ANZCA Bulletin - June 2009 - Australian and New Zealand College ...

Joint Faculty of Intensive Care MedicineThe future of intensivecare medicineContinuedby the need to isolate a growing numberof patients colonized with multi-resistantorganisms and a lack of isolation facilitieson the wards.Television and increasingly the Internet,also continue to set expectations that can bedifficult to emulate in real-life, particularlywhen the realities of resource constraintsare factored into the equation.The demand for HDU care is boomingwhere I work. I believe that this also reflectsmajor resource constraints that those whopractice on hospital wards are experiencing.Specifically, a lack of experienced nursingstaff is threatening the capacity for sickpatients to be cared for out of ICUs. We musttherefore support our non-ICU colleaguesin their quest for resources; doctors, nurses,social workers and therapists, as our goalsare inexorably intertwined.If we are to continue to meet theexpectations of patients and their familiesthen it seems inevitable that societywill need to have its eyes opened to thelimitations of resources that we face on adaily basis. It appears unavoidable that theopportunity costs of providing intensivecare will need to be openly deliberatedagainst infrastructure, education, defenseand the environment and compete withother forms of healthcare for the budget.WorkforceSo how will we rise to meet these manychallenges? In a nutshell, I believe thatthis rests on cultivating a committedworkforce of intensivists with a diversityof complementary skills led by strong,inspirational leaders.Management and Leadership trainingSo what skills am I talking about?There is a rapidly evolving body of evidencesupporting the need for managementand leadership training for healthcareprofessionals and recognition that thisneeds to be tailored to transition pointsin a doctor’s career. I believe that this isabsolutely true as I qualified as a consultantfeeling well trained and yet in retrospectI had no idea of the traps and difficultieswaiting for me as a new consultant.Thirsty for new survival skills, I recentlycompleted a full-time MSc in internationalhealth management at the Imperial CollegeBusiness School in London and found it anabsolute revelation. I am constantly seeingthe relevance in my daily work of subjectssuch as organisational culture, negotiationand conflict management, project andstrategic management, change managementand health policy and finance.If we are to meet the challenges of thefuture we need to have additional skillsthat transcend patient care. We mustunderstand management speak and beable to converse with and engage hospitalmanagers to our cause. We need intensiviststhat aren’t afraid of being political and havethe skills to be eloquent and look beyondthe needs of their individual patients tothe needs of critically ill Australians andNew Zealanders. We need intensivists whowill engage in making the new college asuccessful and powerful body. We needIntensivists influencing government policyand being part of a strong internationalprofessional community.LeadershipI am grateful to have worked and continueto work with a number of extraordinaryleaders - competent clinicians, providersof vision, embracers of change andresponsibility, humanistic, approachableand supportive people who can bring outthe best in their teams - individuals whoallocate resources fairly and inspire kudossuch that teachers, researchers and thosethat perform the bulk of the administrativeduties all feel equally valued and part ofsomething special.It is a tall order but absolutely necessaryto have people such as this running ICUs.In the future, leaders and team memberswith high levels of emotional intelligencewill position themselves to recognize andmanage their own and others’ personalstrengths and weaknesses. The mosteffective teams will be those who canunleash their combined skills on difficultclinical and political problems. These traitswill help us to mitigate conflict and stress,foster innovation, career satisfaction andlongevity, and position us for tackling thechallenges of the future.Work-life balanceFor the first time in history there arefour generations in the workforce. Inthe audience tonight I see so calledTraditionalists, Baby-boomers, GenerationXs like myself and Gen Ys. Various attitudesto life and work have been attributed toeach generation. My generation for exampleis described as skeptical of authority andvaluers of work-life balance.Perhaps it is therefore predictable that Ibelieve that in the future, work-life balanceneeds to be given greater emphasis by ourspecialty if we are to consistently perform atour best and attract the best and brightestfuture intensivists. We must not ignore thefact that health professionals as a groupare vulnerable people with well-knownincreased risks of divorce, substanceabuse and suicide. We must monitor ourown behaviour, observe and support ourcolleagues in achieving their own healthyhabits and as a profession advocate forsustainable working practicesand conditions.ConclusionI hope that I have convinced you that thefuture of intensive care medicine will nodoubt be exciting as well as daunting. Itis somehow fitting that the topic of thismeeting is “Energy crises large and small”.Meeting the many challenges facing ourspecialty will take great energy!But on this account I am not worried.I believe that it is from our patients that wewill find an unlimited source of inspirationand energy that will no doubt sustain ourprofession. I have also watched manytalented and energetic young intensivistsin their academic robes traverse this stagetonight. Over the last week I have engagedwith a selection of the most motivated newfellows imaginable at the New FellowsConference in Coolum. I see the future intheir eyes, the eyes of my trainees and I seeunlimited energy before me as I look outinto this audience.For we are the future – the future is us!Dr Carole FootStaff Intensive Care SpecialistRoyal North Shore Hospital82The ANZCA Bulletin June 2009