All Ramsay staff encouraged to have a say


Ramsay Health Care are encouraging their staff to use their voice.

The organisation recently rolled out the Speaking Up for Safety Program and the Promoting Professional Accountability Program, facilitated by the Cognitive Institute.

The programs put in place a framework for staff – no matter how junior they may be – to speak up and ask questions, particularly in relation to patient safety.

Ramsay’s Chief Risk Officer Australia, Chanelle McEnallay, said the speaking up program was about what’s right, not who’s right.

“Breaking down the barriers of communication between professional to professional, and professional to patient, centres the conversation on patient safety,” she said.

“This increases staff satisfaction because they are involved and heard, therefore retention rates may be higher and a speaking up culture underpins the Ramsay Way and Ramsay’s reputation for providing the safest possible care.”

Senior Education Consultant at the Cognitive Institute, Louise Cuskelly, said it was about speaking respectfully, assertively, and using a common language.

“It’s about creating a culture where, when you go to work somewhere like Ramsay, you feel confident in speaking up for patient safety,” she said.

“And that even if you’re wrong, you give it a go and you are fully supported.

“We use the example of airline safety culture – if you get on a Qantas plane, you know the co-pilot has the confidence to speak up to the pilot and it is welcomed.

“In healthcare, research suggests up to 30 percent or more of hospital staff don’t feel safe raising  a concern and that’s right across any discipline.

“For example, a junior nurse or doctor may not feel safe speaking up. And sometimes people further up the hierarchy don’t feel comfortable being questioned.”

Ramsay’s National Clinical Improvement Development Officer, Hayden Scotter, said the speaking up program recognised that “we can all be wrong, because we are all human.”

“This program increases the chances that small mistakes in communication, leadership, prioritisation, judgement, decision-making and ultimately, situation awareness, are picked up and discussed collaboratively in real time,” he said.

“This assists us enormously in responding to and managing acute deterioration in the clinical setting.”

Ms Cuskelly said there were two types of speaking up.

“The first is, if something is going to cause immediate harm – for example, the wrong dose of medication,” she said.

“The other type of speaking up relates to behaviours that undermine a culture of safety, a type of harm that may occur if something is left unchecked – for example, someone who consistently doesn’t wash their hands has a higher chance of spreading infection.

“So it may not cause harm immediately, but if not addressed may lead to patient harm.

“It’s calling out those behaviours that have been left unchecked.

“And there is an evidence-based framework, a system in place organisation wide to address behaviours that undermine a culture of safety.”

In the event staff do not feel it is safe or effective to speak up directly, they are encouraged to go to their manager. If that is not safe or effective, they can escalate their concern.

“People can put in a report about a behaviour that undermines a culture of safety and then that person receives feedback from a peer – a trained peer, in a peer-to-peer conversation,” Ms Cuskelly said.

“It’s non-judgemental  feedback,  a ‘did you know’ type of conversation. And this is not a punitive system, it’s about checking in and ensuring that people have each other’s backs.

“Anecdotally, we find only about 10 percent of participants require a peer to peer conversation. And of that 10 percent, 70 percent self-regulate and they’re never reported again. These are such good results.”

She added Ramsay had been “phenomenal” in adopting the programs.

“We had total commitment from the Ramsay board and the executive,” Ms Cuskelly said.

“They are very strict on what they call the Ramsay Way, and their values.

“It’s about a culture of safety for staff and for patients. And unless staff feel safe and supported, they’re not going to feel safe about speaking up for patients.”

Ms McEnallay said Ramsay had been delighted with the impact and results of the programs.

“Patients feel safe in hospital when they hear nurses and doctors speaking courteously and with good manners to each other; because it sounds like things are under professional control,” she said.

“The benefits are that teamwork and professional respect are preserved and in many cases enhanced but this culture is tangible and reflected in patient satisfaction surveys.

“The feedback to date from staff and doctors has been phenomenal, even in Asia where speaking up was traditionally discouraged for cultural reasons.”

Mr Scotter said the training had been implemented right across Ramsay Australia, all of Ramsay Malaysia, Ramsay UK and it had started in Ramsay Indonesia.

“We have also implemented a number of national strategies, such as asking every staff member at handover, ‘did you speak up today’ to ensure the language is truly embedded and second nature,” he said.

Ms Cuskelly added the organisation-wide program took at least 12 months to implement and that it was “not for the faint-hearted."

“Ramsay are just so good to deal with, so committed to patient safety and they have those solid, Ramsay Way values. And you know, staff who work there, they know ‘this is the way we do things here’,” she said.

“Staff need to know they are fully supported, and that speaking up, even if they’re wrong, that’s ok.

“It’s about listening up as well – people further up the hierarchy may not be used to being questioned and it’s about how they receive that information.

“We’re human. We all make errors and healthcare is so complex now. We have come a long way, but we can do more and change is happening.”


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