Letters
Health services administration
Volume 193 - Issue 8

Patient safety: time for a transformational change in medical education

Author:  Joanna R Sutherland

Med J Aust 2010; 193 (8): 487-488. || doi: 10.5694/j.1326-5377.2010.tb04016.x
Published online: 18 October 2010
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To the Editor: The editorial by Runciman in the Journal was cogent and timely.1 The Garling report on acute care services in New South Wales public hospitals highlights areas where critical changes need to be made in order to improve patient safety.2 It is widely recognised that junior doctors play a vital role at the coalface in many key areas, including assessment and escalation of care for deteriorating patients and the handover of patient care, both in hospital between shifts and also from hospital to the community. In NSW, these processes are currently receiving much needed attention in order to ensure patient safety within hospital settings.

As Runciman so rightly identifies, junior doctors also play a critical role in “transformational” cultural change. In public hospitals such as my own, it has been fascinating to observe the small ways in which a junior doctor can influence senior clinicians in fields such as compliance with hand hygiene protocols, and in querying transfusion requests which do not conform to National Health and Medical Research Council clinical guidelines. We need to continue to mentor junior doctors so their messages about change and improvement are well delivered and well received.

With the move of junior doctor pre-vocational training into community settings (the Prevocational General Practice Placements Program) there are increasing opportunities for change on a larger scale. In the future, patients will not be the only agents who move from community to hospital settings and back again. Junior doctors will be employed across both settings and will be an important vector for change and improvement. We will also need to encourage supervision by senior doctors who engage with and understand the health system, not just the hospital system.

Providing junior doctors with appropriate tools to drive change (eg, training in graded assertiveness and situational awareness), encouraging them to view their role in health system improvement at the whole-of-community level, and providing leadership across the system, give us every reason to believe that Runciman’s vision of transformational change is possible, and indeed likely.

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