Towards positive health workplaces: Ditch toxic culture for a safe and supportive environment

"Life moves pretty fast. If you don’t stop and look around once in a while, you might miss it.” – Ferris Bueller.

Inspired by the philosophy of the comedic movie Ferris Bueller’s Day Off, I have been backpacking around South-East Asia on my way to Cambodia to work as a volunteer in a primary care clinic.

As I contemplate this column, I have cycled the length of Vietnam (with COVID-19, not to be recommended), feasted on crickets – the food of the future – and spent a lot of time asking other travellers, “Why are you here?” The answers have been fascinating. The entire planet has shared a profound experience, having been through the COVID-19 pandemic. This shared experience has meant that human connection can be found everywhere, as in some way we have all experienced something “same, same but different”.

In truth, though, this sabbatical is more an act of rehabilitation, an acknowledgement that at some stage last year I hit the wall. A confluence of circumstances led to this, related to work and to life outside work.

Many people assume burnout results from working too much or too hard. In fact, research shows clearly that lack of autonomy in a role, dysfunctional workplace dynamics, and a feeling of not being heard or valued, are stronger indicators of the risk of burnout. Sadly, this is the case for too many of us in medicine, and it presents a clear and present danger to the patients we look after.

In July, New Zealand Women in Medicine published the results of our workforce survey.

Over 900 respondents across all stages and specialties of the profession responded. The results were clear: there is a crisis within our workforce.

Disillusionment, hopelessness and a sense of despair are widespread. Doctors report walking off the job. Some specialties are in a death spiral, unable to recruit. A lack of clarity about what the future holds in the new health system has contributed to a sense of helplessness and a feeling shared by many survey respondents that they are expendable and of little value.

Te Whatu Ora is listening, and has acknowledged that workforce wellbeing must be prioritised. The agency has committed to development of a Health Workforce Charter as legislated in the Pae Ora (Healthy Futures) Act 2022, and is undertaking to collect meaningful data on the “state of the nation” via regular sector engagement and pulse surveys of the workforce.

An interim clinical lead for wellbeing, anaesthetist Joanna Sinclair, has been appointed and has the herculean task of developing a framework for workforce wellbeing. Workforce wellbeing is a woolly term. What does it actually mean?

Workforce wellbeing encompasses both physical workplace safety and the prevailing climate and ethos, which in turn impacts on mental health and productivity.

A healthy work environment is supported and is also culturally safe.

In August, the New Zealand Human Rights Commission published Experiences of Workplace Bullying and Harassment in Aotearoa. Forty per cent of survey respondents reported having been bullied within their workplace; healthcare settings had some of the highest reported rates.

In an interview with RNZ National, equal employment opportunities commissioner Saunoamaali’i Karanina Sumeo noted: “Healthcare seems to be the one that goes right across in terms of high prevalence of racial harassment, sexual harassment and bullying.”

In the UK, the Civility Saves Lives movement has campaigned effectively for years to reduce incivility and bullying in healthcare. The evidence – much of which is gathered on its website – is clear: these negative behaviours have profound effects not just on those who directly experience them, but on bystanders and, ultimately, on patients.

Burnout presents a clear and present danger to the patients we look after

I have experience of working in a hospital setting where a poor culture resulted in a cluster of devastating outcomes for patients and whānau.

An external inquiry highlighted a toxic environment, and pointed to bullying and racism within the department as impacting on patient outcomes.

When I drew attention to some of the systemic issues at the time, I was told “drop the bone”, “keep your powder dry” and, most interesting of all, “maybe you’re the problem”. I write this only to illustrate the classic difficulty in reporting difficult issues such as bullying.

It all too often goes unreported because in highlighting it, the reporter draws gunfire and the resulting impact on career and work situation can be devastating. Most people decide it is not worth the cost.

For me, it was time to leave with grace and find a way to channel the helplessness into positive action for change.

Everyone working in healthcare is, no doubt, exhausted after nigh-on three years of full-tilt working through COVID. For me, being able to take a breather, step out of the current and gain perspective has been invaluable.

I have seen how lucky we are in New Zealand compared with the many people whose governments gave them no support during COVID when businesses were shut and tourism was non-existent.

I am gratified to report that everywhere in South-East Asia, I found New Zealand is perceived positively, and seen as populated by good people – stewards of the land, friendly and open. “New Zealand, good place!”

Aotearoa is definitely a good place, a small and wellgoverned country about to embark on the next step of a journey which could transform the health and wellbeing of our population. This starts with acknowledging our workforce as a taonga integral to the success of this project, listening to their concerns and committing to meaningful culture change.

I have been profoundly impressed with Te Whatu Ora leaders’ accessibility and genuine desire to listen and understand. They get it.

As I write this, I look forward to returning and continuing the kōrero. Life is short and, as far as we know, it happens only once, so let’s make it count. Ferris would agree.

Orna McGinn is an Auckland-based specialist GP and chair of the New Zealand Women in Medicine Charitable Trust