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4. Monitor and manage the work environment

 

Orientation - Scene 2

This series of videos  depicts a hypothetical orientation meeting between a term supervisor and JMO in a rural hospital. Scenes 2a and 2b show two contrasting versions of part of the meeting in which the roster is discussed. It demonstrates a number of the 7 principles as well as tips on clear and assertive communication.

 

Background

The JMO's circumstances present challenges for both parties. The JMO has been seconded from his parent hospital in a metropolitan setting to the rural hospital, half way into the term, to fill an urgent vacancy. Unbeknown to the supervisor, the JMO has several specific concerns. Firstly, he has discovered that he has been rostered as the after hours medical officer on day two of his secondment, which causes him anxiety. Secondly, he is disappointed that he was notified of the secondment on the day he returned to work after his honeymoon. Thirdly, he is disgruntled that he was uprooted from a surgical term in his parent hospital to work with the geriatrics team, as he aspires to enter surgical training.

In this scene, the supervisor attempts to clarify the JMO's understanding of the roster, and presumably resolve any concerns. However, both the JMO's and supervisor's  communication is inadequate.

 

The JMO makes ambiguous unassertive references to his concern about being rostered on overtime on his second day. 

 

Supervisor "Have you looked over your roster?"

JMO "Yes, that was interesting!"

Supervisor "Interesting - Good! -  Does it make sense?"

JMO - It all makes sense

The supervisor overlooks an opportunity to directly pick up on these cues (E.g. "Interesting - what do you mean by that?"). Rather, he indirectly responds to the JMO's concern by highlighting that the local team are very supportive.

"I was surprised to see I was rostered on overtime on my second day, so I would like to get a handle on that. But otherwise its OK"

"They have thrown you in the deep end, have they? ..It is being thrown in the deep end but you will get on with it, you will be absolutely fine"

Scene 2b video (with permission HETI)

In this version, both parties use more direct language which succeeds in flagging the roster as a concern.

JMO: "Did you know they have me on overtime on my second day?" 

Supervisor: "I didn't know that - that must have been a surprise"

Unfortunately, the JMO then risks generating conflict by layering his concern with a judgement about the roster manager:

JMO: "It just seems a bit premature - I won't say ill thought out - just a bit premature to be solely responsible on my second day"

It is unnecessary and counterproductive to blame others. One should focus on issues and personal needs. A cleaner more objective approach would have been to simply state the issue he is concerned about, why it concerns him and what he really needs. Some people call this a 3 step "I" statement

Example

1. I am rostered on an overtime shift tomorrow on my second day in this hospital.

2. I am concerned that I am unfamiliar with this hospital processes and local teams as I know from previous experience that patients can deteriorate after hours.

3. I don't feel I can do this shift until I feel more comfortable to work independently, in this hospital.

 

Fortunately, the supervisor demonstrates effective communication by responding to the JMO's clue with a  probe: "Are there any specific concerns you have about that on-call shift?"

These scenarios demonstrate how listening and asking enable people to understand one another's perspectives and concerns. People are reluctant to be open with others who are unfamiliar to them, especially if a power gradient exists.  Picking up on non verbal and verbal cues with an enquiry invites the other person to discuss issues. This is a very effective strategy for supervisors, who may be unaware of, or underestimate, the impact of the power gradient between them and JMOs. Fortunately, in this these videos, the supervisor circumvented the need for further assertiveness on the part of the JMO, by listening, asking and responding the JMO's concerns.

Click here for more tips on assertiveness and an example of how it could have been used in these videos

Summary of charter elements featured

1. Demonstrate respect

#4   remain composed when frustrated or stressed

2. Promote diversity and wellbeing

#5   show concern for others

3. Ensure patients and staff are safe

#10  Clarify when unclear or concerned about advice

#11 Practice within role and consult appropriately

4. Collaborate to create an open, safe and empowering learning environment

#13  Clarify roles, priorities and expectations, regarding communication and consultation.

#14  Show initiative, promote independence and offer support

5. Monitor and manage JMOs' work environment

#17  Monitor workloads and seek and or provide support to manage them

#19  Raise concerns (and encourage others to do the same) if any aspect of one's work impacts negatively on productivity, wellbeing, or career progression.