Tuesday 23 December 2008

Garling Report

That fact that the NSW Health System is in crisis led to the appointment of Mr Peter Garling SC to conduct a review of the acute health care services in NSW in January 2008.

On 27th November, 2008, Mr Garling released his report. Terms of Reference and the report is available here:

http://www.lawlink.nsw.gov.au/lawlink/Special_Projects/ll_splprojects.nsf/pages/acsi_index

The report makes sobering and fascinating reading as Mr Garling outlines the problems which are troubling our health care system, for example, problems such as increased numbers of people accessing health care facilities. Mr Garling praised the skill, competence and dedication of the health care staff, but outlines many changes which need to occur for the health care system to improve. A particularly important point that Garling makes is that "Furthermore, the rigid demarcation between what a doctor’s job is, and what a nurse’s job is, needs to be consigned to history. Once the concept of teamwork is accepted as the norm in treating a patient, it is easier to see why a qualified nurse practitioner should be able to do many jobs once reserved for doctors".

These comments by Garling demonstrate his deep recognition of the power dynamics which are keeping the health care system stuck in its medieval origins and which mitigate against true efficiency and effectiveness for patients well being. Even though Garling only mentions nurse-doctor working relations, his comments are very applicable to the power dynamics which trouble maternity services. His words echo the conclusions of my study into midwife-doctor interactions in the care of birthing women.

thesis available on line here: http://ogma.newcastle.edu.au:8080/vital/access/manager/Repository/uon:2509

The NSW Government is wanting feedback on the Garling Report. You can give feedback here:

http://healthactionplan.nsw.gov.au/provide-feedback.php

Please take a moment to give feedback on this important report. In my feedback I've talked about how birth is normal and that we are seeing iatrogenic outcomes because birth has been treated as an illness. I've argued for an expansion of 1-2-1 midwifery services and talked about how mothers and babies are safer when women feel valued, listen to, respected and given information and then able to make choices which are actioned.

Imagine if we all gave this feedback?

Saturday 6 December 2008

50 Qualities of Successful People

If you stroll along the bookshelves of any book store, you will find hundreds of books telling you how to be successful in many, diverse fields. When you analyse what the books are saying, they all point to the ability to maintain an optimistic attitude in the face of difficult and/or challenging circumstances, as well as the ability to self manage/regulate as foundational requirements for success.

For parents and midwives, success means happy healthy mothers and babies. Happy, healthy mothers and babies are more likely when stressors are managed well. The enormous changes that pregnancy can bring can be challenging and lead to feelings of stress and even distress for some people. The reality is that for all of us, stressful reactions involves chemical messengers which can play havoc with our physiology. Anything we can do to learn to manage stressors in our lives well is a vitally important thing to do for our health and wellbeing.

I found this list of qualities of successful people on Lifehack. When I looked at the list, I realised that the qualities I read there were those of midwives I really admired. I also recognised that the women and men who moved into parenting in the most optimal way displayed these qualities. It seemed to me that all of us could use the benefits these qualities bring and that steady, consistent adoption of these qualities in our lives can make our lives really wonderful.

1. They look for and find opportunities where others see nothing.

2. They find lessons while others only see problems.

3. They are solution focused.

4. They consciously and methodically create their own success.

5. They may be fearful, but they are not controlled or limited by fear.

6. They ask the right questions -- the ones which put them in a positive mindset and emotional state.

7. They rarely complain.

8. They don’t blame, and take complete responsibility for their actions and outcomes.

9. They always find a way to maximize their potential, and use what they have effectively.

10. They are busy, productive and proactive.

11. They align themselves with like-minded people.

12. They are ambitious.

13. They have clarity and certainty about what they want.

14. They innovate instead of imitate.

15. They don’t procrastinate.

16. They are life-long learners.

17. They are glass half full people, while still being practical and down-to-earth.

18. They consistently do what they need to do, regardless of how they are feeling on a given day.

19. They take calculated risks.

20. They deal with problems quickly and effectively.

21. They don’t believe in, or wait for, fate, destiny, chance or luck.

22. They take action before they have to.

23. They are more effective than most at managing their emotions.

24. They are good communicators.

25. They have a plan for their life and they work methodically to turn that plan into a reality.

26. They become exceptional by choice.

27. They work through the tough stuff that most would avoid.

28. They have identified what is important to them and they do their best to live a life which is reflective of those values.

29. They have balance. They know that money is a tool and ultimately, it’s just another resource.

30. They understand the importance of discipline and self-control.

31. They are secure in their sense of self-worth.

32. They are generous and kind.

33. They are happy to admit mistakes and apologize.

34. They are adaptable and embrace change.

35. They keep themselves in shape physically.

36. They work hard and are not lazy.

37. They are resilient.

38. They are open to, and more likely to act upon, feedback.

39. They don’t hang out with toxic people.

40. They don’t invest time or emotional energy into uncontrollable things.

41. They are happy to swim against the tide.

42. They comfortable with their own company.

43. They set high standards for themselves.

44. They don’t rationalize failure.

45. They know how to relax, enjoy what they have in their life and to have fun.

46. Their career is not their identity, it’s their job.

47. They are more interested in what is effective than in what is easy.

48. They finish what they start.

49. They realize that not only are they physical and psychological beings, but emotional and spiritual creatures as well.

50. They practice what they preach.

Lifehack May 12, 2008

Friday 5 December 2008

Garling Report

Adverse publicity ensured the shortcomings of the NSW Health System were spotlighted and it was widely recognised that acute care services were in crisis. On the 29th January 2008, the NSW Governor appointed Mr Peter Garling SC to inquire into and report upon matters falling within the Terms of Reference (link available below).

On the 27th November, 2008, the Final Report of the Special Commission of Inquiry Acute Care Services in NSW Public Hospitals Overview was presented to the NSW Government and released to the public.

The report is available here:

http://www.lawlink.nsw.gov.au/lawlink/Special_Projects/ll_splprojects.nsf/vwFiles/E_Overview.pdf/$file/E_Overview.pdf

The report makes sobering and fascinating reading as Mr Garling highlights the troubled aspects of our health care system. Garling is impressed by the skill, dedication and competence of health care service staff but notes that many things need to change so that staff can work more effectively. Of particular importance, Garling notes:

"Furthermore, the rigid demarcation between what a doctor’s job is, and what a nurse’s job is, needs to be consigned to history. Once the concept of teamwork is accepted as the norm in treating a patient, it is easier to see why a qualified nurse practitioner should be able to do many jobs once reserved for doctors".

This is a very positive comment and fits with the thesis of my research into midwives and doctors interactions in the care of birthing women. I know Garling only mentions nursing staff in this statement, but it is equally applicable to maternity care issues, if not even more so, given that childbirth is, above all else, a healthy process suffering from iatrogenic outcomes.

You can access the terms of reference here:

Terms of reference

http://www.lawlink.nsw.gov.au/lawlink/special_projects/ll_splprojects.nsf/pages/acsi_terms

The Garling Report is available for comment and the link to the comment pages is here:


Feedback on Garling Report

http://healthactionplan.nsw.gov.au/provide-feedback.php

Please have your say and make the point that maternity services need to be focussed on what keeps women and babies safe. Women and babies are safer when the services which are being provided are women centered, that is respectful of and listening to women's concerns, questions,ideas and choices and ensuring that women's choices are implemented. It is also about ensuring that the profession that is expert in working with women to keep birth normal, that is midwives, are primary care givers.