As useful as a foot in the face

I can handle most of the gross things that come along with parenting pretty well, but wobbly teeth is just not one of them. My daughter has been tormenting me with a wobbly front tooth for months now. Since well before Easter it’s been wriggling away and I’ve been trying to avoid it.

The other night after dinner she and her little brother were being their rambunctious selves jumping around on the couch. Yes, I know I should probably do the whole “the couch is not a jungle gym” type line, but there are some times in life where a moment of peace (not quiet peace mind you) is worth the price of deflated cushions.

This was one of those times. My husband and I were enjoying an uninterrupted conversation amongst the screams and laughter that was growing in volume. And then, silence.

If you’re a parent you know that sudden onset silence is one of the most suspicious. It usually means one of two things: mischief or injury. The latter is typically followed by a loud scream breaking the silence. That didn’t come.

I looked at my daughter and she had a strange expression. She was making a comic like gulp. She looked dazed.

“What happened?” I asked, waiting for her to unleash about her brother.

Nothing. Just shock. Her hand went to her mouth.

“I think I swallowed my tooth!”

“What do you mean you swallowed your tooth?” I asked as I tried my hardest to suppress just how grossed out I was feeling by this. “How did that happen?”

“He stepped on my face. I THINK I JUST SWALLOWED MY TOOTH!”

We looked around for a while between the cushions, over our floor that was in desperate need of a vacuum. Nothing. She disappeared to the bathroom. I kept searching to no avail. Oh no. The tooth that has taken months to dislodge has gone missing.

Surely I could find it. I had to find it. How were we going to manage the disappointment of a six year old who has been waiting in anticipation  for months to deliver her prized front tooth to the Tooth Fairy? On top of that, the thought of her swallowing it was too disgusting to cope with. Must. Find. Tooth.

Back she came from the bathroom.

“Are you ok?” I asked, ready to console her about how swallowing a tooth is normal and not something to worry about.

No consolation was necessary. She broke out her gappy smile and had pen and paper in hand ready to write a note to the Tooth Fairy and tell all her friends.

Life’s like that sometimes I think. Waiting for what feels like forever for something to happen. Allowing nature to take it’s course. Learning to be patient. Then every now and then something comes along like a little brother stepping on your face to accelerate progress whether you like it or not. You can’t always control the circumstances, but I suppose you can control your response.

 

Reflections of A Year of Blogging

This month marks twelve months of (relatively) consistent blogging. This is my 128th post. I started wanting to improve my writing skills, I never realised how transformative the process of writing would be.

Writing consistently has has helped me to take more risks and push myself out of my comfort zone. It has introduced me to new connections and opportunities. But, perhaps most importantly, it has helped me to develop a stronger sense of self. Its this sense of self that has afforded me the confidence to forge my own path and see what happens.

I certainly didn’t think twelve months ago that I’d be founding a startup with my husband! Yet, in many ways writing and launching a startup have been similar pursuits. Each requires you to manage this weird juxtaposition of hubris and humility within yourself. Putting yourself out there and saying something out loud, being audacious enough to offer something up to the world means that you have to back yourself and your idea. But it also means that you’re learning and iterating your approach in public view. That means you have to be humble, recognise and learn along the way.

Honestly, it’s a challenging headspace to maintain. Whether or not I can is yet to be seen. There have been weeks like this one where I feel flat and uncertain. Others where I’m flying with optimism. But it’s been maintaining some degree of process that has kept me going relatively consistently. I’m grateful to have learned that. And the writing has been a key part of that process.

It makes me hopeful for the next twelve months.

 

Our talent pool is leaking

This week I came across a paper about achieving gender parity in pharmacy leadership positions. Don’t get too excited, it’s still predicted to be about 10 years away! But it did make me think a bit deeper about why it might be this way. Pharmacy has been a female-dominated profession for many years. In my experience, while there are pockets where boys clubs exist, the vast majority of men I’ve come across in the profession are far from sexist. I know plenty of strong female pharmacists within the profession that garner respect and do good work. What’s going on?

When it was being talked about on Twitter, one of the comments from a ‘next-gen’ pharmacist wondered if we will be having the opposite conversation in in 20 years. I could see where he was coming from. From his perspective, he’s the sole male representative on a number of committees – maybe gender disparity is a generational issue? I’m guessing many early career pharmacists feel similar to him, that the future is female. I’m not so sure about those who have had children since starting their career will think it’s such a sure thing though.

We don’t seem to talk about the impact of children on career much in pharmacy. At least I’ve never come across it. It seems to be one of those things that despite occurring often, its rarely talked about openly and sincerely. There seems to be some sort of stigma attached. Acknowledging that you want to balance work and family life can be interpreted as being weak and less committed. Ignoring it and ploughing ahead professionally can be interpreted as being cold and unfeminine. Then there’s the judgement associated with not having children!

I think one of the positive things that’s come out of the Covid-19 pandemic is that it’s forcibly dropped the veil between work and home life. Talking about family responsibilities, and the impact that this has on career development has become (slightly) less taboo. So what the hell hey, let’s talk about it.

I can’t speak to other women’s experiences, so I’m going to stick to speaking about my own. This feels much more self-indulgent than I’m typically comfortable with, but I can’t think of another way to communicate it so I’m just going to go with it.

Let me start by explaining that I’ve never been a particularly clucky type of female who fawns over other people’s babies and plays with small children, but I have always wanted to have a family. There was never any doubt in my mind that if I was indeed able to have children, I would. In fact, the very potential of having children impacted my career before I even had either a career or children. Pharmacy made it onto my shortlist of careers in part because of the potential to continue working part time.

I started off in hospital pharmacy in 2003 where I was pretty happy taking on whatever opportunities presented themselves to me. One of the things I noticed early on though was that there seemed to be a gulf between those who were early in their career and those in the later part. There seemed to be a relative absence of female pharmacists in their mid-career (30 to 50) who were available to mentor those of us earlier in our career.

Over the years I took on whatever career opportunities came my way, but I never really got involved in the professional association side of things. Meetings and networking has never been my thing. I met who would turn out to be my husband in 2007. My approach was to work earnestly to establish myself as best as I could early so that I would be in a reasonable position to take a break and have kids around the ten year mark.

In 2011 an opportunity came up to take on a totally different kind of role establishing a pharmacy service as part of a community palliative care team. The following year I got married and turned 30. Amid these life changes I found myself feeling conflicted. On one hand, I was excited to be pursuing a new chapter of my career and doing pretty well professionally. On the other, my years working at the Women’s and Children’s hospital meant I knew all about things like fertility and age-related pregnancy risks that get worse from the 35 year mark. This wasn’t just some sort of quiet, self-reflective kind of conflict either. As soon as I got engaged, multiple people seemed to think it was socially acceptable to ask me about my plans for having a family (FYI, just because a female is of a certain age and in a committed relationship, it does not make it acceptable to ask about personal details like family planning).

Until I found myself in the situation, I never realised that the further involved you are in your career the harder it is to take a break from it. What appeared like a ‘good time’ to have children when I started out my career did not feel like it at the time.

By mid-2013 I found myself enrolled in a part-time PhD and working to finalise the ongoing funding for the pharmacist role I had successfully established. I was also pregnant with my first baby. I was not enthusiastic about telling anyone at work that I was pregnant. I knew my contract was due to end and was comfortable that I was not going to return to the role post-baby, but I didn’t want to risk my pregnancy entering into their decision making process about continuing the role. (I also worked with a lot of older women and I couldn’t stomach the thought of pregnancy being the only topic of conversation anyone talked to me about from then on.) Once the funding got finalised, I told them I was five months pregnant and set to work to get them in the position to find someone great to take on the role. We managed to do that and I left the role in their hands at the end of 2013 with my baby due at the end of January.

I experienced a bit of an identity crisis when I first went on maternity leave which I wasn’t prepared for it at all. I was expecting to get all into cleaning and home projects and stuff preparing for the baby, I didn’t anticipate feeling so lost. I never realised how much of our identity gets tied up with professional role and job title.

This feeling of confusion didn’t go away once my daughter was born. It wasn’t because I felt brain dead or unmotivated. Far from it. I was still enrolled in my PhD,  I was getting involved in other contract work in assessment and teaching. It was more like I felt out of the loop. I still attended the occasional local CPD event, but I felt like I had become an ‘other’ and on the outer professionally. People don’t seem to know what to talk to you about when you don’t have a neat job description.

I made the decision not to return to a ‘proper job’ following maternity leave, opting to continue my part-time PhD instead. I’m grateful to have been in a position financially and with a supportive partner where this could be a viable choice. I’ve been able to remain engaged and intellectually while maintaining enough flexibility to remain involved in family life, and welcomed my son in 2017. It’s been much harder to remain engaged in the professional community though.

While some of the challenges in engaging in the professional community relate to my priorities and how I want to spend my time, I have notices some major shifts in two areas that have created barriers that I am quite sure others would also experience- finances and time.

Pre-children, my expendable income was much higher and I didn’t care so much about spending $500 plus on a face to face CPD activity or even more to attend a conference. I was also employed by a public hospital so I had access to funding which made things much more reasonable. When you’re self-employed or working part-time (or at a low wage like a PhD stipend) it’s a different story.

The other major change has been time. Attending events in real time, be they face to face or online (e.g. webinar) becomes a challenge in logistics and negotiation. Anything that coincides with a meal time or bedtime is not easy to accommodate. Events occurring over weekends and requiring travel bring different considerations. Attending face to face CPD and conferences have become a luxury item for me.

I’m not sharing this to be a complainer, I’m just saying how it is for me. And I’m guessing that if it’s been challenging for me then there’s a good chance that there are others who have also encountered similar challenges. I don’t know what they are, but i think it’s worth talking about them so that we can understand them.

Achieving gender parity in pharmacy leadership isn’t just about fulfilling quotas or achieving representation targets on committees, it’s about making use of the depth and breadth of our entire talent pool. At the moment that talent pool has a great big leak in it. It’s time to fix it.

 

Worth the Effort?

The first paper I submitted to a peer reviewed journal was not a fun experience. Reviewer one gave me two sentences of support. Reviewer two gave me seven pages detailing nearly 40 reasons why what I was saying was terrible. My heart began racing as soon as I opened the document. The fury began to rise when I saw the first point raised by the reviewer showed they clearly had no idea what they were talking about. It got worse as I went on.

I was infuriated. And I was confused. How could one reviewer think it was fine as it was, and another rip it to absolute shreds? How was I supposed to reconcile this?

My immediate reaction was to give up on it because the system clearly sucked. Why was it my job to educate the reviewer on the concepts that underpinned the paper? Shouldn’t they at least be expected to do some background reading before they comment so negatively? While the answer should be yes, the reality was that they hadn’t. I couldn’t do anything to change that.

The choice I was left with was whether I was going to take the time to help them understand my point of view or not. Ranting about the system seemed a lot easier than taking the time to address the litany of points raised by reviewer two, but it alone wouldn’t do anything to get me closer to my goal.

I still ranted about the system (I believe I still am now), but I also took a good hard look at what I had written and how effective it was at conveying what I wanted to say to the reader. Because at the end of the day, writing a journal article is first and foremost about connecting with the reader. If you don’t do that, it’s not worth much.

I’m still learning how to apply this lesson more regularly in other parts of my life. Some situations are easier than others. I can’t say I always do it with conversations with my father, that’s for sure! But I’m consciously putting in effort to trying to get better at it. And it’s making me hyper-sensitive to the many public examples of when it doesn’t happen. The countless examples of people favouring polarised argument over constructive discourse.

One of the examples that seems to be very current relates to the whole anti-vax movement. Personally, I think the very use term ‘anti-vaxxer’ completely undermines any possibility of engaging in a constructive conversation to address issues of concern. If we’re aiming to further marginalise them so they consolidate their efforts, then I think we’re doing a fine job. If we actually want to improve uptake of vaccinations and avoid pushing those with concerns and hesitancy into the fold of the dogmatic extreme then I think we’re failing miserably.

And of course the other current and complex example relates to racism. This is an emotional issue for everyone in different ways and it’s extremely difficult to know how to navigate it as a Caucasian. I imagine it’s beyond exhausting for people of colour to educate others, some of who use their wilful ignorance as an excuse for abhorrent behaviour. And I think they’re right, each of us should take a more active role in educating ourselves and our peers and stop being so complacent. In my mind, it’s about wanting to build a fair and just society and making a contribution to making that change happen.

Each of these scenarios are very different, but they all have something in common. If the goal is to create some sort of change that depends on input of others, we need to make the effort to tailor our message and deliver it in a way that enables them to hear us . The more we despise or disagree with them, the truer this becomes. Afterall, this isn’t about winning an argument, it’s about creating change.

 

 

 

 

Progress is a Trend Line

This morning in my attempt to get back into running I did the first day of the couch to 5k program. It didn’t feel great. When I think about where I was this time last year it felt really bad. But then I remembered how I was when I did the first day of C25K the first time. That made me feel better. I might not be able to run 10km at the moment (or probably even 5km) but I am much much better than I was when I started.

Progress is often like this. We expect it to be linear and consistent, but it so rarely is. The important thing with progress is to study the trend, not the individual moments in time.

I see the events in the US and it feels  hopeless and insurmountable. How do we find ourselves in this position yet again? How has there not been any progress made?

Then I remember our visit to the Civil Rights Museum in Memphis two years ago. I remember being confronted with just how bad things were. It wasn’t just the slavery, it was the attempted annihilation of a whole cultural identity. This didn’t disappear with the end of the civil war, the oppression and treatment as sub-class citizens persisted to modern times. The sixties were almost like another civil war, with bombings of buses, forced segregation and all sorts of atrocities that were openly accepted, if not enabled, by people in positions of power. All based on a collective societal view of white supremacy.

When I hear that term it conjures up images of neo nazis and people with criminal behaviour. Romper Stomper. Bad people. But I suppose they’re just the most extreme examples. When I think about it more deeply, less personally perhaps, I can see a different perspective. I can see just how much our society is geared toward meeting the needs of white people. How I’ve benefited from that. And I can see that when we prioritise the needs of one group over another, even if its not intentional, we diminish the needs of the other.

My views on racism have matured a lot over recent years. Some of it a result of actively pursuing greater cultural awareness, but some of it because our society has also matured. Last week, my six year old daughter came home from school telling me all about Sorry Day and Reconciliation Week. Years earlier she taught me how to count in the language of the Kaurna people and how to recite the acknowledgement of country. When I was at school, we didn’t talk about the Kaurna people at all. I didn’t know I had friends with parents from the Stolen Generation until I was an adult. I don’t think some of them knew. There was such shame and stigma associated with it that it didn’t even get talked about. That wasn’t so long ago.

We see events like the death of George Floyd and riots in the US, or Rio Tinto bombing a sacred Aboriginal site and it feels like no progress is being made. We judge society by the worst that happens, because just one incident like these is too many. But we need to remember that we are making progress. It might not feel like it at times, but we are. And we need to keep working at it.

 

Time to Dump the Dumping Ground

In the latest edition of Pharmacy Grit, there was an opinion piece trying to make the case for Surgery to be recognised by the Board of Pharmacy Specialties. There was something about this article that really irked me. I wasn’t sure why it annoyed me so much, but I knew it had something to do with this closing section…

Not a dumping ground for just any pharmacist
Surgical wards have traditionally been grouped as ‘miscellaneous’ wards that can be covered by a pharmacist of any skill level. But will you ever ask an ENT surgeon to remove your appendix? How about a urologist to fix your broken elbow? Most hospital pharmacy departments still expect any ward pharmacist to be able to provide pharmacy services to any surgical ward….

… The Board of Pharmacy Specialties (BPS) from the United States offers credentialing qualifications for a dozen specialty practices, each of which acknowledge qualified pharmacists who are able to practice pharmacy at advanced practice levels. None of these 12 qualifications cover any surgical specialty.

Are the options really that dichotomous? You either are a specialty or a “dumping ground” for “a pharmacist of any skill level”? This concerns me.

I think part of the problem is that whenever the conversation of specialisation comes up, its almost inevitable that two concepts get conflated; credentialing and mastery.

Recognition as a specialty by the BPS is a method of credentialing; a way to provide public confidence that those individuals bearing that credential meet a minimum standard of skills and knowledge relevant to that area. Credentialing is very important within healthcare…provided there is a public interest case for it.

Looking at the BPS credentials, there seem to be three broad categories of specialties. Others may categorise them differently, but generally speaking there are:

  • those that align with general principles of pharmacy practice that could be applied in many different clinical contexts – e.g. geriatrics, paediatrics, pharmacotherapy, nutrition support, ambulatory care
  • those that address clinical concerns that are most prevalent in society, have a high impact on public health and in which pharmacotherapy is a primary treatment modality – e.g. cardiology, psychiatric, infectious diseases
  • those that require very specific skills/knowledge that are carry a high risk to the public – e.g. oncology, compound sterile preparations, critical care, nuclear pharmacy, solid organ transplant

For sure, I think there is a case to be made that other specialties belong on this list. Women’s health is one that comes to mind. Drugs in pregnancy and lactation both applies across different contexts and requires specific skills that carry high risk. Pain is another one that I immediately think of. But I’m not convinced surgery belongs on this list of credentialed specialties.

That’s not to say that surgery should be considered a ‘dumping ground’ for ‘a pharmacist of any skill level’. Nor am I saying that if someone finds they have an interest in surgery and want to carve out a niche for themselves in that area that they should be discouraged from doing so. I think they should be encouraged to pursue their interest enthusiastically and lead from the front. This is where the mastery bit comes in.

I don’t subscribe to the idea that you achieve mastery by obtaining a credential. If that were the case, I could claim to be a master at geriatric pharmacy, because I passed the Geriatric Pharmacy specialty exam in 2013. (I can tell you right now, that would be a false claim). Obtaining credentials is an important part of your journey toward mastery, for sure. They can help provide direction as you work to master your craft, and highlight blind spots. Credentials can give you validation that you do know what you’re talking about, and help keep imposter syndrome at bay. But very few credentials can be relied upon to signify true mastery, because most of them are by definition describing what is considered the standard, not excellent. That is, after all, the whole point.

I subscribe to the philosophy that mastery is a continued pursuit of learning and achievement; both of your craft and of your self. This isn’t about getting to a defined destination. It isn’t about choosing an area to specialise in and progressively working toward it (although it can be). It’s about continually striving to practise to your full scope, regardless of context. If you do this, your scope will increase and evolve over time, as you yourself grow as an individual.

So let me get real specific, using surgery as an example because that’s what the article was about. I’m going to be extreme in my examples to make a point. Please don’t take this as me suggesting that all pharmacists fall neatly under these categories (I’m not).

Consider three early career pharmacists, each starting out on a three month rotation covering a surgical ward. One wants to become an oncology pharmacist, one wants to become a surgical pharmacist, and the other is happy to be employed and go with the flow.

The wannabe oncology pharmacist sees the rotation through. They see to their daily tasks, medication reconciliation, organise discharge medicines and respond to queries from the ward. They do a perfectly adequate job. After enduring a few more rotations in other areas they eventually get their position to train to be an oncology pharmacist.

The wannabe surgical pharmacist is a superstar. They seek out opportunities to learn as much about surgery as they can during the rotation. They read up about every detail of every case. They ask questions of the nurses. They ask to be involved in pre-admission clinic. They talk to the patients about their experiences to develop their empathy and understanding. They do an amazing job. After enduring a few more rotations in other areas they are eventually able to get back to surgery and build a practice in that area.

The happy go lucky pharmacist embraces the opportunity. They follow their curiosity. They learn new things by reading up on cases, asking questions of the nurses, and being generally inquisitive. They talk with patients about their experiences and as they do, their empathy and understanding grows. They hear about the pre-admission clinic and ask to see what it’s about. They move to their next rotation where they learn more new things. They bring with them the things they learned from their surgery rotation, and develop those skills and areas of knowledge even further. They continue to learn and grow in whatever context they are in, and so too does their scope of practice.

I believe that achieving higher standards of quality pharmacy practice in surgery (or any area) relies upon attitude more than recognition as a credentialed specialty. In fact, I think that the use of the term ‘specialty’ can get in the way of driving the quality agenda. Because the way that ‘specialty’ is used often carries with it an implication that specialists are by default advanced. Whether it’s intended or not, this infers that generalists are less advanced, which undervalues their role. How do we expect to get the most out of the workforce if they don’t feel valued? This sort of conversation reinforces a dumping ground mentality, it doesn’t remove it.

I think we need to change the conversation from specialty to mastery. Start talking about attitude, not outcome. Start setting the expectation that pharmacists will employ a growth mindset, practice to their full scope and pursue personal mastery. Recognise that personal mastery begins with mastering the craft of pharmacy practice. If our primary purpose is to deliver quality care, you work to deliver that care because you’re a professional. It doesn’t matter what the context is or if you’re going to get a certificate at the end of it. Credentials are a part of the journey toward mastery, not the destination.

If you’re lucky enough to know what you want to be when you ‘grow up’, then I’m happy for you. Pursue it with gusto. We need you. But make sure you’re not so focused on your destination that you miss the learning and growth opportunities along the way, whether they fit within your ideal path or not. Make sure you have the skills to survive if an obstacle gets in the way, or circumstances change and disrupt things. And if you do get to where you wanted to be, don’t stop.

But if you don’t know where you are headed, that’s ok. Don’t use that as an excuse to under perform though. Don’t give credit to the idea that your value is determined by the position you hold, because that’s bullshit. Whether you’re an early career pharmacist, a part-timer or someone who simply enjoys variety…your value is in your contribution, not your job title. That is within your control.

No area of pharmacy practice is a ‘dumping ground’. Not the surgical ward, not the dispensary, not medicines information, not manufacturing, not aged care, not community pharmacy…you get the idea. If you want to specialise, specialise. If you want to get one credential or many, go do it. No one career path is superior, nor any setting of practice. All are essential to achieving quality use of medicines. Let’s embrace our diversity, pursue mastery and get rid of the ‘dumping ground’ completely.

 

Same data, different view

I thought about sharing this post on our Traversity blog, but I’m not quite sure it’s appropropriate. I’m still learning how to navigate this whole business communications thing, and I have a feeling I need to err on the side of conservative a bit more than I would like. So I shall share it here instead.

I’ve been taking my start up obsession deeper lately and have been re-watching Silicon Valley. The final episode of season one is particularly hilarious (albeit crude) scene, even when watching the second time around.

I will try and remain professional so won’t go into the details of what they’re talking about (you can watch it here if you don’t get offended easily), but the crux of it is that they’re a small team looking at a tech problem that heaps of smart people have tried to address before, all of whom have reached a similar outcome. Their team made what appeared to be a major breakthrough recently which they thought would put them at an advantage, only to be matched by a much larger competitor. They find themselves in the position where they need to do something better, or fold.

In their moment of despair and feeling downtrodden, they turn to rude insults and banter to lighten the mood. And they go deep with the insults…using a whiteboard to map out a whole schematic with equations and everything (which are apparently mathematically sound).

As Richard, the Founder and lead developer sits absorbing the conversation around him he has a mental breakthrough. A breakthrough enabled through the structural analogy. Everyone’s been approaching the issue from the same angle – unidirectionally. What if they approached it from the middle-out – bidirectionally – instead?

This results in a mega breakthrough which catapults their technology ahead of their dominant competitor and everyone else, and they’re back in the game, at least for a few more episodes.

As inappropriate as this analogy may be, I use it because it relates to my own experience recently with my understanding of integrated care.

Integrated care is one of the major concepts that underpins health policy initiatives of many nations trying to deal with the growing demand for health services relating to an ageing population and increased prevalence of chronic conditions. When my PhD supervisor suggested that I look into the concept of integrated care I did so more out of compliance than desire. I begrudgingly worked my way through the literature, a lot of which was very wordy and confusing. It felt to me like the kind of concept that was built for policy, not practice. The interventions reported in the literature looked great on paper, but how could you possibly deliver them at scale across an entire country? It’d be like running tests based on a Rolls Royce but using Toyota Corollas for the roll out…it wouldn’t exactly provide the same user experience.

If you approach integrated care only from the top down (i.e. through policy and infrastructure etc), it doesn’t go very far. There’ll be the practices that get paid for the pilot, then a few other early adopter/innovators, but there’ll probably come a point where a local maximum is reached and it’s hard to get broad scale adoption. This is great for the pockets where the innovation happens, sure. But there’s a risk it will end up broadening the divide between the exemplary care providers (who were probably pretty good at quality improvement anyway) and those who are satisfied with sticking to the status quo. Not exactly equitable healthcare.

If you approach integrated care only from the bottom up (i.e. through practice based initiatives), it doesn’t go very far either. Say there’s a group of motivated care providers who can see a way of delivering care differently and they get themselves a grant to run a practice improvement project. This sort of practice based research is really valuable, and chances are it will produce a positive outcome for the patients that they serve. But how do you get that innovation to spread beyond that particular practice? How do they continue to deliver that standard of service once the funding runs out, as it so often does? Implementing innovation without the support needed to deliver it (remunerations, infrastructure, policy etc) runs the risk of ending up with a bunch of highly skilled but burnt out care providers, who may one day grow tired of martyring themselves and disengage completely.

For integrated care to work, it has to come from both directions. This message is throughout the integrated care literature, it’s nothing new. It just took Silicon Valley scene for me to see the practical implications of it.

Australian governments and decision makers are doing a lot of work to develop the policy framework and remuneration models to support the development of new ways of working required to deliver more integrated care. That’s great, we need this. But we also need more. We need a way of moving the concept of integrated care beyond policy speak, and into something that is meaningful to those who will have to do the work to make it happen.

I’m not talking about accreditation standards and other mechanisms of fear and control. You can’t just create a policy with accompanying standard, it won’t work. You can’t just ‘do’ integrated care.

Integrated care not only requires individuals to engage in new ways of working, it requires people to work together in new ways. This isn’t just hard work, it’s bloody hard work. I’m not just talking about clinicians here by the way. Administrative staff, practice managers, technologists…there are many types of people who are integral to delivering these types of complex interventions.

We need to create an environment that fosters connection between the policy and decision-makers and those who are doing the work to make change a reality. An environment built upon mutual respect. One that motivates individuals to participate in integrated care initiatives by providing them with greater fulfilment in their work. Supports them by providing what they need to get the work done. Encourages them to develop their professional autonomy, mastery and purpose.

That’s what Traversity is here for, to provide a venue for this to happen. It’s up to all of us to take action and make good things happen, so we might as well get started. Please join us.

Still here

I’ve been pretty quiet on this blog over the past couple of weeks. No, I have not abandoned my pursuit of trying to write better. Quite the opposite.

Our website went live about two weeks ago, so I’ve been trying to write some pieces for that. I wrote one that was quite fun today about the RACGP’s latest campaign Expert Advice Matters (fun to write, that is, I’m not sure about reading).

I’m still going to be on here from time to time writing, but probably won’t be as regular as I have been over the past nine months or so. But please, if you happen to read this, do come and join us at Traversity.

The community is only just getting started and we need people who want to shape the culture in a positive way. It’s pretty much covid-free (as covid-free as you can get at the moment) and is not the usual social media newsfeed/grand posturing type stuff. We are really focused on quality of interaction versus quantity of members, posts etc. but we could use more members. Honestly, right now it’s pretty much me talking into the void, so I’d really appreciate some company!

 

The next right thing

Frozen II has been the music of choice in our household over the past few months. I wasn’t that keen at first listen, but it’s grown on me (could be a survival mode thing?). It’s got a real broadway musical vibe.

In the final act, Anna has a tragic moment where she sings a song that is super sad and stricken with grief. It’s about pulling herself up off the floor to do the next right thing.

Last week in his newsletter, Ryan Holiday wrote along a similar theme
The important thing is that we are not afraid. That we don’t overthink things. That we don’t get distracted with the worst-case scenario on top of the worst-case scenario on top of the collision of two other worst-case scenarios. Because that doesn’t help us with what’s right in front of us right now. It doesn’t help us put one foot in front of the other, whether it’s on a spacewalk or a tough business call. It doesn’t help us slow our heart rate down whether we’re re-entering the earth’s atmosphere or watching a plummeting stock portfolio. It doesn’t help us remember that we’ve trained for this, that there is a playbook for how to proceed.

Not everyone who achieves things does so by having a sense of bravado and a smile on their face. Sometimes it’s more a matter of pushing through and keeping going with whatever the next step is supposed to be. It might not feel good, that’s ok. But that’s the hard thing about doing hard things.

Trailor park life

I feel like over this past month our neighbourhood has magically transformed from a closed off inner city suburb into a giant caravan park. People are sitting in their front yards, saying hello as they pass by. There are hardly any cars on the roads or planes flying by. Yesterday evening the park was a hive of appropriately socially distanced activity; dogs and children getting exercised all over the place. I fully expect to see someone walk down the street in their pyjamas before the months end.

But the thing about being in a caravan park is that they’re usually (for me) associated with holidays. Typically lazy holidays by the beach where the kids just play all day and you might get a chance to read a book or two. It is not the type of environment that is conducive to getting work done. The daily struggle with being productive while having a child to keep entertained is ever present. So is the guilt that goes along with it.

I feel guilty for not being productive enough. Not being disciplined enough to focus on my work when I get the opportunity. Conversely, I feel guilty that I’m not giving my daughter enough attention. She’s been totally cut off from all her friends and obviously craving other kids to play with. She practically chased another kid to the park the other day when she saw them walking by, just to be in their presence. She’s at an awkward age where she’s old enough to know she misses her friends, but not old enough to know how to connect with them over distance. She wants to play, not socialise.

I feel so conflicted about what to do next term. It’s been suggested that unless we can’t support remote learning that we keep our kids at home. But what does that mean? It’s pretty ambiguous. I mean, I can support remote learning, it just comes at the cost of everything else I was hoping to achieve. I think part of me wants a legitimate, regular paying job just to feel comfortable with sending my kid to school.

I’ll figure it out, I know. But at the moment I’m just going to take a moment to feel disgruntled about it within my newfound peaceful caravan park type environment; sitting on the front verandah with the birds chirping and enjoying a cup of tea. Coming up with a plan about what to do about it can wait until another day.