder's work and to determine which areas need improvement. Most audits are completed quarterly or monthly depending on the need, for example, ensuring that episodes with sepsis are coded accurately to ensure that the right reimbursement through Activity Based Funding (ABF) will be received. My second task was to audit the Clinical Documentation Queries. A clinical coder can raise a query to the clinician if there are ambiguous information in the patient record. Raising a query can sometimes change the Diagnosis-related Group (DRG) coded to the episode which could increase the National Weighted Activity Unit (NWAU), which means more money.

Auditing the documentation query was used to determine how efficient the process is, how many days it takes to receive feedback from the different specialities and the difference of NWAU if there is a DRG change. This also allows the Clinical Documentation Specialists (CDS) to educate clinicians on how to document in a way that's easy for clinical coders to code. 

During my placement, I managed to audit all the four quarters of the 2016/17 financial year. Firstly, I collected all the data from the five hospitals in the District and stored it in one database. After each audit, there was a positive cost differential from the DRG changes. The clinical coders were encouraged to raise queries as much as they can, as there is a higher chance of getting more money reimbursed from a changed DRG. The audits also found which specialities took the longest to provide feedback; this allowed the CDS team to target these specialities to improve the efficiency of the documentation query process.

My second placement for the internship was in Human Resources (HR). I was fortunate enough to be working closely with the Director of Human Resources of WSLHD. My supervisor allowed me to attend various meetings with her in order to observe the way she managed her team. I was also able to network with Directors across the district through these meetings. HR revolves around ensuring that policies put in place are upheld by all employees. HR's job is also to ensure that the right processes are put in place to ensure that all employees are given a fair chance in the instance of a breach of policy. HR is also responsible for providing support to managers on how to deal with performance issues in the workplace.

During this placement, there were no set projects for me to be involved in. What I have learnt in HR is the work which comes up when there is a complaint lodged or if there has been a breach of one of the policies. Each issue is addressed in a case-by-case basis and is processed depending on which policy was breached. A breach to a policy would be considered as a misconduct and is managed through the NSW Health PD2014_042 Managing Misconduct. The policy outlines the procedures to be conducted to determine the right and fair disciplinary actions to a misconduct behaviour.

A risk assessment would be completed to determine the seriousness of the incident. An incident is given a rating against the Severity Assessment Code (SAC) matrix from the NSW Health PD2014_004 Incident Management Policy. A SAC rating of 1 is considered an extreme risk, for example, a clinical incident that has resulted in a patient's death. The SAC matrix also has guidelines on what actions to take once the risk rating has been determined. 

An investigation would usually then occur to obtain all the information from the employee/s involved in the incident and to gain an understanding of the nature of the environment which might have caused the employee/s to breach policies. Parties involved in the incident could be issued an allegations letter where they are expected to write a response. Interviews can be conducted to obtain information from all parties involved in the incident. Once all the information has been received, an investigation report is written for an independent decision maker (usually a level 2-3 manager) to review and produce an outcome for the parties. An outcome can vary from a first and final warning, suspension or termination of employment in more serious cases. 

Depending on the workload of the HR managers, I was able to assist in drafting risk assessments, briefs to suspend, allegation letters, and other documents to help with the processes. I was also involved in a change project within the Integrated Care & Community Health space and assisted with finding redeployment options for staff affected by restructures.

I have just started my next placement with the Information and Technology Services department. I am hoping to gain experience in project and change management with the Digital Health Program rolling out in WSLHD. 

Reflection: A Year at Justice Health and Forensic Mental Health Network

Author: Jess Harris, 2nd year HMIP Intern
Date: 18/01/2017

Entering a prison for the first time is a somewhat nerve-wracking experience. The countless  men and women in green tracksuits, the shouting that comes from the prison yards and the loud creaks that come from the prison guards ‘cracking’ open a cell.

My year at Justice Health & Forensic Mental Health Network (JH&FMHN) has been an unforgettable and rewarding experience in ways that I didn’t expect.

Prior to joining the ACHSM Health Management Intern Program, I completed a Bachelor Degree in Socio-Legal Studies at Sydney University. With a strong interest in sociology, law and health, I came to the decision that Justice Health & Forensic Mental Health Network was the perfect organisation for my first year placement.

During my first few weeks at JH&FMHN, whilst struggling to understand the organisation and the patient cohort, I was privileged enough to hear our former CE Julie Babineau speak about why the work that we do is so important. She pointed out that many of our patients have grown up without the same opportunities that we have had; without guidance, without an education and without knowing right from wrong, which is why this lived experience impacts their health, resilience and their decision making.

Crime statistics show that intergenerational incarceration is a significant issue as 45% of our juvenile offenders have a parent in custody and 30% of the adult custodial cohort received out of home care before the age of 16. Hearing Ms Babineau speak was a profound moment for me and really changed the way I thought of our patient cohort from that point on.   

Throughout the year, I have had the privilege of working with many teams on a range of projects. I had the opportunity to spend time with the Forensic Mental Health team and our patients on a Your Experience of Service survey and the Family and Carer Experience Survey. Walking into the Silverwater Correctional Complex to interview the patients, I was faced with the stark reality of the experience and plight of our patients. Each patient had a unique story to tell and varying backgrounds, each yearning for an ear to listen. It was confronting to hear. Hearing the patients’ stories first hand was an enlightening and enriching experience that provided me with the passion to do my part to make their experience with the health services better.

For my next placement, I worked with the Clinical and Corporate Governance Unit. In November 2016, JH&FMHN went through the onsite Accreditation survey and this was a wonderful opportunity to learn about all aspects of the organisation, in relation to safe and quality service provision. Accompanying the surveyors to the onsite surveys across the State was extremely beneficial in understanding the constraints the sites are often working under in the correctional settings, and the positive work that they are achieving despite these constraints. 

Throughout the year I have been afforded unparalleled learning experiences including attending the ACI Patient Experience Week Symposium, Forensic Mental Health Forum, Redesign Leaders Network Days, Aboriginal Closing the Gap celebrations, ACHSM Congress and the JH&FMHN Leadership and Change Forum. I have also facilitated a number of events including the Redesign Leaders Network Day at JH&FMHN, an ACHSM Professional Development Day at JH&FMHN, as well as assisting with the Network’s Patient Experience Week event.

At the beginning of the year I walked into the Long Bay Cafeteria a nervous wreck unsure of what direction I should look, how I should act and whether it was acceptable to talk to the inmate chefs. 11 months later, I can say that JH&FMHN feels like home to me. I have developed on a personal and professional level with the support and guidance from all my colleagues. I cannot thank JH&FMHN enough for this opportunity.

Herd Immunity - Why you probably won't get measles in Australia

Author: Gideon Meyerowitz-Katz

Date: 11/12/16

The other day I shared a fantastic infographic, and I was asked by a few people to elaborate. You may have heard about herd immunity (when I was in high school we actually had a science project dedicated to it), but there’s a good chance that you have never really had it explained.

It really is a great infographic; there is also a cool simulation at The Guardian, who made the thing

Herd immunity is a public health term that is one of the most important parts of the theory behind vaccination. It basically means the point at which there are enough people immune to infection to prevent people who are not immune from getting infected. It’s the reason that we don’t have to vaccinate every person to stop everyone from getting measles.

Pretty damn cool, I’d say.

A lot of herd immunity is about maths. I’ve handily italicized the maths for anyone who hates numbers. Skip away!

Attack rates, reproduction numbers and scary maths

As well as being one of my favourite public health terms, attack rate is a key part of herd immunity. It is a measure of the proportion of people who are infected by a disease in the population. Say there is a measles outbreak in a school of 100 kids. If 10 of those kids get measles, the attack rate is 10/100=10%. It’s a pretty simple metric to see how many people are infected in a population by a specific disease.

Along with the attack rate we can calculate a Reproduction Rate for the disease we are looking at, commonly called Ro. This reproduction rate is simply the number of individuals that are infected by each person who contracts the disease. The higher the number, the more people get infected. 

Measles has a very high reproduction rate, at 12–18 people infected, mumps is much lower at 4–7. On average, each person who has measles will infect about 3x as many new people as each person with mumps.

Herd Immunity

Most diseases are infectious for a week or so, although it varies greatly. Imagine you catch measles. You are infectious for a couple of days whilst only feeling minor symptoms (cough, runny nose). You then come down with a nasty fever, and after seeing the doctor stay at home for the rest of your infectious period.

In this example, you’ve limited your contact with uninfected people by staying at home once you realized you were sick. Even so, you’re still likely to have infected a significant number of people whilst you were wondering around, blissfully unaware.

But what if these people were vaccinated? If the vast majority of people you ran into on the street were already immune to catching measles, you might only pass on the disease to one person before going home. If they were all vaccinated, the outbreak of measles would stop with you.

This leads us to the Effective Reproduction Rate (called R). This is the rate at which a disease will spread given the percentage of a population that is already immune. It’s just the reproduction rate multiplied by the % of the population susceptible to the disease; if the Ro for measles is 18, and half of the population is immune, then R is 18x.5=9. In this population, each infected person will only pass on measles to 9 people, rather than 18.

This is how we calculate herd immunity. For a disease to be considered stable, each person can only on average infect 1 or fewer other people. In other words, R has to be less than or equal to 1.

For measles, Ro is 18. Therefore, 18x%=1, or 1/18=%. This means that the % of people who need to be vaccinated to prevent the spread of measles in a population has to be higher than 1–1/18, or ~95%.

This is how herd immunity works. It’s a simple mathematical function; if enough people are immune to a disease, it cannot spread beyond the initial infected person and dies out.

Why do people still get sick?

The first objection you’ll always hear when talking about herd immunity is “people aren’t cows”. This is stupid.

The second, less stupid objection is “people do still catch measles/mumps/German measles/love of the dance/typhoid/etc! That means herd immunity can’t work!”. Basically, if everyone’s vaccinated (and vaccines work), then how can anyone get sick?

Firstly, herd immunity is a simple mathematical function. The immunity can be conferred either through vaccination or just natural immunity; most diseases peter out without vaccination around the 90% infected mark, simply because enough people become immune.

The second reasons is simple; vaccination rates are often just not high enough to fully prevent diseases, particularly overseas. Some countries have had disease ‘eliminated’, which means that there is no reservoir of disease in the country, but many haven’t reached this point. Most of the disease outbreaks you see are people getting sick overseas and bringing it back to a vulnerable community who don’t have sufficiently high vaccination rates.

Why it matters

Herd immunity is important for one reason; not everyone can get vaccinated. For example, people who are undergoing chemotherapy for cancer have compromised immune systems and can get very sick if they receive certain vaccines.

But if enough people are vaccinated, they will be protected anyway.

Australia has some of the best vaccination rates in the world, with most areas topping 95% for the recommended vaccines. We have incredibly low rates of vaccine-preventable disease because of this.

But there are some communities who, for a number of reasons, have lower vaccination rates. Some of them have socio-economic issues with attending the doctor. Some think that vaccines are a secret government plot to make us into docile sheep*.

Whatever the reason, these communities lower the rates of protection, and end up putting us all at risk. Which is shit, because when people don’t get their vaccines, the most vulnerable are the first to suffer.

So protect the babies, old people and chemo patients and get your vaccines. You’re probably due for a booster right now.

If you liked this article, you can follow Gideon on Medium, Facebook or Twitter.

A Day in the Life of Jith Perera, 1st Year Intern

Author: By Caleb Teh with Jith Perera

Date: September 29, 2015

7.30am

My morning routine since starting the internship has been to arrive at work and sort through my emails and calendar for the day. This morning is no different. I’ve gotten a few emails about team meetings that I have been scheduling. The team meetings are an important tool in maintaining open, two-way communication between the project team and the ITS staff. Furthermore, it allows us to address any concerns and anxieties that may arise as a result of the Transformation program.

I’ve also had to reschedule a meeting with Ellie McCann, Manager of Education and Training Services in the Western Sydney Local Health District (WSLHD). Ellie manages the program in Western Sydney and we have been trying to organise a catch up to discuss how I am developing in the program so far.

8.30am

One of the things I’ve learned is that in health, being a male health intern means that you are in demand to be the independent male on interview panels! There are interviews occurring for an administration officer role so I spend some time reviewing applicants and providing my recommendations for interview.

The last thing I do as part of my “me” time this morning is to register for the ACHSM Congress in October. This is the first year that all interns from Queensland, Victoria and New South Wales are attending Congress so I am really keen to network and hear from some exciting speakers!

9.30am

My previous placement involved organising a “Quality Improvement Curriculum” with the Clinical Governance team in the WSLHD. The pilot program ran over four whole-day sessions on an introductory to patient safety and clinical quality, person-centered care, adverse events and improvement science.

This morning I met up with Ms Rizwan who is a Masters student now assisting with the ongoing development of the curriculum. I discussed with her the future plans for the Curriculum, such as the communications strategy and particular groups that we want to target as attendees. We received some very valuable feedback from the pilot that will now be used to shape Curriculum as it goes forward.

10.45am

I head back to the office to spend some quality time reviewing the Risk Register for ITS with Sabrina Walsh, the Chief Information Officer at WSLHD. There are a number of risks we have documented that need to be reworded to better articulate the actual risk and the mitigation strategies.

1pm

Grab a quick lunch. I am being healthy so today its chicken breast and some broccoli! I spend a few minutes at lunch organising the monthly meeting we have for Western Sydney trainees and interns. I’ve organised Tom O’Callaghan, Change Manager for the Transformation Program to come speak to us on change management and stakeholder mapping and engagement.

1.30pm

As part of our communications strategy for the Transformation Project, Tom and I meet with departmental teams on a regular basis to address any concerns or burning questions they may have. Furthermore, this gives us an opportunity to provide an update on our work and engage with the stakeholders.

The Transformation Program involves the enhancement of the ITS function to better meet the future demands of the Health Services environment. The program involves:

2.30pm

Team meeting time. My current team has three others: a Change Management Lead, Project Manager and a Technical Consultant. My immediate supervisors are the Change Management Lead (primarily responsible for stake holder engagement, organisational development, communications and change management) and the Project Manager (primarily responsible for delivering on project objectives).

The Transformation Program team meets on a daily basis to get together to nut out some of the key issues we are facing and plan ahead. We spend today’s meeting going through our progress with stakeholder engagement and communications. In particular, we have been working on a “question and answer” log to make sure we are providing consistent messaging for common questions.

3pm

I leave work early today to head out to the Emerging Health Leaders Forum lead in PwC’s Sydney head office. This forum explored disruption in health and how new ideas will change how health care is delivered in the future. This is exactly the type of thing that I am interested in being part of! There are some great talks and a couple of which are very relevant to my current role in ICT. I hang around to chat to others (including a few interns who have come as well) and head home at around 830pm.

9.30pm

I finish up the day with getting an hour of work on an assignment for Health Service Resource Management, as part of my Masters in Health Administration. Days don’t always end this late, but a combination of a new placement, regular extracurricular professional functions and a busy period at university has meant the days are a little longer.

The Seven Sins of Leadership

Author: Benjamin Ferry

Date: 3 August 2015

I have recently had an opportunity to view some of the ACHSM webcasts. For those who haven’t had an opportunity to review these webcasts, there is a comprehensive database available.

One of these webcasts is a 2010 presentation on The Seven Sins of Leadership. It is presented by Professor Mohamed Khadra, Professor of Surgery at Sydney University and Head of Urological Surgery at the Nepean Hospital, New South Wales. Professor Khadra has had an extensive career in various health and educational settings around Australia and internationally. Furthermore, he has written three books on the Australian healthcare system. While I recommend you watch his 45-minute webcast, for those of you who are time-poor I have summarised the webcast, and applied an ACHSM Management Trainee perspective.

Before I list the seven sins, I anticipate that you will be able to identify managers or co-workers who exhibit one or even many of these traits. While it can be entertaining to diagnose these people, this train of thought misses the real opportunity that exists with this exercise. The real challenge is to ask ourselves which of these traits we have been guilty of and, moving forward, how we can improve our leadership style. Furthermore, can I suggest that these traits can apply to anyone in an organisation, regardless if you are CEO or a Management Intern.

The Seven Sins of leadership are as follows.

Pride

It’s important to note that having pride about the quality of your work or organisation can be positive or even desirable. However it is important not to focus on yourself in terms of organisation rank or position and in terms of claiming credit for achievements. As we know, there are not many achievements that occur in Health without multiple inputs from various stakeholders.

Greed and Gluttony

It is easy for many to say that, as an employee of a healthcare service, by virtue nobody could be guilty of greed or gluttony, and that this title should be reserved for Wall Street bankers. However, as we know there are finite resources in our health systems and organisations. When we make decisions about funding requests or spending, are we certain that we are acting in the best interest of all stakeholders or of a small minority?

Sloth

There have been many who have lamented about how slow progress or change is within the healthcare system. However, we need to be responsible for our own decision-making processes. For example, are we organising meetings for a subject that could be resolved with an email or even a phone call? Are we being so risk-averse, that we are avoiding making a decision?

Wrath

There are not many people who display physical outrage, and throw office furniture. However are we constantly using the 'us versus them' mentality? For example, Our department versus another department or organization?

Envy

Being more concerned about our next promotion opportunity rather than focusing on our current responsibilities. While there are many opportunities on erecruit, there are often similar opportunities within our own department or even our own portfolio.

Lust

Desperately wanting a position or role so badly, that we wish the person that currently holds that position would leave that role or the organisation.

On a more positive note Professor Khadra describes good leaders as displaying:

Vision

They know the direction of where the organization or department needs to move.

Communication

They can effectively explain to those around them how it is possible to achieve the vision.

Integrity

They are open and consistent in regards to their decision-making process.

Compassion

Not only are they compassionate to patients and the community, but also to their staff and co-workers.

Respect

They support their staff and co-workers through the good times and the bad.

To view this webcast and other great presentations, please visit the Resources >  Webcasts  section in the website menu above.

Benjamin is a 2nd year Management Intern in the NSW HMIP.

Profile: Jessica Drysdale, NSW Management Intern

Author: Jessica Drysdale

Date: July 20, 2015

Before applying for the program, I completed my Bachelor in Occupational Therapy, and my separate Masters in Physiotherapy and Health Policy. I previously worked as a physiotherapist at the Children’s Hospital Westmead and thoroughly enjoyed the clinical skills that it involved.

I applied to the NSW HMIP to deepen my understanding of the processes and systems underpinning the healthcare system, seeing it as a challenging but valuable opportunity to transition from practising clinician to health management.

The NSW HMIP provides me with an opportunity to gather practical experience, while developing my knowledge in a variety of settings within NSW Health. It’s also a chance to build on my clinical experience as a physiotherapist and apply my theoretical knowledge attained during my Master of Health Policy. Throughout the program, I hope that the experiences I go through will provide me with further knowledge of the policies, processes, systems and financial influences that impact the decision-making within a hospital and the NSW Health system as a whole. I also hope that it will provide me with the chance to contribute to the health profession as a skilled, high-potential, entry-level health service management professional.

The Agency for Clinical Innovation (ACI) works with clinicians, consumers and managers to design and promote better healthcare for NSW. To date, the ACI has provided me with wonderful and engaging experiences. From attending executive meetings to developing models of care and consensus guidelines, every day holds something new, exciting and challenging.Attending and helping to coordinate symposiums, forums and health redesign schools gives me unparalleled insight into the innovative world of health. Experienced and knowledgeable health managers who are willing to share with you their wisdom and provide you with opportunities to participate in their work also surround you.

Following from these opportunities, I embarked on an international study tour as a part of the Clinical Excellence Commission’s Ian O’Rourke Scholarship for patient safety for which I was encouraged to apply by my managers and directors.

Outside of the placement organisation, the program has allowed me to undertake a Master in Health Administration (La Trobe University) and have access to professional development and mentoring from experienced members in the health arena.Perhaps most importantly, I personally enjoyed the opportunity to develop a network of friends and colleagues – amid my cohort as well as through previous trainees with whom I collaborate. I am still unsure of exactly where I will be at the end of the two-year program. However I can say without any uncertainty that it was definitely the best move I have made for my career to date. 

Interview with Dr Elizabeth West

Author: Caitlin Hazell

Date: 27/05/2015

Dr Elizabeth West is a third year Medical Administration Trainee based at Westmead Hospital. She is currently completing her traineeship through the Royal Australasian College of Medical Administrators which includes studying a Masters of Health Management at the University of New South Wales.

The following are excerpts of an interview with Dr West conducted by Caitlin Hazell, Management intern at Western Sydney Local Health District.

How it all began

I went to medical school at the University of Sydney. I did the graduate medical training program and did an undergraduate degree in science, majoring in mathematics. In some ways this wasn’t as helpful for my medical degree as I would have benefitted more in physiology, anatomy, pathology and similar biomedical sciences. However, the research and study I did made me develop a real taste for research in physics and mathematics and is something that I have carried with me through the years and has been a great strength for me and has been an ongoing theme in my life as a doctor.

What sparked your interest in Health Management?

After exploring avenues such as cardiology and obstetrics and gynaecology as a junior doctor, I started questioning how much of a life I would have as I would have to work extremely hard day in day out, nights and weekends for the next 7-8 years. I didn’t feel like it would give me a chance to develop my own personal life. I had to take a step back and reflect and regroup to decide what I was going to do. By this stage, I had been working as a career medical officer in other hospitals and became very aware of the variations of clinical care that were being provided across the different facilities. I started to question who was overseeing this governance of care and the standards. I was very inspired by one of my colleagues who was involved in safety and quality. She alerted me of a position in medical administration for a trainee at one of the private hospitals and that was the moment that everything changed. I looked at the Royal Australasian College of Medical Administrators and was very impressed by the competencies and values that they were espousing. Rather than floating around and struggling to correct the system on an individual basis, I could apply significant changes with a much broader brush as an administrator.

So this is your first administration role?

Yes, I’m currently in my third year as a Medical Administration Trainee with the Royal Australasian College of Medical Administrators. This includes doing a Masters in Health Management at the University of New South Wales. I’ve never looked back! I’ve had enormous challenges at times, but I’ve been extremely lucky to have wonderful mentorship.

Tips on time management

Time management is really important. I can’t afford to watch TV, I’m very strict with myself about getting enough sleep and I get up early in the morning to study and complete my assignments. It’s hard because having a social life is a bit of a luxury but I think it’s very important to maintain close friendships, to have support and have those who are important to you understand the challenges you are facing.

On feeling challenged

I had a big eye opening moment when I encountered a head of department who was reluctant to discuss his cases with me and made me feel unwelcome and that I was putting my nose where I shouldn’t be. I had to see the situation from afar and manage it as if everything is the sum of players and agendas rather than a personal attack. That has been an enormous turning point for me on many levels and it lead me to come up with one of my mottos: “The first one who loses it, loses.” It is a bit of a game, and people who lose their temper or get angry have lost control of the situation, and that is very interesting.

Tips on leadership

I have heard people say that clinical leadership responsibility is for consultants and Heads of Department and Organisational leaders only. Reasoning for this including “I’m just a medical student” or “I’m just an intern” and “it’s not my place to speak up”. What concerns me is that, this attitude about leadership profoundly disables the potential of necessary leaders within a health organisation from doing their jobs correctly. If the premise is that we are here to provide excellent patient centred care, then it is not just for some people to provide leadership, it is for everyone to provide leadership and to be welcomed to do so and to be enabled by education and tools to do so. Leadership skills need to be conveyed and embedded across the health organisation, not just to consultants, not just those in ‘senior’ positions. This is a concept that is hugely important because at the end of the day, patients depend on all health staff to be providing not only care but leadership in improving care.

Advice for future health managers

Find a good mentor, or two or three. Build a support base and fill it with colleagues with whom you can troubleshoot in a safe and confidential setting. Get to know yourself, write lots, talk lots, think lots, read other people’s experiences, watch how other people do things, question always and enjoy the process. One of the greatest gifts is being able to competently and confidently manage high pressure and high tension situations, and it’s great to have these capabilities formulated into a curriculum within which we are participating. Have fun, laugh every day, not just cynically. This job is meant to be wonderful and the amount of satisfaction you can achieve from the good you can do is huge. Don’t hold back your appreciation for the good things your colleagues do. You have to be balanced psychologically and remind yourself why you are here, because it isn’t easy and the nature of the job is challenging. But knowing the bigger picture and reminding yourself of it is important, especially as a health manager.

2015 NSW Health Management Internship Program Orientation

Author: Audrey Lazaris

Date: 02/03/2015

The 2015 NSW Health Management Internship Program (HMIP) Orientation began with 12 excited, albeit slightly confused, new interns, each bringing with them a wealth of varied work experience and university study, as far ranging as health sciences and medical physics, to law and finance. All were ready and raring to begin the newly revised two year HMIP, and looking forward to the new opportunities and experiences it’ll provide.

Amongst a flurry of paperwork, admin matters and scones, the interns began to get their heads around the program structure. Each of us will spend the year at our respective placement organisation within NSW Health, rotating through various departments and placements, while developing a set of key competencies vital in any health management career. These are based on the recently developed Emerging Manager Competency Framework, which not only provides a means to assess each intern’s learning and development, but also allows for critical self-evaluation. The 2015 first year interns will be spending their placements across Sydney in health organisations, including South Eastern Sydney and Western Sydney Local Health Districts, The Children’s Hospital Network, Justice Health & Forensic Mental Health, The Agency for Clinical Innovation, NSW Ambulance and ABF Taskforce.

An introduction by the ACHSM Chief Executive Catherine Chaffey started the day off in perfect fashion, instilling a sense of enthusiasm in the new interns, as we pondered the career paths ahead of us. After learning about the expectations and requirements of our work placement, the administrative side of the academic component of the HMIP was explained by Professor Sandra Leggat. All interns will undertake a two-year Master of Health Administration via distance education through La Trobe University, which seems like the perfect academic complement to our professional experience. The subject options include Human Resource Management, Health Law and Ethics, Health Policy Analysis and Health Care Quality, and will involve online lectures, readings, weekly blog postings and written reports.

The second day of orientation brought with it the second year trainees, and together the two cohorts were split into four “working groups”. These include: Intern News, Marketing, Congress and Recruitment, each with their own tasks and projects to complete throughout the year. It’s another opportunity for each of us to develop a new skillset that will be valuable in our workplaces.  

We then had the wonderful opportunity to listen to Dr Kim Hill, the Executive Medical Director of Western Sydney Local Health District, who challenged us to think broadly about the changing NSW health system, to always maintain open communication and to be confident in ourselves and our own work, without being afraid to seek advice from colleagues.

A presentation from the ACHSM NSW State Branch President, Associate Professor Dominic Dawson followed, with some insights into ACHSM and working within NSW Health. This was followed by a panel of former ACHSM trainees, who spoke about their experiences in the program and how this helped prepare them for their careers beyond the program. They gave us an invaluable insight into life in the HMIP and tips to get the most out of our two years as interns.

The day concluded with a networking session involving the interns and their workplace supervisors, and was a lovely end to a busy, yet inspiring orientation program.  What inspired me the most during orientation was Dr Kim Hill quoting Einstein: “Out of clutter, find simplicity. From discord, find harmony. In the middle of difficulty, lies opportunity.” I think it’s the perfect mantra to apply to our two year internship journey, hoping that indeed we all find invaluable opportunities throughout the next two years, whilst hopefully maintaining a degree of harmony and simplicity as we begin to navigate our new career paths.

Audrey Lazaris is a first-year ACHSM Health Management Intern, currently placed at Justice Health and Forensic Mental Health Network, where she is working in Redesign & Innovation and the Research & Evaluation Service. 

What healthcare can learn from other industries

Author: Edmund Ng

Healthcare is an industry that is continually looking to improve itself, and that’s no surprise. Clinicians, managers, and support staff alike are all faced with numerous issues on a daily basis that might prevent them from doing their job as well as possible; and when that job  ultimately affects patient care, improvement is something worth focusing on.

There are three ways of creating solutions to any problem: use the tools you already have in a different manner; create new tools altogether; or adapt the tools that others are using for your own purposes. Perhaps the most commonly referenced tool that healthcare has appropriated from another industry is that of Lean Manufacturing and the Toyota Production System which focuses on the elimination of waste in order to increase value and efficiency – sound familiar?

The following are examples of practices from other industries that have been or could be transferred to healthcare.

Improvements in Communication:

• Staff at Great Ormond Street Hospital for Children in London have adapted the “pit stop” techniques of the Ferrari Formula One team to reduce errors 
• during patient handover between surgery and ICU [1]. The new protocol was shown to reduce clinical/technical errors, errors in transfer of information, and staff perceptions of teamwork. 
• In the same way that passengers on an aeroplane receive a safety briefing each time they board a flight, Salford Royal has produced a 2.5 minute patient safety briefing that is played on the wards, at the hospital’s main entrance and is available across the hospital computer network [2]. The film addresses eight key steps to ensuring patient safety during their admission including fall avoidance, infection prevention, pressure injuries, medication safety and encouragement to ask clinicians any questions they might have.                                                                                     

Reducing Cost

Health care can learn how to reduce costs by looking to supply chain management from the retail sector [3], in particular by using purchasing volume to achieve lower prices.

Using Technology: 

• As patient information is increasingly becoming electronic, there is an opportunity to learn from the experiences of the finance/banking sector as it moved through a similar transition decades ago. In particular, banks are able to securely store and manage sensitive customer information, whilst also freely providing customers with access to their own information via mobile devices; this closely mirrors the movement of healthcare towards a patient-centric model.
• It’s widely accepted that the plethora of data being generated on a daily basis by hospitals and health care more broadly lends itself easily to the application of big data analytics. While IBM has taken this initiative to focus on individual patients using Watson [4], there may be an opportunity to use this information to target services at particular geographical area based on need. This is a model adopted by Sysco, a food service supplier in the United States, who alter their supply chain to match where demand is greatest for their products [5].

Although healthcare is a unique and hugely complex industry, some of its most pressing concerns may have been addressed in other sectors. The challenge lies in having the creativity and wisdom to know what knowledge can be directly transferred, and how and when to modify the solutions to fit the context of healthcare.

References

1. Catchpole, K.R., De Leval, M.R., McEwan, A., et al. (2007). Patient handover from surgery to intensive care: using Formula 1 pit-stop and aviation models to improve safety and quality. Pediatric Anesthesia 17(5):470-8.
2. Haelo (2015). How Salford Royal ‘rolled out’ a patient safety briefing | Haelo. Accessed April 2015 at http://www.haelo.org.uk/2015/02/how-salford-royal-rolled-out-a-patient-safety-briefing/
3. Agwunobi, J. and London, P.A. (2009). Removing Costs from the Health Care Supply Chain: Lessons from Mass Retail. Health Affairs 28(5):1336-1342.
4. Friedman, L.F. (2014). IBM’s Watson Supercomputer May Soon Be The Best Doctor In the World | Business Insider. Business Insider Australia. Accessed April 2015 at http://www.businessinsider.com.au/ibms-watson-may-soon-be-the-best-doctor-in-the-world-2014-4
5. Hazra, T. (2013). Data Analytics: What Healthcare Can Learn From Other Industries. Advance Healthcare Network: Executive Insight. Accessed April 2015 at http://healthcare-executive-insight.advanceweb.com/Features/Articles/Data-Analytics-What-Healthcare-Can-Learn-From-Other-Industries.aspx

How to manage stress at work

Author: Jacqueline Kozman, 2nd year Trainee

Date: 12/12/2014

As our second year trainees are starting their career in health management, it is important for them to be able to recognise more about the stresses they will face in the workplace, and how to control them. While some workplace stress is normal, excessive stress can interfere with your productivity and impact your physical and emotional health; your ability to deal with stress might be the difference between success or failure.

The ability to manage job stress is something that can be learnt. There are a variety of ways in which you can reduce both your overall stress levels and the stress you find on the job and in the workplace. These include:

Tip 1: Recognise warning signs of excessive stress at work

When you feel overwhelmed at work, you lose confidence and may become irritable or withdrawn. This can make you less productive and less effective in your job, and make the work seem less rewarding. If you ignore the warning signs of work stress, they can lead to bigger problems. Beyond interfering with job performance and satisfaction, chronic or intense stress can also lead to physical and emotional health problems.

Tip 2: Reduce job stress by taking care of yourself

· Get moving, make food choices that keep you going, get enough sleep and get support.

Tip 3: Reduce job stress by prioritising and organising

• Create a balanced schedule. All work and no play is a recipe for burnout.
• Don’t over-commit yourself. All too often, we underestimate how long things will take.
• Get to work on time - don’t add to your stress levels by running late.
• Prioritise tasks. Make a list of tasks you have to do, and tackle them in order of importance.
• Delegate responsibility. You don’t have to do it all yourself. If other people can take care of the task, why not let them?
• Be willing to compromise. When you ask someone to contribute differently to a task, revise a deadline, or change their behaviour at work, be willing to do the same. Sometimes, if you can both bend a little, you’ll be able to find a happy middle ground that reduces the stress levels for everyone.

Tip 4: Reduce job stress by improving emotional intelligence

• Emotional intelligence is the ability to manage and use your emotions in positive and constructive ways.
• Realise when you’re stressed
• Stay connected to your internal emotional experience
• Recognise and effectively use non-verbal cues such as body language
• Develop the capacity to meet challenges with humour
• Resolve conflict positively

Tip 5: Reduce job stress by breaking bad habits

• Resist perfectionism.
• Clean up your act.
• Flip your negative thinking to positive thinking.
• Don’t try to control the uncontrollable.

Tip 6: Learn how managers or employers can reduce job stress

It's in a manager's best interest to keep stress levels in the workplace to a minimum. Managers can act as positive role models, especially in times of high stress, by following the tips outlined in this article. If a respected manager can remain calm in stressful work situations, it is much easier for his or her employees to also remain calm.

Reference: Jeanne Segal, Ph.D., Melinda Smith, M.A., Lawrence Robinson, and Robert Segal, M.A. Last updated: November 2014. Retrieved from http://www.helpguide.org/articles/stress/stress-at-work.htm

Healthy Living by DOING different things

Author: Keerthana Urmise, 2nd year trainee

Date: 31/07/2014

Take a minute to think about the people you know whom you consider to be really active and creative. Chances are they have had quite broad experiences in their lives and exposed themselves to a wide range of stimuli. A creative mind desires three mantras: new challenges, exercise and a healthy diet.

At least once a week, challenge yourself to do something you wouldn’t normally do

• See a genre film that you would not normally gravitate to
• Attend a public lecture on a topic you know nothing about it
• Try cooking a meal you have never cooked before
• Randomly select a short course to attend

Maintaining exercise and making habits stick

• Recruit social support: Find a partner who will support your effort to reduce or eliminate some undesirable habits.
• Record your activity: Write down how much time you spent exercising, or how far you walked. Use a pedometer.
• Make no excuses: If you’re tired, try walking for five minutes and see how you feel after that.
• Find a variety of activities you enjoy: Walk, cycle, swim, tennis, weights, yoga, gym classes, dance classes etc.
• Reward yourself: Decide on a monthly goal and when you get there, reward yourself appropriately.      

Enjoy your food

• Try to eat a rainbow of fruits and vegetables, carbs and whole grains, and healthy fats.
• Eat with others whenever possible.
• Take time to chew your food and enjoy mealtimes.
• Listen to your body.
• Eat breakfast, and eat smaller meals throughout the day.     

Habits generally develop when you schedule behaviours at specific times and on a regular basis which suits your lifestyle. Developing a habit- especially when it comes to replacing unhealthy behaviours with more desirable routines- is enhanced when the new habit attached to a value and linked to a specific time or place.

Ageism? The challenge of being a young manager

Author: Edmund Ng, 1st year Trainee

Date: 15/07/2014
As young professionals are increasingly tapped on the shoulder to enter the world of management, the scenario of leading a team whose combined age is several multiples of your university entrance score is no longer an absurdity, or even a rarity – its commonplace. But whilst senior management may recognise the value of your “youthful energy” and “fresh perspectives”, new managers are often subject to issues of age-, or experience-related scepticism and criticism. Here are several ways to keep your team onside when they’re concerned about the number of candles on your cake.

1. Seek their opinion – allow older colleagues to have their input into problem solving. Recognise the value of their knowledge and experience when developing solutions, and don’t be afraid to ask for assistance from others who clearly know more than you.

2. Keep their lifestyle in mind – recognise that older colleagues will probably have a very different day to day lifestyle to you, often with family commitments and responsibilities that will restrict their working habits.
3.  Be generous in showing appreciation – you’d be surprised by far something like a simple “thank you” can go; show your appreciation and acknowledge their efforts and achievements.
4. Avoid micro-management – if your team is full of experts with experience, then chances are they know how to do their job. Focus on setting operational goals, and trust them to determine how best to meet those goals. Only begin tightening your grip if performance slips.
5. Be confident – No one feels comfortable around an insecure leader, so recognise the strengths of your skillset and put them to use. Although you’re young, there’s a reason why management selected you for this position, it’s just up to you to show demonstrate those reasons to your team.

Being a new manager is always difficult and winning people over is no easier. But by keeping the principles of trust, respect and appreciation in mind, you’ll be able to move past these hurdles readily and get on with making a difference in your organisation.

Freedom is 5pm – A tour of Silverwater Correctional Facility

Author: Weller Zheng, 2nd Year Management Trainee at Long Bay Correctional Facility, Justice Health &Forensic Mental Health

Date: 23 May 2014

When working in the office, there are always moments when I look at the blue sky and ardently wish for liberation from my cubicle. Now that I work at the Long Bay Correctional Complex, I look outside to see inmates walking in circles on the prison yard, and I am ardently grateful that I can still go home. Such are the unexpected consolations of working beside a prison.

This feeling increased when I visited the Metropolitan Remand and Reception Centre (MRRC) inside the Silverwater Correctional Complex in Sydney last week. Hellal arranged a tour for me. He had been a Nurse Unit Manager at Silverwater, and was now working with me at the Justice Health headquarters at Long Bay.

On the morning, we drove to the facility through the suburban streets of Granville. We turned into what looked like an industrial park. Only the barbed wire on its high fences indicated that it was a prison. Hellal reminded me to leave my mobile phone, and all metal objects behind in the car.

Of the three facilities at Silverwater, we were inside the maximum security facility. As we walked to the reception centre, a couple of men in green tracksuits were raking leaves, and another was driving a mower. “They’re minimum security inmates from next door,” Hellal said. “They do a lot of the gardening jobs. Highly sought after work too.”

The inside of reception resembled airport security. Instead of presenting my passport, I had to get my biometric details recorded. A couple of police officers and family visitors were before us. When I stepped up, the guard conducted me to put my index finger up and down a few times onto the scanner with each hand. I looked into the sliver of mirror and a green dot appeared that I aligned into middle of my eyes by adjusting the mirror.

We were then let through the metal detector and into the first set of gates, which operated like an airlock. After all the visitors were all inside the room did the other door open. This was only a brief respite as we met a few more doors until we reached the inner sanctum. There, a Victorian era house stood inside well-manicured garden. It was the prison headquarters that housed all the executive administration.

Hellal took me to where the trucks first unloaded inmates. Between the loading yard and interior of the main jail block stood a row of three cells. The first cell had fresh inmates that were changing into their new green tracksuits. Their belongings had been downsized to a sack containing toiletries and another change of tracksuit. The second cell had inmates awaiting their health screening. The third cell was for inmates leaving to go to court or other prisons.

Right next to this was the health screening cells, which were divided into two levels. I wanted to go have a look, so Hellal introduced us to the guard and asked for his permission. It was important for our own safety that the guards knew we were inside. Security was the highest priority.

We walked into the one of the cells. They were for patients that were at the risk of committing suicide. The mattress was sprayed with a flame retardant chemical. The blanket was of a rough material that couldn’t be torn. The toilet was in an exposed corner with no seat. We had to leave the cell when a guard led an inmate inside, where he promptly lay down and pulled over his blanket.

“The health screening is the most important part to get right,” Hellal told me. “If there’s an issue here, it affects the whole facility and prison system. If a patient dies because of misdiagnosis, then that’s our fault.”

After the inmates were screened, they were moved to a cell in one of the main wings. Each wing had two levels of cells, facing a common area with tables, a microwave, fridge, ping pong table and books. Each wing was identical in these configurations and was serviced by the main clinic.

On our way to the main clinic, we passed the maximum seclusion area. High profile prisoners may be put in here, or those with real security concerns. Closer to the main clinic was a methadone dispensing unit. It was a booth with plastic windows. It was empty, but two nurses would usually sit behind the counter, check signatures and then dispense methadone in plastic cups.

Compared to the quiet of the cells, the main clinic was bustling. In some rooms a few nurses were examining patients. Other rooms were for dental, allied health and medical staff. Another room contained the office of the Drug Court program. There was also a room of new diagnostic equipment, which was purchased to save costly trips to the external laboratories. Medications were kept in another. It was a complete primary health clinic.

After viewing these health facilities, I asked Hellal if we could go see some of the other workshops where the inmates worked. We entered an electronics workshop, where rows of green tracksuits stood refurbishing airline headsets, assembling water heating units and stripping wires. Like a proud father, the guard (whose badge said prison industries) took us along each assembly step and highlighted the training opportunities and skills gained.

Having satisfied my curiosity, we took our leave of the hardworking inmates. On our way out, we had to go through all the doors again. Just as we were inside the airlock room, Hellal met the General Manager of the prison and started talking like old friends.

When the General Manager wanted to leave again, the doors had become completely locked. For those few moments, we were imprisoned: the captors had become the captured. When the doors opened again, I was grateful for my freedom to return to my cubicle, work until five o clock, and then go home.

New experiences

Author: Michaela Cashman, 2nd year Trainee

Date: 22 May 2014

In March 2014, I was lucky enough to shadow a leading Anaesthetist for a day in theatres to experience the front line. This opportunity came about due to helping out scribing at an event, as they needed an extra pair of hands and I was then talking to a senior clinician they asked if I wanted to spend a day with them in theatres. Following on from that, they got the clearances from their hospital and I from my line manager to spend the day shadowing them. 

On the day, I spent time shadowing her:

• going in and out of different theatres watching different types of surgery
• bearing witness to the fast paced environment of running 10 + theatres
• observing prioritisation and triaging of surgery
• observing clinical handover
• liaising with management regarding workforce
• communicating with all the clinician’s to ensure the theatres are staffed and operating efficiently and effectively

To date, this was the best day I have experienced in the program. As a future health manager it is critical to understand and continually be reminded of the pressures of the front line staff and the amazing people we have working in our system. Therefore whenever we are developing systems/models of care/implementing new ways of doing things, it is important to understand the context in which we work. It also reminded me of the importance of developing relationships and working with clinicians to ensure that they have all the appropriate resources and workforce needed to deliver safe and quality care. 

Finally, this opportunity came from saying yes to being an extra set of hands at a function and therefore it reminded me to never say no to anything and see everything as an opportunity.