Leading Self: Lessons from an Annus Horribilis

1. Leading Self: Lessons from an Annus Horribilis Dr Peggy Brown Director-General ACT Health

2. Leads Self A transformative leader is: • is emotionally intelligent • understands and manages the impact of their assumptions, values, attitudes and behaviours on themselves and others, particularly in stressful situations • seeks out opportunities for personal development • assumes responsibility to reflect on their performance as a leader and engages in personal learning and growth • demonstrates strength of character • is honest and shows integrity, courage and resilience

3. “Stars may be seen from the bottom of a deep well, when they cannot be discerned from the top of a mountain. So are many things learned in adversity which the prosperous man dreams not of.” Charles Spurgeon

4. ACT • Population 370,000 (regional ~ 620,000) • ACT Government provides 2 levels of government (state/local) • 17 Members of Legislative Assembly - 5 Ministers • Minister for Health = Chief Minister • ACT Health provides central health department functions and operates the major health service • Challenges of economy of scale • High level of scrutiny and accountability

5. 2012: A Challenging Year! • Forecast end of the world! • Consolidate restructure of 2011 • National health reform • Health Infrastructure Program • ACT election • ACHS accreditation • Manipulation of ED data • Staff deaths

6. National Health Reform • Consolidate LHN/LHN Council • Establish Clinical Senate (Local lead clinicians group) • Implement ABF • NEAT target (ED) • NEST targets (Elective Surgery) • Subacute beds

7. Health Infrastructure Program (HIP) Aim: To meet the future healthcare needs of the ACT and surrounding region 4 Pillars: • Models of care • Health workforce • ICT Including e-health • Capital works

8. Health Infrastructure Program (HIP) Completed in 2012 Underway/In Planning in 2012 Belconnen Community Health Tuggeranong Community Health Stage 2 & 3 CHWC Ngunnawal Bush Healing Farm University of Canberra Public Hospital Rebuild Buildings 2 & 3 at TCH Secure Mental Health Adolescent Mental Health Central Sterilising • Adult Mental Health Unit • Centenary Hospital for Women and Children – Stage 1 • Gungahlin Community Health Centre • Staging and Decanting projects

9. National Health Reform/HIP • Complex & fast paced • Political sensitivity +++ (in an election year) • Multiple interdependencies • Facilitate and support others to deliver • Require clear focus on governance • At times, challenging my own knowledge base

10. Election & Accreditation • Election 20 October 2012 • 4 year fixed terms in ACT • 3rd term minority Labor government • Changing governments in other states • Health = Number 1 issue • ACHS Accreditation November 2012 • Organisation wide survey (corporate, clinical and in-depth mental health)

11. Beware the Curse! “You must be doing something right – I’m not reading about health on the front page of the Canberra Times all the time!”

12. Manipulation of ED Data • 5 April: Phone call from AIHW re: anomalies in ED (timeliness) data set - ?Administrative error • Preliminary internal investigations suggested deliberate data manipulation • 20 April: Relevant senior staff advised that a formal forensic data audit would be conducted • 21 April: Executive Director admitted responsibility for data manipulation – immediate suspension • Inform Minister and inform staff

13. Next steps • Media conference to announce issue and next steps • Formal forensic data audit • Independent Steering Committee established to oversee audit • Minister referred the matter to the Auditor-General -> initiated audit • Minister declared the potential for a perceived conflict of interest and stepped aside in relation to this matter

14. Forensic Data Audit • What, who, how? • PwC found 11,700 data changes going back to 2010 but predominantly in 2011 and early 2012 • Majority of changes were consistent with the admission by the individual Executive although involvement of other persons could not be definitively excluded • A number of systems issues contributed to the opportunity for changes to be made • Recommendations made

15. Auditor-General Audit • Utilised results from forensic data audit • Took statements under oath • What, who, how and why? • Noted poor IT systems and practices • Also managerial pressure at TCH on background of high level of public reporting about ED performance (focus of health reform) • Likely that individuals other than Executive involved • Recommendations made

16. What Followed Next • Significant media and political interest • Development of a Data Integrity Strategy (collection, validation, storage, analysis, reporting, administration) • Review of data and information management governance • Director of Data (Information) Integrity position established • Action Plan for combined recommendations • Referred to Police for investigation of potential fraud • Recall before Estimates Committee • Public Affairs Committee after AG Report handed down • Executive resigned

17. Staff Deaths in 2012 • Tragic accident in front of TCH 3 May 2012 • 1 staff member killed; another seriously injured • Both from same small unit (cardiac technicians) • Significant impact on staff morale at TCH • Funeral followed by a memorial service at Canberra Hospital • Fundraising event to assist family • Review into safe options for pedestrian crossing • Support for staff

18. Staff Deaths in 2012 • 3 doctors died unexpectedly within 1 month • Mid July (aged 53 years) • Early August (aged 48 years) • Mid August (aged 57 years) • Another 2 longstanding staff members died of cancer after relatively short illnesses • Attended 4 funerals and 4 memorial services in 2012

19. Election • Turbulent time leading up to caretaker period • Health was a major focus • Busy leading up to election day – incoming government briefs • Some inevitable challenges e.g. electioneering on hospital campus • Ensure non-partisan and maintain respect for all parties • Result not known for 2 weeks post-election • Minority Labor government with Labor-Greens agreement • Minister retained health portfolio!

20. Accreditation • Last big hurdle of the year • ?The last bit of bad news for 2012 • ? Adequate preparation -possibly a little light on due to other ‘distractions’ • Modicum of concern about impact a negative assessment would have – organisationally and politically • Desperately wanted quality of service to be validated ....and it was!! (1xOA, 18xEA, 28xMA)

21. Other Events in a Big Year • Resignations of: Deputy Director-General Executive Director of Nursing and Midwifery Executive Director of Medical Services • Disclosures of alleged serious matters requiring investigation

22. Other Events in a Big Year • Daughter got her learner’s license • Son broke his hand twice • Husband changed jobs • I developed ophthalmic herpes & orbital cellulitis!

23. At a Personal Level • Began the year expecting it to be challenging – but never expected it to be as challenging as it was! • Shock and disbelief - What next? • Why is this happening? Personal failing? Punishment? • Beyond the realms of personal control ... • Perhaps the end of the world really is coming! • Strong awareness of the need to get back up and keep going • Also need to acknowledge emotional impact on different groups within the organisation and on the whole organisation • Conscious of the need to support the Minister and Government

24. Data Manipulation • Open & honest • Calm and clear headed - don’t make rash decisions in the heat of the moment • Communicate - explain the issues and the next steps to the staff, the community and the politicians • Compassionate – not vilify a good person who made a mistake • Mindful of internal sensitivities – morale of ED staff; not engage in blame and finger pointing • Fixing the systems problems will take time • Share experience and learn from others

25. Staff Deaths • Required courage – previous experience of deaths in the workplace • Not dispassionate or detached • Communicate – Acknowledge the pain and facilitate grieving, foreshadow the healing • Value and acknowledge the staff and their contributions • Promote resilience and support- Faced challenges before – Don’t give up • Maintain staff morale and service delivery • Examine own health status

26. What did I learn about leadership? • Leadership is all about: • inspiring trust and confidence • guiding and influencing others • Need to be attuned to the impact of the issues/events on others as well as on yourself • Communication is key – always seek to listen and to keep people informed

27. What did I learn about leadership? • Trust in others and work together • You don’t have to do it all – just create the space where others can excel! • Don’t have to be perfect – just persistent, professional, passionate and present • Leaders need support too – ensure you seek it out • ‘Post traumatic growth’ is real!

28. What did I learn about myself? • Stronger and more resilient than I previously believed • Resilience not a personal attribute but the product of the person and their environment • Psychiatry training actually a good foundation for role as DG – understand human behaviour and ‘contain’ emotional distress

29. What helped me? Great foundations within organisation – committed executive and staff Clear personal and organisational values– what’s right and wrong Strong sense of personal support from staff Unwavering support from husband, family and friends Sympathetic ear from DG colleagues Psychiatry peer group – validation and support Professional background – self-awareness & perspective

30. “Life isn't about waiting for the storm to pass... It's about learning to dance in the rain.” Unknown