BY DR RODERICK MCRAE, CHAIR, AMA FEDERAL COUNCIL OF PUBLIC HOSPITAL DOCTORS

Even a casual observer of decisions affecting human resources over time will have seen highly recommended, expert-panel derived trends come and go. But not before having been proven to have been useless, or worse, damaging to the workplace performance, trust and cohesiveness it sought to improve.

To name some recent managerial fashions: ‘contracting out’ (code for losing control over core aspects of the organisation and losing good people); ‘performance measures that encourage internal employee versus employee competition’ (thus emphasising self-interest and mistrust instead of jointly advancing organisation goals, and entirely stifling cooperation); and developing a ‘culture that cares’ (as we quickly learn to distrust any organisation that tells us ‘we care about our people’ when this is intrinsically not the case). 

We are now confronting yet another one of these managerial fashion misadventures in public hospitals through attempts to rob Staff Specialists of their office space in favour of open-plan or ‘hot desking’ or ‘hoteling’ office arrangements. It may be fair to say that hospitals can struggle to accommodate their patients and their staff; limitations on space and capital for spend do exist. But this fashion faux pas agenda is actually not to create patient or even patient-care space. The agenda is instead about acting on the completely wrong beliefs that clinician offices are somehow elitist or don’t serve a genuine purpose. How wrong on both counts! This fashion sense is far worse than anything I ever wore in the 1970s. 

I must first focus on the mental health and general workplace wellbeing of my colleagues. An open-plan arrangement creates a lack of personal space, little-to-no privacy, constant noise and movement distraction, excessive transparency, and prevents a way of avoiding interactions that we require. Consider the ‘hard’ conversations that have to be had with a patient due to receive life-altering news they are not expecting, while the occupant of the next desk is on the phones to obtain agency staff for the night nursing shift. Consider the ‘hard’ conversations with an enthusiastic trainee who is not going to meet the required standard. Given our workload and responsibilities, basically, our cognitive and emotional resources become depleted if we don’t have an office to call our own. 

Hot desking/office hoteling prohibits creation of a personalised space (which is naturally comforting) and given that on any particular visit or shift you could be seated anywhere in the building, establishing valuable close relationships with nearby colleagues becomes impossible because a consistent opportunity to build rapport is undermined. How does fragmentation of collegiate relationships, insecurity arising from not having personal space and their negative impact on doctors’ health and wellbeing optimise clinical outcomes for our patients? 

Surely achievement of improved clinical outcomes would have to be the main aim of the whole open-plan idea, wouldn’t it? I include our key training and mentoring role as a clinical improvement goal. Substantial research shows that where there are open-plan arrangements, the low levels of privacy lead to defensive behaviours and strained workplace relationships. However, fashion sense doesn’t tend to worry about evidence; the open-plan leads to exactly the opposite to the clinically desirable trust-based, quality-focused supervisory and collegiate relationship.

If the idea is about efficiency, gaining ‘value for money’ by ‘productive use of space’, the imposed inefficiencies and reduced productivity arising from open-plan (due to increases in interruptions, reduced activity and productivity, and increased health-related absences, according to relevant research) makes the idea pointless. If the idea is about encouraging collaboration, some studies show that people in open-plan spaces, knowing that they may be overheard or interrupted, or are disturbing others, have shorter and more-superficial discussions than they otherwise would; hardly optimum in a clinical setting.

If the idea is about ‘doctors aren’t special so shouldn’t have offices’, no one is arguing we are special. The obviously accurate proposition is that a ‘one-size-fits-all’ approach does not work for all roles within a hospital. As Specialists, we have mentoring, supervision and peer review responsibilities, mountains of administrative work, clinical privacy considerations, and a need to think deeply about clinical complexity. These require private space.

Hospital productivity, collaboration goals and most importantly good patient outcomes come through doctors feeling good about their environment and through knowing they are valued and respected by their hospital. To make my point in general terms, ‘productive’ and ‘value’ are rarely well-defined but often that for which one strives. By default, these terms just become a euphemism for ‘being seen to do heaps of things’. This ‘being seen to do’ becomes crucial in open-plans, as it is the ‘common sense’ way to convince those around you (and possibly even yourself) that you’re doing your job well. Instead, and in fact, this perversely rewards quantity over quality and encourages even more hours spent in the workplace over fatigue management.  

Your CPHD recommends strong pushback to any move toward open-plan or other non-office-based ‘inspired’ accommodation for Staff Specialists. One way is to engage in a contest via the Consultation Clause contained in your State/ Territory – AMA/ ASMOF Enterprise Bargaining Agreement. I am most familiar with the new AMA Victorian Medical Specialist Agreement 2018-2021, which clearly defines such a move as being a ‘major change’ that would have a ‘significant effect’ on Specialists. This activates structured procedures to guarantee the voice of Specialists and prohibits the implementations of decisions without contest about the validity of evidence. It can be a really noisy contest. Also, I point out, that any hospital slip-up in compliance with the quite prescriptive consultation obligations is in breach of the Agreement, and thus capable of being tested in the Fair Work Commission (this observation/invitation might by itself cause a hospital rethink). 

Remember, this, like any fashion, once in place, may be hard to displace because the architecture/floor plan would fundamentally change. Make sure you report any move in this direction to AMA ASMOF and organise to prevent what would represent a high degree of disrespect to the profession. Your CPHD will definitely be keeping an eye on this key matter.