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Changing workplace culture


Perhaps it saddened her that some of her bright and beautiful colleagues were becoming unrecognisable versions of themselves from the fresh-faced, generous, and happy people she had met in first-year medical school. Perhaps she saw an inevitable future of a workplace that is becoming increasingly time-pressured, hostile, and angry. Maybe she didn’t want to be one of those people who just walked past. Or perhaps she just needed a forum to display her finely honed skills in stand-up comedy.

Whatever the reasons, Dr Rebecca Davis (an Emergency Physician at Bankstown-Lidcombe Hospital in Sydney) decided to do something about the crisis that is slowly creeping into our workplace. It started as a thought bubble earlier in the year and culminated in something genuinely inspiring – the NSW Emergency Trainee Health and Wellbeing Day. We all get frustrated with the status quo. Many people develop ideas to make a change. But very few put those ideas into action.

Her idea was to bring a bunch of NSW Emergency Medicine Trainees into one room to talk about strategies and ideas to improve their health and well-being. It ended up being much, much more.

This is the first part of a series of posts that will summarise and capture the day’s spirit. We will start at the end of the day when the Emergency Trainees brainstorm and share a few of their ideas to change workplace culture. This is a summary of their list:

Be kind to one another!

Feed your colleagues. It’s an easy way to counteract the “hangriness”. It is surprising how calm a surgical registrar can become after a small piece of delicious chocolate.

Hold joint teaching sessions with inpatient teams. This helps to develop collegiality and lessens the “us vs them” attitude

The post-night shift coffee debrief is essential

More clinical debriefs are necessary after traumatic events

More formal debriefing training is required. We know it is important; we don’t know how to do it. We also know that a poorly run debrief can make things worse.

Formal leadership training is needed. We are often thrust into the role and expected to thrive in it but we are never actually taught how to do it.

We need to prioritise breaks. Think about scheduling breaks eg. Registrar 1 takes the 1200-1230 slot, Registrar 2 takes the 1230-1300 slot.

Batons. What about the “lunch baton”? I think this is how it works….someone goes to lunch, they hand a baton over to another doctor who takes handover and covers for the lunch person, when the lunch person comes back from lunch, the doctor who took handover hands that baton to another doctor who takes handover for their patients. The baton keeps changing hands until everyone has had lunch. not sure if I got the logistics right on that one…but you get the idea.

What about the idea of taking “team breaks”? Inpatient teams have daily breaks together to bond and sort out their day. We never do that in the ED. Is this possible in your department?

Capitalise on simple pleasures provided by your department and don’t cut costs in these areas! Egg. “full cream” milk, good quality tea bags etc

Show appreciation to those who perform well ie. give positive feedback eg. have a monthly “inpatient registrar of the month” award or “ED registrar of the year” prize.

Could you involve inpatient teams in your social functions? Having a coffee with the radiologists makes you realise that they are not vampires after all…who knew?

Pass on thanks and thank you letters from patients or hospital execs to the ED team. Share the compliments that the department receives with the whole team. The team needs to know that their work is appreciated and gives them something to strive towards.

Send a message/email to the supervisor of the inpatient team registrar to pass on any positive feedback. This is much more powerful than just passing on the feedback to the individual. Reward good behaviour and let everyone know about it.

Show appreciation of the work of the night team. They often feel undervalued. They often have had a hectic night and are made to feel like their work has been substandard due to sarcastic remarks or passive-aggressive comments about things being “unsorted” in the morning. A little bit of thanks goes a long way

Change the culture of the night shift to day team handover. If possible, get the night team to go home on time and for the day team to sort out any outstanding jobs

Elect a registrar representative to present concerns to the management group. This approach of standing in unity holds greater weight than individuals occasionally expressing discontent.

Formalised training for being the in-charge doctor is needed. At least some of the anxiety of walking into your first night shift in-charge of the department can be alleviated with some formal guidance on how to supervise staff and run a department.

Say thank you to each other!

My feeling was that we only just scratched the surface of the collective wisdom of the group. There was general excitement that the conversation will continue and that this is just the beginning of lasting change.


  • Mark is an emergency physician at Bankstown Hospital in Sydney who has a lifelong dream of being listed in the Guinness Book of World Records for the longest rats tail in history. Should he fail to fulfil this dream his fallback plan is to create a super army of elite emergency doctors through his work in medical education.


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