NoWEM Virtual Town Hall Q+A
ACEM Presidential Candidate Responses to NoWEM Members’ Questions
Dr Clare Skinner
In your tenure as President, what will you do to advance gender equity?
I would like to acknowledge work that has already been done by the Diversity and Inclusion Steering Group and by AWE. We have achieved constitutional change which has facilitated inclusion of three women on the ACEM Board – a vast improvement to how the Board looked a few years ago. We have introduced standardised reporting on gender balance across the ACEM Board and standing committees, and we have implemented committee nomination and selection processes which recognise the importance of diversity in strategic decision-making. A college gender equity statement has been published and we have developed ACEM core values which embed the importance of equity in all that the college, and its members, strive to achieve.
Acknowledging that parenting duties, while not gender specific, are largely undertaken by people who identify as female, the publication of the ACEM parenting statement and adoption of Breastfeeding Australia’s breastfeeding friendly workplace standards will go a long way to improve engagement of female members who parent in college representation.
There is still a long way to go. While the Expert Advisory Group report recommended a gender equity target of 40%, this has not been formally announced and it does not go far enough. I will advocate for ACEM to adopt a gender equity quota of 40% for the Board, plus all committees and councils.
ACEM should be actively developing leadership capability and supporting members of all genders into leadership roles, especially Director and DEMT positions. This should be achieved through a mix of gender reporting, courses and workshops, and mentoring programs. We should adopt the recommendations of the Workplace Gender Equity Agency to improve equity in remuneration, leadership and strategic performance.
Of course, we must also acknowledge that gender is complex and non-binary, and ensure our language and systems are thoughtful and inclusive at all times.
As a feminist, I believe it is important to recognise and dismantle layers of prejudice that have driven exclusion and disengagement of marginalised groups. I am proud to belong to a college with highly diverse membership. To improve gender equity, we need to improve representation of all members, and to ideally reflect the community we serve. We need to educate our members and trainees to become anti-racist, culturally competent, and encourage them to develop strategies to recognise and address their own privilege. We need to work to remove bias from our training materials and career advancement processes. We need to continue to actively promote diversity and inclusion by setting targets, monitoring performance and celebrating our achievements.
How will you engage members who are not actively involved with ACEM? What do you think the College has to offer them?
I think about this question often and there are no easy answers. If you look through my CV, you will notice that there are times when I have not been actively engaged with ACEM. After being involved in work on access block and overcrowding as a trainee, I took a break to get established as a specialist, start a family, and concentrate on academic roles. I then re-engaged with ACEM around work on discrimination and bullying in 2016-17. I reflect on those times when I was less engaged with college to consider my response.
I would hope to engage those who would like to be engaged through leading with heart and soul. Providing honest communication, listening carefully, and responding to issues facing members and trainees as they arise. Being kind, human and approachable, and being genuinely collaborative and inclusive.
The most important thing, by far, is to remember that ACEM is a member-based organisation. The needs and priorities of members must be the key drivers of strategic and policy decisions. We are the college, and the college is strongest when it reflects all of us. Broad engagement will help us work towards better clinical and training systems, which align with the lived experience of members.
Of course, not everyone has the time or inclination to be involved in ACEM committees or sections. Many FACEMs are involved in other representative activities, for example with government, academia or professional organisations, and we need to link in better to work with shared purpose towards common goals, and to optimise information sharing and strategic thinking. Many FACEMs have other priorities. We need to make sure that communication lines are open, so we can reflect their experiences, address their needs, and be welcoming if and when they do choose to get more involved, by removing barriers to engagement and participation in college entities. In particular, eligibility to nominate for senior roles such as President and Censor-in-Chief should be reviewed to ensure that non-college leadership experience is recognised. We should ensure that committee selection processes balance senior expertise and corporate knowledge with opportunities for new members to engage.
We also need to consider the ‘real-life’ barriers to participation in college committees, including lack of paid clinical support time and competing carer roles. We must do our best to counter these – through a combination of virtual meetings and consideration of paid travel, carer and meeting allowances when in-person attendance is required.
How will you strive to achieve excellence in Emergency care for Aboriginal, Torres Strait Islander and Mãori peoples?
This is very important to me and will be a priority during my term.
ACEM has done important work with the Reconciliation Action Plan in Australia and the Manaaki Mana Strategy in Aotearoa New Zealand. We need to build on this work, to improve access to clinical care, health literacy and individual and population level health outcomes for First Nations Peoples. This is particularly important in the context of my own special interest area, Mental Health in the ED.
This work must, and can only, be done in partnership with leaders and local communities. Co-design is vitally important. Respect for customs, culture, language and land must be deep and genuine. We must avoid repeating the mistakes and trauma of colonisation.
The reasons for poor health outcomes are complex and varied. I don’t pretend to have the answers, but I promise to listen to advice, to read, to work hard, and to have the humility to recognise the limits of my personal knowledge and experience. I also acknowledge that it is not the job of colleagues from First Nations cultures to educate me. I promise to do my fair share of the work.
An important and related endeavour is to ensure that ACEM fellowship and non-specialist training is accessible, relevant and affordable for colleagues from First Nations cultures, and to improve pathways into medical school and through postgraduate medical training, in collaboration with universities and other training providers.
What are you going to do to support FACEMs and trainees based in regional and rural departments?
I would like to acknowledge the unique challenges of regional and rural practice. I have written about my experiences doing rural locum shifts as a trainee, and I have recently been involved in a review of clinical services in rural NSW, so the challenges and rewards of rural Emergency medicine are front of mind for me.
Both Australia and Aotearoa New Zealand are countries with relatively small populations unevenly spread over rugged landscapes. Distance is a challenge, especially when it comes to workforce distribution, referral pathways and transport, and access to specialised clinical infrastructure.
As acute generalists, FACEMs are a vital part of rural and regional health systems. We need to ensure that ACEM is training doctors who can work effectively in non-tertiary, lesser-resourced environments. Experience is an excellent teacher, so we need to create incentives for trainees to undertake rotations in rural and regional areas. We should encourage inclusion of rural time into training pathways, with opt-out instead of opt-in rural terms. Improved networking between metropolitan and rural teaching hospitals should encourage two-directional sharing of workforce and educational resources, including support for education, recruitment, and sub-specialty clinical advice. ACEM should advocate for jurisdictions to provide all trainees and members who relocate for work or training with travel and accommodation allowances, not just those moving from city to country.
ACEM should partner with ACRRM and RACGP to deliver up-to-date critical care training to all rural generalists providing Emergency care, not just those enrolled with ACEM, through non-specialist training pathways, especially the EMET – with ACEM positioned as the leader in Emergency Medicine education for all professionals working in Emergency Departments across Australia and Aotearoa New Zealand. FACEMs should continue to be involved in developing high quality telemedicine to support smaller rural sites, balancing technical support with the vital requirement for rural towns to have experienced clinicians embedded in the local community and providing in-person care.
How will you balance being a President for members in both Australia and Aotearoa, specifically if there continues to be a vast difference in COVID rates?
I would like to thank Dr John Bonning for being an engaged and committed leader during the pandemic. John has really stepped up to demonstrate that it is possible to listen to issues faced in other jurisdictions, and to advocate and drive strategic change while not able to travel across land and sea borders.
I have strong relationships (and friendships) with colleagues in Aotearoa New Zealand, formed during visits to attend and speak at local conferences, and strengthened through my work on the shared, but subtly different, challenges we face when managing people who present to ED with mental health symptoms. Through the health system reform committee, I have also been involved in discussions attempting to align national approaches to time-based targets, which has given me deeper understanding of the operation of EDs in New Zealand.
Australia and Aotearoa have a lot in common, but there are key differences. I see these as providing opportunities for learning. As an Australian, I am envious of integrated care pathways that seem to operate well (from the outside), of innovative approaches to technology, and of political leadership imbued with kindness, empathy, and humanity.
Collaboration is important. Every standing committee must have representation from Aotearoa, and meetings should be timed to facilitate attendance for members from all time zones. Inclusion of virtual meetings in committee schedules will reduce time lost to travel, although it is important to still occasionally meet in-person, pandemic restrictions permitting. As an Australian, I will always be mindful that my bigger country does not automatically have the best approach.
COVID is our immediate shared challenge, and I would like to think that despite varying local response strategies and pandemic curves, we are truly in this together. There are other big challenges facing our corner of the globe, including climate change, and Aotearoa and Australia will face them better with an integrated approach. I have a good record of facilitating trans-Tasman collaboration in committee and policy roles, and I hope to continue this as President.
What lessons can we learn from this period of the COVID epidemic that you will be promoting to help EM function better in future?
So many! These are strange, scary and uncertain times – and the pandemic has been devastating for our colleagues and their communities across the world.
The big silver lining has been the re-awakening of clinical (and more specifically, medical) engagement in health system decision-making, and it is has been especially encouraging to see FACEMs in COVID response leadership roles. Our whole-of-system, problem-solving approach, has been very useful during the pandemic, and it is important that we continue to stay involved in critical health system redesign.
I have described my role as clinical lead for the EM COVID response in NSW elsewhere, so I won’t go into detail here. I’m proud to have been involved in what has so far been a largely successful approach to a tricky virus. Clear, consistent and honest communication with clinicians has been a big change. Strategic use of both social and traditional media has been welcome too. The NSW state-wide clinical council, which allows senior clinicians to discuss critical policy, will be useful to drive interdisciplinary collaboration in non-pandemic times, and ideally will remain in operation.
There is much to change in how we practice Emergency medicine. Physical layouts need a complete re-think, to minimise infection control and to improve patient and staff safety. Work-flow must also change, to allow efficient movement of staff and patients through the department, based on early senior streaming and assessment. Staffing models and work practice changes through the pandemic have given us a glimpse of more efficient and effective ways of working. Direct referral models for stable patients, such as triage to paediatric clinic, or surgical assessment units, have reduced ED crowding and improved the patient journey. Virtual work has made work-life integration more achievable for many of us with carer responsibilities and has changed the way we provide education too.
Perhaps the biggest change has been the introduction of widespread, tech-supported virtual care, especially in the aged care and mental health spaces, which has allowed direct specialist assessment and management of vulnerable patients without a trip to ED. Virtual care has also allowed expansion of hospital-in-the-home models, which allow patients to have detailed monitoring and assessment in their own environments, with outreach visits or clinic appointments as required. These have great potential to relieve bottlenecks in ED and to provide our patients with better choices when partnering with health professionals to manage their care.
There are a couple of lessons in what not to do that deserve a mention too. With the rapid onset of the pandemic, appointments into leadership appointments were made without formal processes. The time has come to review representation, with a view to ensuring genuine inclusion, especially of marginalised groups who are especially vulnerable during the pandemic. Equity must not be forgotten. There are also lessons in how health bureaucracies operate, and we must not let this opportunity to strengthen governance and finance structures which drive health delivery and training systems pass us by.
What are your top 3 priorities for your term?
This is tricky – I wish I had more than three! Also, I suspect that Presidential terms never quite work out how you predict, but here goes:
1. Keep building on important work on engagement and inclusion – ensuring diverse representation on college committees and councils, enhanced communication, genuine collaboration and partnership with members and other professional groups
2. Workforce and work practice reform – make what we do efficient, effective, and sustainable, including implementation of new models of care and innovative technologies.
3. Health system improvement – continue our important work on mental health, aged care, improved access and outcomes for First Nations Peoples, and equitable resourcing of rural and regional Emergency care.
This article from Croakey outlines some of my ideas for ED and health system reform:
https://www.croakey.org/at-a-time-of-looming-crisis-a-vision-for-health-system-transformation/
Articles I have written on a broad range of topics are available via my website clareskinner.com.
I am also happy for NoWEM members to contact me directly via social media or email clareskinner@gmail.com if they have further questions. I will do my best to answer them.
Thank you for the interesting questions, and please stay in touch.
Clare
Dr Kim Hansen
Thank you for the opportunity to communicate with members. My “virtual” door will remain open for any questions or concerns as President if I am elected.
In your tenure as president what will you do to advance gender equity?
I founded AWE (Advancing Women in Medicine) in 2018 as a mechanism to support women into and in leadership positions in Emergency Medicine, both inside and outside the College. I’ve been Inaugural Chair since and we want this support to be as broad as possible, enabling women in the most junior roles up to empower themselves and each other to succeed. We recognise the disadvantage and discrimination that may occur in addition to gender bias for many females – race, religion, disability, and sexuality are a few examples.
To do this, I envision the ACEM President can support AWE and all members by:
· Advocacy- for issues that specifically affect female members of the College. AWE has released a Gender Equity statement and now is focussing on a Parenting statement to address issues related to support and career progression while parenting dependent children. While this does not affect all women and does affect men as well, women can be disproportionately affected and the College can work to address this. Sadly, I continue to hear of parents suffering disadvantage in the workplace.
· Mentoring– enhance opportunities for female FACEMs, other female College members and trainees throughout all stages of their careers. A long-term goal of true equality starts by supporting our newest members.
· Networking - events to encourage female and male supporters to gather. We have had successful events in Perth, Rotorua and Hobart and more are planned when we can meet again. A leadership workshop is planned as well. These events enable us to start powerful conversations and build alliances.
· Research - into women in Emergency medicine, who are we, where we are at, what levels do we obtain, and what are the impediments to success? Other specialities are leading the way but we can follow.
How will you engage members who are not actively involved with ACEM? What do you think the College has to offer them?
Our College, without doubt, will be strengthened by increasing the number and diversity of FACEM involvement; no matter who you are, where you are from, where you work or how experienced you are. I am passionate about inclusivity and engagement. It is important that the College is not seen as a small group of individuals who meet in Melbourne, but as all of us, no matter how big or small our engagement is. The College has a lot to offer and is continuing to broaden its interest base, whether through “special interest” Sections, advocacy on topical issues or through strengthening state, territory and New Zealand Faculties. As we promote these, and reach out to othermembers, our engagement increases. Improving the ACEM websitewould also help with member engagement and is a priority of mine.
How will you strive to achieve excellence in emergency care for Aboriginal, Torres Strait Islander and Maori peoples?
ACEM is committed to improving the emergency care of Aboriginal, Torres Strait Islander and Maori peoples but data shows our healthcare systems have a long way to go. The Australia’s Reconciliation Action Plan is partially complete and will be a focus of the next ACEM president. Aotearoa New Zealand’s Manaaki Mana Strategy has just started, and requires ongoing focus.
I have been fortunate to have lived and worked in an Aboriginal community for several months (Woorabinda in Central Queensland) and learnt much from the rich experience. I have also worked with Indigenous FACEMs and Maori doctors and recognise I don’t have all the answers. Working with Aboriginal, Torres Strait Islander and Maori healthcare workers and communities is an essential part of the improvement process. We have other experts working within the College, such as the Indigenous Health Committee, who need support and resources to lead the changes required.
What are you going to do to support FACEMs and trainees based in regional and rural departments?
Fellows may be interested to know that I have been asked this question repeatedly during my candidacy. It is always great to hear what ACEM members are passionate about. Both my state government (Queensland) and the federal government have groups working on maldistribution, retention and support for regional and rural doctors. I have been involved in high level conversations at a state level with some innovative programs (for example, sponsoring new consultants to rural areas who rotate for intermittently to larger centres).
Many of you may know that the ACEM Curriculum has recently had a major review and the suggestion of compulsory rural terms was not adopted. We did see an increase in the duration that trainees can spend at many smaller rural and regional departments which is welcomed.
I support addressing the current maldistributionof the ED workforce. Evidence would support engaging people interested in and inclined to rural medicine early in their career before the late stage registrar or consultant years. This may mean supporting entry to medical school for people from regional and rural areas, supporting medical students and junior doctors to rotate to rural and regional areas, and supporting those from regional or rural into ACEM’s speciality training through the ACEM SIFT (Selection Into FACEM Training) process. We need to advocate for these experiences to be adequately resourced and rewarding, as too often the medical students or junior doctors have inadequate or unsafe accommodation and a stretched roster with inadequate supervision (no doubt due to workforce shortage rather than intention).
Regional EDs in Queensland have thrived under my watch as Faculty Chair, especially in terms of workforce issues, access block and relationships with hospital executives. As a College we need to both support and celebrate our regional rural ED doctors as much as possible.
Lastly, another solution is to set up successful networks between metropolitan and regional departments that encourage rotations and movement (ideally for both trainees and consultants). This can work in both directions, giving us all the different experience that we are lacking. I have worked across a number of regional and rural EDs, including Rockhampton, Gold Coast, Mt Morgan, Woorabinda and Yeppoon and it is an intensely rewarding experience with an enormous breadth of presentations and responsibility. Queensland is the most de-centralised state in Australia, and New Zealand is also similarly de-centralised. In Queensland we have done well with FACEM coverage compared with other states in all ACEM-accredited EDs. Almost all EDs with FACEMs have no long-term vacancies in Queensland and innovative, flexible workforce options abound.
How will you balance being a president for members in both Australia and Aotearoa, specifically if there continues to be a vast difference in COVID rates?
It’s a binational College and a binational job. I’ve been fortunate to travel to New Zealand many times and commit to spending time in EDs there if elected (once restrictions are lifted). In the meantime, zoom is our friend and will be increasingly utilised to engage each other across the Tasman Sea. The COVID rates are different across Australia and New Zealand, with Western Australia and Northern Territory more than matching New Zealand’s success at present and Victoria suffering. But as Auckland’s and Queenland’s recent experience shows, we must remain vigilant even after long periods of success. Sharing data and information is essential to keep patients and staff safe in all locations. The process of sharing the Victoria’s healthcare worker infection data recently is welcomed.
What lessons can we learn from this period of the COVID epidemic that you will be promoting to help EM function better in future?
Emergency Medicine has reached a point in our evolution that we must define and redefine our speciality - putting staff and patient safety first. The COVID epidemic has shown that health departments are not always on the front foot, risking our patients and our workforce. Long term problems, such as access block, workforce wellbeing and staffing, are coming home to roost. With COVID, we have a mandate to protect our departments with appropriate PPE, ED redesign and improved hospital processes to reduce overcrowding in our waiting rooms, corridors, and ambulance ramps - and not be a waiting room for the hospital.
I have written a few papers on this that readers can refer to:
· New Normal ED – ACEM Guidelines
· Workforce and Wellbeing – ACEM Guidelines (with Dr Mya Cubitt and Dr Rob Mitchell)
· Early lessons from COVID‐19 that may reduce future emergency department crowding (co-authored with a small group from IFEM’s Access Block Task Force which I co-chair)-
What are your top 3 priorities for your term?
Staff safety– it has never been so threatened and never been so important. Without safe staff, our ED’s ability care for their communities is compromised.
Addressing access block by improving patient flow and hospital processes. This will improve patient safety and staff safety. COVID19 is our mandate for change.
Workforce wellbeing– through diversity and inclusion, engagement, support for trainees, and measures to support mental health.
I have put together a video which articulates my vision for Emergency Medicine:
If you’ve got his far – congratulations and thank you for your interest in ACEM and the election. I look forward to connecting in future to share concerns, ideas and solutions.
Stay safe and well,
Kim Hansen
Dr Didier Palmer
In your tenure as president what will you do to advance gender equity?
I think to judge what someone will do then it is useful to look at what they have done.
In the NT Top End I have developed a gender equal consultant workforce (including in ED leadership positions) in my tertiary ED and network .... that has been the case for a decade, partly by luck but mainly by design. Why? Because it works, to me a no-brainer.
In the college three years ago as deputy chair of CAPP with Yusuf Nagree as chair we developed and implemented policy on appointments on all CAPP entities which includes active selection on the basis of gender equality and other diversity measures (new or older FACEM/metro or rural/cultural background etc). This has successfully led to most of our committees attaining as much diversity as possible with the applicants .... Our present exceptions being the research committee (predominantly men) and the public health committee (predominantly women).
When I commenced on the ACEM board 4 years ago it was to my embarrassment 100% male. The only way I could navigate a better gender balance was to vote myself off the board (I was there as Deputy Chair of CAPP). I voted that the deputy chairs of CAPP and COE be removed from the board so that we could appoint two women FACEM members and a further woman as an indigenous & consumer representative. I was subsequently re-appointed after the tragic death of my friend Yusuf Nagree as I was elected chair of CAPP. We are now in the process of appointing two positions (financial and legal specialists) as the incumbents have completed time. I suspect by the end of the year we will have a gender equal board regardless of the result of this election....
Within the college I think we have got the structure and policy around appointments about right for now, barring a few tweaks, but these are new changes and they need to be culturally embedded and woven into the fabric of everything we do. There are always forces of entropy at play. That requires vigilance, monitoring and reporting to ensure we maintain and report on gender equality and investigate and act when we see imbalance.
So what will I do if elected president .... Embed as above and then look to the more difficult .... Equity in the ED. Again, not simply numbers across the board but also in leadership positions. We also need to support leaders to be better leaders. More difficult because ACEM does not have governance over appointments. One area that ACEM can work on is leadership development and support for our emerging (and established) leaders. We have already partnered with Swinburne University on leadership qualitative research in EDs across Australasia and will look to translate that into leadership support, mentoring and courses for emerging leaders. We have also seen, over the past few years, ACEM accreditation of departments concentrate purely on the education process and decouple from recommendations on departmental organisation/funding/in-hospital support etc. We need a separate and parallel ACEM accreditation of departments which looks beyond training and into things like overcrowding/staffing levels/gender balance/cultural safety (patients and staff)/error trapping/quality and safety/ equipment/environment/patient experience/ED design/compliance with ACEM policy/hospital support ...... dimensions that reflect patient care, safety, governance and good leadership (beyond NHQHS tick box accreditation) and when established will give us a lever to improve ED culture .... A “Safe ED”.
How will you engage members who are not actively involved with ACEM? What do you think the College has to offer them?
Relevance, a perennial problem for medical colleges. Fundamentally the raison d’être for ACEM (and most other medical colleges) is provision of a specialist training program and monitoring CPD. There are obviously much wider and important roles in health system advocacy, membership advocacy, development of the discipline, research, overseas EM development and support, conferences and much more.
We need to inform better what it is we do because many don’t know ...... and when you do know the breadth of activity then there is often a niche that you can find to contribute to. We also need to get better at encouraging and facilitating participation which can be daunting ...... I know I was overwhelmed when I first started on college groups ... we need to be more supportive and mentor better.
Not everyone wants to contribute formally to committees and part of the solution to that is “sections” where you can dip in and out and your commitment is very much self-governed ........ two years ago we revised our entire committee structure and developed sections .... AWE / Paeds / Trauma / Private EM / Pre-Hospital / Geriatric EM amongst the first tranche with Telehealth EM and others in the pipeline. Currently we are revising sections as “communities of practice” ..... each with an executive and unlimited membership for those with an interest in particular areas. These groups can share and develop interests and also contribute to and influence ACEM decisions and directions.
How will you strive to achieve excellence in emergency care for Aboriginal, Torres Strait Islander and Maori peoples?
Close to my heart, I have spent my consultant career working in the Top End of the NT (not just in EDs but also in retrieval and visiting Aboriginal & Torres Strait Islander communities to deliver education) and every day I see the inequity of every aspect (health care is not even the most important part) of the lives of the first peoples. We have to be part of righting this.
Much like the first question on gender, you only create cultural change by bringing a voice to the decision making table. On my local ED executive I appointed a senior Aboriginal Health Worker with a specific remit to review every decision we make through the prism of an Indigenous eye, we have recently done the same on the board of ACEM. It is an essential first (baby) step. It is from that voice (and supporting and empowering that voice) that we develop policy, projects that become practice, gain funding, close the loop and prove we have made a difference (and not just ticked a box), and ultimately encourage more first peoples to become nurses, doctors and that highest calling of all ..... emergency physicians!
We need to build on what the college has done with Liz Mowatt and others with the Reconciliation Action Plan and the Indigenous Health Subcommittee. It is now time to “operationalise” and make tangible in individual EDs the things we talk about. I think we could do this first by linking cultural safety domains and governance to the “Safe ED” accreditation concept mentioned above.
What are you going to do to support FACEMs and trainees based in regional and rural departments?
Again, something close to my heart.
Solutions are not just related to FACEMs and trainees but the whole system of rural and remote EM: workforce mal-distribution; regional FTE; Rural Generalist education in EM; rural nursing training in EM; functional clinical networks that give real time support; functional educational networks for rural trainees (ACEM and Rural Generalist and nurses with EM skills); upskilling rotations built into contracts; training pathways in rural centres.
These are all things I want to develop. I have spent the last 18 months on a part of that leading a multi-college group (ACEM, RACGP, ACCRM, NZ Division) to redesign the curriculum of the cert and diploma into a three tier nested program with Cert / Diploma / Advanced Diploma. Presently working with primary care colleges to transcribe the Advanced Diploma into the requirement for rural generalist accreditation in EM.
The question above is asking, I think, about mandatory training in rural EDs. I am a believer. I started as a single-handed consultant in Darwin 20 years ago and now run a tertiary ED network with 30 consultants, 80% did some training in Darwin and the others heard about it from those who trained in Darwin. To take the plunge you need to experience it in your training. This will also be a driver to help all the things that need to happen to improve regional and rural emergency care.
How will you balance being a president for members in both Australia and Aotearoa, specifically if there continues to be a vast difference in COVID rates?
Fundamentally EM is the same in both countries but there are major difference in health systems and local circumstance and culture .... I have been on a steep learning curve working with John Bonning as he has been learning about some aspects of the Australian health system. Really the only way to ensure you are representing areas you know less about is by ensuring you have the best advice. We have in the last few months proven that travel can be overcome to a large extent with zoom and other platforms with parallel advantages for our planet. I think over the next year or two we are going to see differential COVID rates in various areas in Australia and Aotearoa and those will change in time as well.
What lessons can we learn from this period of the COVID epidemic that you will be promoting to help EM function better in future?
Many of the problems EM faces are not solvable within EM but within the wider healthcare system. We have the opportunity to re-imagine the health care system to improve healthcare and emergency care for all. The reality of politics dictates that not everything we wish for will happen but some of it will, so we have to try .... Some basic stuff we need to change:
· Break down silos between departments of health / community / social services
· Share data
· Reduce low / no value care
· Team based care at top of scope
· Improve primary care skill base and capacity in prevention / chronic disease maintenance / unscheduled care
· Community engagement and prioritisation to create funding models which drive health equity
· Factor into health care policy social determinants of health
· Bridge the silos of federal and state funded health services in Australia
· And much more
Utopian you may think but there are opportunities.
Regarding EM overcrowding as unethical – not just poor optics tolerated for financial reasons – the public know it is wrong and increasingly know it is because of hospital capacity. This is a great advocacy opportunity.
Through COVID it has been shown in many jurisdictions that we as a specialty are leaders in health care delivery and can adapt and change. This can only help our profile and perceived value within health departments and governments which is often translated into a greater say at the table to change and improve the things we want to change and improve.
None of this will be achieved on our own, we will have to do this as a college in partnership with a coalition of the willing to advocate to government.
What are your top 3 priorities for your term?
Only three? .... OK, the big ones which are external facing .... with subclauses!
1. COVID – staff safety, implement lessons (ED design / pandemic planning / PPE supply chains etc), overcrowding advocacy and time-based target redesign to push inpatient efficiency, redesigning health care
2. Workforce – oversupply of trainees and hence FACEMs by 2030, if we decrease trainees how do we remodel service delivery – a discussion we need to have as a college
3. Rural & Regional EM – it is fragile, it is inequitable, it needs change ... as answered in a previous question
Didier Palmer