ASMOF by madeagency3

The Newsletter of The Australian Salaried Medical Officersâ&#x20AC;&#x2122; Federation NSW

NEWSLETTER | SUMMER 2019

ASMOF - THE DOCTORSâ&#x20AC;&#x2122; UNION

On behalf of our State Council, I am pleased to present this report to members. 2018 was another busy year for our Union. Highlights of the past year include:

NEWSLETTER | SUMMER 2019

• Election of a new State Council and State Executive team • Continued growth in the Union’s membership •W e have continued to build good relationships, and strengthen existing ones, with key individuals and organisations in the past year • I mproving our effectiveness as an effective lobbying force with the media, government and employers •B uilding a strong base of evidence-based policy and research to support the Union’s advocacy work •H igh quality financial management from the Union’s office •T he Union’s industrial officers continued to robustly and effectively support our members during the year with advice, representation and advocacy •T he Union’s administrative staff continued to provide high quality support to members, the Executive and State Council

ASMOF - THE DOCTORSâ&#x20AC;&#x2122; UNION

We have had many successes, like helping defeat the privatisation of five public hospitals. But we have also experienced defeats and there are many battles that will continue into 2019. Most notably our campaign to protect office accommodation for staff specialists, our campaign to win safer working conditions for Doctors-in Training and our continuing advocacy on behalf of members at the privatised Northern Beaches Hospital. Our membership grew by 10% and we finished the year with 5100 members in NSW. Itâ&#x20AC;&#x2122;s a tribute to our staff that we have been able to sustain such growth. However, this high level of growth cannot go on forever and that is why in 2019 we are going to start focusing on more targeted evidence-based strategies to ensure growth continues. Membership numbers are just one measure of the success of a union. It is essential that we maintain and grow our density so that we have the strength and power to win results. But when people join ASMOF, it is for more than just industrial advice or representation. We also need to ensure that people identify with ASMOF as a union that shares their values.

NEWSLETTER | SUMMER 2019

Our members look to the union to be a leader in our industry, to advocate at the highest levels for jobs for our newest doctors, for better government funding, for better engagement with doctors, for better hospital facilities and on a raft of other issues. We will engage with members through solid campaigning about those issues which matter to them in their workplace and our industry. As always, I would like to thank all our elected representatives along with the staff of ASMOF for their hard work over the past 12 months. Our union would not be in such a strong position without their efforts.

Dr Tony Sara ASMOF NSW President

ASMOF – THE DOCTORS’ UNION

2018 – THE YEAR IN REVIEW Over the last year ASMOF has continued to consolidate our position as the union and industry advocate for salaried doctors. We have an unparalleled reputation as a strong and passionate voice for our members. We lobby and campaign to promote and protect the broad interests of salaried medical practitioners and for the provision and development of quality health services. We have campaigned on behalf of our members, seen our membership grow, negotiated key improvements for members, and actively engaged with key stakeholders to protect and bolster our members interests. The membership and financial results we have been able to achieve in this time are particularly pleasing – with over 10% membership growth. This is due to the great work of our staff and the passion and commitment of members and delegates.

NEWSLETTER | SUMMER 2019

Our staff work towards five key objectives and during the year we have delivered on those areas. 1. We have delivered good outcomes for members protecting and expanding the rights, wages and benefits. 2. We have improved our communication, building a better media profile and brand recognition. 3. We have made enormous leaps in our internal systems and processes.

“The government’s policy effectively denies us the basic right to collectively bargain over wages and conditions…”

4. Our membership continues to grow, and our members are now more active than ever before. 5. We have continued to ensure our staff are provided with the necessary professional development and training. While our membership growth is encouraging, we can never be complacent. As with most unions, and other membershipbased organisations, constant innovation and change is required. We must ensure we are meeting the needs of our existing and potential members. Our financial position requires constant attention and a careful focus on reducing costs wherever possible. Our members would expect nothing less. In common with other unions in NSW, ASMOF is finding it increasingly difficult to achieve substantial pay rises in bargaining and to pursue Award improvements, or even fight Award breaches. This is because of the NSW Government’s unfair Wages Policy and other associated budget-cutting measures. The government’s policy effectively denies us the basic right to collectively bargain over wages and conditions or to have members’ wages and conditions determined by an impartial and independent arbiter. In practice the policy enables the Government, in its capacity as an employer, to unilaterally determine the wages and conditions of its employees. In their report False Economies - The Unintended Consequences of NSW Public Sector Wage Restraint, researches Troy Henderson and Jim Stanford consider the unintended consequences of the NSW Government’s Wages Policy.

ASMOF – THE DOCTORS’ UNION

They found five unintended, harmful side-effects of the ongoing wage cap, including: 1. Over the five years from 2011 through 2016, the state’s public- sector wage suppression reduced consumer spending in the state by a cumulative total of some $3.4 billion, harming businesses large and small. 2. Australia’s national GDP was reduced by an estimated cumulative total of almost $8 billion over the 2011-16 period.

“That is why we support the Change the Rules campaign initiated by the ACTU.”

3. The NSW government’s wage austerity therefore reduced its own revenue (through that reduction in GDP) by an estimated $1.2 billion over the 2001-2016 period. 4. Each public-sector worker’s “workload” increased by 7.5 percent in the last five years – yet the wages policy in fact suppresses true productivity growth in the public sector. 5. The NSW government’s extraordinary interventions, removing normal wage bargaining rights from a significant and influential section of the state labour market, have contributed to the unprecedented stagnation of wages in the overall state labour market – one that the government itself admits is hampering both economic growth and fiscal well-being. The longer the wage cap remains in place, the larger will these costs (of foregone consumer spending, offsetting reductions in state revenues, and the spill over impact onto private labour market outcomes) become. That is why we support the Change the Rules campaign initiated by the ACTU. And in the lead up to the 2019 NSW State election we, and many other unions, will be asking both sides of politics to change the rules to: • Remove the wages cap • Make the IRC independent again with sufficient resources to run applications in a timely and just manner • Allow agencies like NSW Health and the Union to collectively bargain and to agree on outcomes that encapsulates work value/productivity and work health and safety issues • Not undertake any further privatisation of services, and • Abolish the Efficiency Dividend (which at its current level means a 3% finding cut to all agencies).

“When Northern Beaches did open on 31 October 2018 the flaws inherent in the so called public partnership model were exposed to all.”

NEWSLETTER | SUMMER 2019

PRIVATISATION – THE FAILURES OF NORTHERN BEACHES HOSPITAL In January 2018, ASMOF, alongside the other Health Unions, forced the current Berejiklian Government to concede against privatising five regional Hospitals in NSW. It was a state-wide campaign that saw us fighting in Goulburn, Wyong, Shellharbour, Maitland and Bowral. Over the course of the campaign, ASMOF consistently posed the question to the Government –show us the evidence in NSW where a public private partnership has worked? The answer from the Government was always Northern Beaches Hospital, even though the hospital had not opened. When Northern Beaches did open on 31 October 2018 the flaws inherent in the so called public private partnership model were exposed to all. Less than two weeks out from opening, Healthscope, the private operator of Northern Beaches Hospital, sent us the contracts for our members and offered us a weekend to provide comments. This was despite ASMOF seeking answers to these fundamental questions for over three years. The terms and conditions included were not comparable, and demonstrably less favourable than their current conditions under NSW Health.

ASMOF – THE DOCTORS’ UNION

Then, within hours of the official opening, reports of a litany of issues began to emerge. Anaesthetists threatened to cancel all elective surgery due to severe staffing and equipment shortages and other systemic problems. Our junior doctors were visibly distressed. Fundamental supplies (including body bags) were not available, surgical and anaesthesia rosters were never finalised, persistent IT issues, onerous on-call requirements, and a non-functioning haematology department.

“ As a result, we have seen a clear turnaround from Healthscope and the Ministry, leading to the creation of a committee.”

The list appeared endless. Within two days of the Hospital opening, the Chief Executive resigned. Shortly after, senior medical staff held a vote of no confidence in the Director of Medical Services, seeing her resign a week later. ASMOF was forced to defend our members by taking Healthscope and the Ministry to the NSW Industrial Relations Commission over a breach of the Project Deed, and to issue a notice to our junior doctors that we would support them for refusing to treat patients due to safety concerns. As a result, we have seen a clear turnaround from Healthscope and the Ministry, leading to the creation of a committee with ASMOF and the AMA to ensure Northern Beaches continues to function. Nevertheless, the above is painful and dangerous reminder of why Public Private Partnerships (aka privatising public assets) have no place in health. Too often, the private operator puts profit over patient care and fundamental questions are overlooked, or worse, specifically ignored. The consequence, at the end of day, is the increased potential for the unnecessary loss of life or injury. At ASMOF, we believe there is a better way. Stop privatising our hospitals and fund our public health system so we can continue to maintain our internationally recognised standard of care.

NEWSLETTER | SUMMER 2019

10 REASONS WHY THE PRIVATISATION OF HOSPITALS MUST STOP: 1. Your services get worse Public services involve caring for people. But private companies make a profit from public services by cutting corners or under investing. There is a conflict between making a profit and taking the time to care.

“If a private company runs a service, they are not democratically accountable to you.”

2. Privatisation costs you more You pay more, both as a taxpayer and directly when they privatise public services. And it’s not just things like energy and transport. Look at the Port Macquarie Hospital fiasco. In a privatised service, profits must be paid to shareholders, not reinvested in better services. Interest rates are higher for private companies than they are for government. Plus, there are the extra costs of creating and regulating an artificial market. 3. You can’t hold private companies accountable If a private company runs a service, they are not democratically accountable to you. You don’t have a voice. Contracts to deliver public services are agreed between private companies and government behind closed doors. There is very little transparency, public accountability or scrutiny. The companies are not subject to freedom of information requests because of commercial confidentiality’. When private companies fail to deliver, the public has no powers to intervene and government doesn’t always have the time or expertise to force them to keep their promises. 4. Privatisation creates a divided society Public services are important to meet everyone’s basic needs, so we can all be part of the community. Hospitals are not optional extras. We all need and rely on public services - they are universal. That means they need to be accessible and high quality for everyone. Privatisation often goes hand in hand with encouraging richer people to pay more and opt out of the services we all use. This leads to division, making it harder to provide excellent public services for everyone. 5. You don’t get a democratic voice When we go to the shops, we all make our own individual decisions about what we want. Public services are different – they give us a chance to come together to decide what kind of society we want to live in.

ASMOF – THE DOCTORS’ UNION

6. Public services are natural monopolies Privatisation was introduced because of a belief in free markets and consumer choice. But public services are often what economists call ‘natural monopolies’. There’s no real competition. Private monopolies often become the worst of all worlds. You don’t have consumer power because you can’t go elsewhere. But you don’t have power as a citizen to make the service better through democratic accountability.

“If private companies are running our public services and are too big to fail, the public must pick up the pieces when things go wrong.”

7. Private companies cherry pick services Private companies’ cherry pick the profitable bits of a service so they can make as much money as possible. It’s more efficient to run public services in public ownership so that profits can be reinvested across the whole network as needed. 8. Privatisation means fragmentation When lots of private companies are involved in delivering a public service, this can create a complicated, fragmented system where it’s not always clear who’s doing what. Private companies don’t necessarily have much incentive to work together and share information. This makes it difficult to provide an integrated service. 9. Privatisation means less flexibility Government departments are responsible for meeting the needs of the public – but privatisation means less flexibility for changing circumstances. If an outsourcing contract with a private company needs changing, government must pay more to make changes or improvements, add in extras or to opt out. And selling off public assets or public land means we the public have fewer options and resources for delivering the services we’ll need in the future. 10. Privatisation is risky Look what happened when Port Macquarie Hospital failed. If private companies are running our public services and are too big to fail, the public must pick up the pieces when things go wrong.

NEWSLETTER | SUMMER 2019

ASMOF – THE DOCTORS’ UNION

SENIOR DOCTOR ENGAGEMENT SURVEY The 2018 Senior Doctor Engagement survey is open and we ask that all staff specialist and clinical academic members complete the survey.

As ASMOF President Dr Sara says, “There exists a robust body of evidence regarding how organisational culture, teamwork and strong clinical engagement deliver better patient experience, stronger financial management and better-quality care.”

In 2015 ASMOF and the AMA conducted the first Senior Doctor Engagement survey. You can read the results of that survey here. This resulted from the “Joint Statement of Cooperation” with the NSW Minister for Health which, among other things, said that ASMOF and the AMA will conduct an annual survey of senior medical practitioners to gauge their level of engagement in the public health system. The survey gives all members the opportunity to express their views on a range of areas like practices and culture in your workplace, employee engagement, job satisfaction, views on leadership, change management and several other important areas. The survey results will provide us with a benchmark for NSW Health around engagement and will play a crucial role in contributing to the evidence base for all hospitals and local health districts to improve engagement with doctors. Why is clinician engagement so important? The Garling report confirmed what the union always knew – an engaged medical workforce results in both better patient care and more efficient hospitals, and it gave us more evidence to push to embed clinical engagement in the system. As ASMOF President Dr Sara says, “There exists robust evidence based regarding how organisational culture, teamwork and strong clinical engagement deliver: better patient experience, stronger financial management and better-quality care.” We know that strong clinical engagement delivers: • Better patient experience • Stronger financial management • Higher staff morale • Less absenteeism and stress. Much of the available research on clinical engagement comes from studies of the NHS. For instance the British

NEWSLETTER | SUMMER 2019

health policy charity The Kings Fund commissioned the Institute of Employment Studies to carry out a number of studies on the importance of leadership, management and medical engagement.

“There was a breakdown of good working relations between clinicians and management, which Garling colourfully likens to the Great Schism (of the Church) of 1054.”

In 2008 ASMOF (NSW), AMA (NSW) and the NSWNA commissioned the Workplace Research Centre of the University of Sydney to survey the views and experiences of doctors and nurses in the public hospital system. Within this survey, several issues relating to the level of consultation and trust were able to be tested against a national benchmark survey of over 8000 workers. In a startling illustration of the level of distrust between doctors and management, the survey revealed that almost 70% of NSW public hospital doctors disagreed with the statement that “Managers at my workplace can be trusted to tell things the way they are”, compared to a figure of only 20% for the “average” Australian worker. The report of the Garling Inquiry, published on 27 November 2008, said (among other things): • I nterprofessional communication, trust and respect are key ingredients in effective organisations, but have been lacking in NSW health services •T here was a “breakdown of good working relations between clinicians and management”, which Garling colourfully likens to the Great Schism (of the Church) of 1054 •T his was ‘very detrimental to patients’ and a disincentive for medical professionals to remain in the public hospital system • The NSW health system has entered a period of crisis, describing our hospitals as good by world standards, in many cases ranking towards the top, but too often unable to deal with the sudden increase in patients, the rising cost of treatment, and the pressures on a skilled workforce spread too thinly and too poorly supported in the dozens of administrative tasks which take them away from their patients • “ We are on the brink of seeing whether the public system can survive and flourish or whether it will become a relic of better times”

ASMOF – THE DOCTORS’ UNION

•C hange should be driven by clinicians “from the bottom up” •T hat rectifying this will require an improved approach to information and communication, regular clinical and behavioural audits, and a system of “delegated authority”, with clinical leaders as “the champions of the changes”, and • Implementation of the report’s recommendations will require strong leadership and continuing consultation with clinicians and the community.

“The 2018 Senior Doctor Engagement survey is open, and we ask that all staff specialist and clinical academic members complete the survey.”

•T he importance of clinical engagement was further acknowledged in the Joint Statement of cooperation (‘statement’) regarding clinical engagement between ASMOF, the AMA NSW and the NSW Minister for Health. The comparison between the results of this survey and the AMA/ASMOF survey undertaken in 2008 during the Garling enquiry is encouraging. The survey reveals an improvement in morale across hospital doctors in NSW. • I n 2008, 65-70% of respondent doctors had seriously considered leaving the public health system in the previous 12 months. • In 2015, only 39% of doctors expressed this intention. •M ost respondents are very positive about their work with 94% of doctors feeling highly valued by their patients and co-workers. The results of the survey also suggest the need for improvement in some areas with a majority or close to a majority of respondents disagreeing that senior management is effectively engaging with senior doctors.

NEWSLETTER | SUMMER 2019

SNAPSHOT 2018 Members: 5100 Incoming (new) members:

1109

Monies recovered for members: $200,000 Cases handled by industrial team: 1715

ASMOF – THE DOCTORS’ UNION

“Members tell us that the impact of open plan offices goes beyond short term cost savings with adverse consequences to productivity, confidentiality, privacy, health and job satisfaction.”

AGILE WORKING/OPEN PLAN – GOOD FOR GOOGLE, NOT FOR DOCTORS Office accommodation became one of the hottest issues of 2018 and members are concerned with the one size fit all strategy being adopted by NSW Health. We know the main driver of open plan work arrangements (including new ways of working, activity-based working, hot desking, etc) is cost. But, whilst we know the pressure of budget constraints, the government is taking a very short-term view of trying to fit more employees into available space whilst ignoring the research highlighting the negative effects of open plan workplaces. Why is this important for members? Members tell us that the impact of open plan offices goes beyond short term cost savings with adverse consequences to productivity, confidentiality, privacy, health and job satisfaction. The consequences that flow from implementing a one size fits all open plan policy will potentially affect the lives of patients through greater levels of fatigue and resulting mistakes, together with breaches of confidentiality. Further, it will likely exacerbate the prevalent psychological distress and mental illness faced by senior and junior doctors. Why don’t we support a one size fits all approach to office accommodation? Simple. This approach does not work, and we believe it is breach of our members basic industrial rights. All employees need to have work spaces appropriate and appropriately equipped to enable them to carry out their duties effectively. The nature of a Staff Specialists’ position requires them in addition to their clinical duties to teach, to research and, as a senior clinician, be involved in the management of their department.

good for google - not for doctors

NSW Health is threatening to take away our offices, force us to work in open plan and ‘hot desk’. This will compromise the capacity for health professionals to deliver the best possible care.

NSW Health calls it ‘Agile Working’. But this is code for open plan and hot-desk work arrangements. They say it’s about a ‘better way to work’ – but we know it’s just about cutting costs to meet the government’s three per cent per year Efficiency Dividend. As these work arrangements are rolled out across hospitals the practical effect will be that Staff Specialists lose their dedicated offices

ASMOF members have raised concerns including: losing a space for confidential discussions with patients, carers, colleagues and trainees losing access to a private space for intense concentration without distraction needing to pack up and store important records at the end of each day.

and must share workspaces.

Despite international research unequivocally showing that open plan work is not appropriate for hospitals, NSW Health appears determined to push through with these cuts. ASMOF opposes this short sighted policy.

That’s why we are inviting you to an urgent meeting on the issue: AT: ___________________________________

ON: ___________________________________

We need to stand together and defend our working arrangements before it’s too late. Because Open Plan is the Wrong Plan.

Authorised by Dr A. Sara, President of ASMOF NSW.

ASMOF – THE DOCTORS’ UNION

What are we asking NSW Health to do? To look beyond short term cost savings and seriously consider the long term consequences that will inevitably ensue, as demonstrated in a multitude of studies (See Bernstein ES, Turban S. 2018, The impact of the ‘open’ workspace on human collaboration; Otterbring T, et al. 2017, The relationship between office type and job satisfaction: Testing a multiple meditation model through ease of interaction and well-being; Jahncke H, et al. 2011, Open-plan office noise: Cognitive performance and restoration, Journal of Environmental Psychology; Richardson A, et al 2017, Office design and health: a systematic review; Robertson P. 2014, Open plan offices are a health and productivity risk – Canada Life; Kim J, de Dear R. 2013, Workspace satisfaction: The privacy communication trade-off in open-plan offices). To listen to the concerns of our members and agree to implement ASMOF’s Recommended Minimum Office Accommodation Standards (ASMOF Office Standards), which provides for the following: • All 0.6 to 1.0 FTE positions are to have their own office. • Positions which are 0.1 to 0.5 FTE can be required to share an office. There may be situations that this may not be appropriate and should be dealt with on a case by case basis. It would generally not be expected that more than two staff would be allocated to any one office. • Those positions that are subject to genuine job-sharing arrangements can also share an office. • Office space to be nine square metres for Staff Specialists and Clinical Academics. • Positions that have managerial responsibilities attached (identified for example by the provision of a managerial allowance) or have roles that require similar consideration (such as for example Directors of Training) should have office space of at least 12 square metres. • The office is to be adjacent to service areas if physically possible. • Interview/meeting rooms should be nearby and reasonably accessible. • The office must be secure and lockable, along with being reasonably soundproof. It should be cleaned regularly and maintained to reasonable standards. The office layout must be to acceptable ergonomic standards.

NEWSLETTER | SUMMER 2019

• The office must contain as a minimum a desk, chair, phone, network computer, lockable filing cabinets, and bookshelves. Ready access to a printer and photocopier would be expected. Shared offices should have sufficient allocation of office equipment/furniture for each staff member.

“Most recent research provide a damning indictment on open plan arrangements, including agile working.”

Property NSW and the Principles also assert that flexible working will lead to increased collaboration. Collaboration is a small aspect of the many duties of a Staff Specialist, whose research, administrative, and managerial duties are predominately individual based work requiring private and quiet spaces away from interruption and distraction. Furthermore, research has proven that collaboration decreases in flexible working environments such as open plan offices. (Bernstein ES, Turban S. 2018, The impact of the ‘open’ workspace on human collaboration.) What does the research say? Most recent research provide a damning indictment on open plan arrangements, including agile working. Productivity In the United States research shows the estimated annual loss in productivity due to the disengagement and distraction caused by open plan offices is US$500 billion (Otterbring T, et al. 2017, The relationship between office type and job satisfaction: Testing a multiple meditation model through ease of interaction and well-being). Further studies have consistently shown that “noise and lack of privacy are the key sources of dissatisfaction in open-plan office layouts” (Kim J, de Dear R. 2013, Workspace satisfaction: The privacy-communication trade-off in open-plan offices). Kim found the loss of productivity due to noise disturbance was double in open plan offices compared to private offices. This is due to the lack of sound isolation and personal control that open plan offices provide, which results in employees experiencing “excessive uncontrolled social contact and interruptions due to close proximity to others and perceived loss of privacy”. Further, high noise environments have also been shown to adversely affect memory performance, increase fatigue and reduce motivation (Jahncke H, et al. 2011, Open-plan office noise: Cognitive performance and restoration, Journal of Environmental Psychology).

ASMOF – THE DOCTORS’ UNION

Jahncke also found that productivity diminishes as a consequence of the significant increase in email and IM that open plan offices lead to due to the reduction in face-to-face interactions. The argument that open plan workspaces, in its various forms including ABW, will lead to an increase in collaboration has undoubtedly been proven to be false. Collaboration

“ Our member feedback shows that having a quiet space, free from interruptions and distractions is essential to carry out this work.”

NSW Health asserts a key priority is to increase collaboration. But individual complex knowledge-based work remains the key facet of Staff Specialists work, with collaborative work representing a small component. Our member feedback shows that having a quiet space, free from interruptions and distractions is essential to carry out this work. The Jahncke research mentioned above showed that collaboration, particularly face to face interaction, decreases significantly (approximately 70%) after transitioning from cubicles to open plan workspaces. Notably, the study found that rather than prompting increasingly vibrant face- to-face collaboration, open architecture appeared to trigger a natural response to socially withdraw from officemates and interact instead over email and IM. Further open plan offices can reduce certain conditions conducive to collaboration and collective intelligence, including employee satisfaction, focus, and privacy. Other studies show that open plan offices impede complex focused work that requires concentration due to the inability to focus. The main features of open plan offices that contribute to the inability to focus include noise, telephones ringing, face- to-face and telephone conversations, office technology and the awareness of others moving (Augustin S. 2014, Designing for Collaboration and Collaborating for Design, Journal of Interior Design; Baldry C & Barnes A. 2012, The open-plan academy: space, control and the undermining of the professional identity, Work, Employment & Society; Gorgievski M.J, et al. 2010, After the fire: New ways of working in an academic setting). Many Staff Specialists would be unable to undertake complex research and clinical trials, which requires a great level of concentration and mental energy whilst being constantly interrupted in an open plan office.

NEWSLETTER | SUMMER 2019

Strategies to overcome distractions have been shown to be ineffective or lead to staff conflicts. For instance, it is unlikely that a staff member will feel comfortable with confronting a colleague that speaks loudly, especially if this staff member is junior. Further, it is not difficult to imagine that such confrontations and the inability to avoid co-workers will lead to tension and conflict.

“Higher workplace density was showed to be associaated with higher psychological work stressors.”

The suggestion that a staff member could simply move to another location also defeats the notion of collaboration whilst ignoring the impracticalities and great inconvenience of finding a new space to work (Gorgievski M.J, et al. 2010, After the fire: New ways of working in an academic setting). Health Another feature of open plan offices that contributes to the reduction of productivity is the impact on health. Studies have found that sick leave is 62% to 70% higher in open plan offices than in enclosed offices (Richardson A, et al 2017, Office design and health: a systematic review; Robertson P. 2014, Open plan offices are a health and productivity risk – Canada Life). Higher workplace density was showed to be associated with higher psychological work stressors, which in turn, lead to poorer physical health, emotional and cognitive irritation and lower mental work ability. Doctors already face significant problems related to psychological distress and mental ill-health, due to the culture of medicine and the working conditions that doctors are expected to work under. The added psychological stress that open plan offices entail would likely exacerbate the mental health issues that have led doctors to suffer conditions such as depression, or tragically to commit suicide. The risk of spreading infectious or contagious illness cannot be ignored either as it is real and significantly higher in open plan offices. In 2014, The Medical Journal of Australia reported a case in which a chief of staff of a large open plan office was diagnosed with tuberculosis. A quarter of his co-workers subsequently tested positive.

ASMOF - THE DOCTORS’ UNION

“(An open plan) approach does not work, and we believe it is breach of our members basic industrial rights. All employees need to have work spaces appropriate and appropriately equipped to enable them to carry out their duties effectively. The nature of a Staff Specialists’ position requires them in additional to their clinical duties to teach, to research and, as a senior clinician, be involved in the management of their department.”

ASMOF – THE DOCTORS’ UNION

Confidentiality Invasions of patient privacy in an open plan office is a serious and real concern for Staff Specialists who need to discuss patient matters with colleagues, review sensitive and confidential information, and talk with patients or their family members. In an open plan office, there is far great likelihood that confidential conversations will be overheard, and confidential information will be capable of being accessed by those who should not be able to access the information.

“In a recent study that analysed job satisfaction, enclosed offices were found to outscore open plan offices on every environmental factor, which relevantly include noise, sound and visual privacy, and ease of interaction.”

This problem will not be solved through the provision of bookable and non-bookable rooms, which has been proven to be the case in several studies (Ryan S. 2014, ASCC issues discussion paper: Open plan office space (Academic Staff)). Meeting rooms were either always booked or unavailable for impromptu meetings. Practically and logistically, NSW Health must consider the sheer difficulty involved with moving large piles of books and papers. Staff Specialists are often working on multiple tasks requiring numerous piles of paper and computers. The idea that all paperwork is now digitalised is a myth and is simply not the case. Staff Specialists require access to research, teaching materials, patient files, slides, reports, scans, confidential papers, computers, specialised software, and academic books. All of these materials and equipment cannot be left unattended and unsecure in open areas. An enclosed lockable office allows a Staff Specialist to secure and access these materials when called away urgently which can occur frequently on an ad hoc basis. Job Satisfaction In a recent study that analysed job satisfaction, enclosed offices were found to outscore open plan offices on every environmental factor, which relevantly include noise, sound and visual privacy, and ease of interaction (Kim J, de Dear R. 2013, Workspace satisfaction: The privacy- communication trade-off in open-plan offices). All of these factors go to the ability to be able to concentrate when undertaking complex knowledge-based work that may involve highly confidential material. High workspace density has also been found to be inversely associated with job satisfaction for people with high job-complexity and high organisational tenure.

NEWSLETTER | SUMMER 2019

What can you do to assist with our office accommodation campaign? • Know your rights. If you are told there will be changes to your current office accommodation arrangements, contact the Union immediately at allocation@asmof.org.au • The employer is obliged to consult with you and the Union

“Help us organise a meeting in your workplace for ASMOF to talk to you and your colleagues about our campaign to protect your rights.”

• Never agree to any changes, including agreeing to any plans or schematic designs for redevelopment without telling us about it. The basic principle is never agree to work in an open plan office space. • We need specific examples of why good office accommodation is important to you. Please email us your examples to allocation@asmof.org.au • Help us organise a meeting in your workplace for ASMOF to talk to you and your colleagues about our campaign to protect your rights. • Ask your colleagues to join ASMOF, the Doctors’ Union.

ASMOF - THE DOCTORS’ UNION

DIT HIGHLIGHTS FOR 2018 The ASMOF/AMA Alliance was set up in 2013 to ensure that Doctors in Training were able to get the benefits of both organisations - professional and policy advice from the AMA and the collective and individual representation of ASMOF. Over the last five years we have recovered over $9 million in underpaid. In 2018: •W e continued to campaign and win improvements in safe working hours and unrostered overtime. •W e established three working groups (award, unrostered overtime and safe working hours) to plan and prioritise our campaigning focus for 2019. •T he second Hospital Health Check Survey was released with 1352 respondents and 18.5% increase on last year. •W e campaigned hard to ensure our members are not disadvantaged because of the withdrawal of the Westmead ICU accreditation. •W e ran an important arbitration in the NSW Industrial Relations Commission over hospitals not paying members their entitlements when undertaking remote clinical appraisals. • We made Healthscope and the NSW Government sit up and listen to the concerns of members at the Northern Beaches Hospital. This has led to the creation of a peak weekly meetings with the MOH, Healthscope and NSLHD and the AMA.

IT TOOK ME FIVE YEARS TO COMPLETE THE DEGREE

AND ONLY FIVE MINUTES TO JOIN THE ALLIANCE!

ASMOF - THE DOCTORS’ UNION

AUSTRALIA’S PRECARIOUS LABOUR PROBLEM AND FIXED TERM CONTRACTS One of the biggest debates raging in Australia at present concerns the stability and security of Australian jobs. As ASMOF members will know, the Australian Union movement has been tirelessly fighting to fix the current industrial laws through its “Change the Rules” campaign to ensure better job security for workers. We are seeing more and more employees being forced onto casual employment arrangements, labour hire, fixed-term and independent contractor positions. These types of arrangements are creating more insecure work and eating away at employee entitlements. There is, however, some good news with a recent new decision by the Full Bench of the Fair Work Commission. This decision has opened the door for employees on “outer limit” fixed-term contracts to access unfair dismissal under the Fair Work Act. Under the Fair Work Act, an employee can only access the unfair dismissal jurisdiction if they have been dismissed within the meaning of section 386 in that the employee has: a) been terminated on the employer’s initiative; or b) resigned from their employment by way of force or conduct engaged in by the employer. Previously, where an employee was dismissed on the expiry date of a fixed-term contract, they would generally not have been dismissed at the employer’s initiative. Instead, the contract would have been considered to have ended due to the expiration of the contract. This meant that such an employee would be prevented from making an unfair dismissal claim. However, the Full Bench has opened the door to such employee’s accessing unfair dismissal.

NEWSLETTER | SUMMER 2019

The case of Khayam v Navitas English Pty Ltd In this case Mr Khayam was employed by Navitas as a casual from 2005 until 2012. He was then offered a series of fixedterm contracts between 2012 and 2016. Towards the end of Mr Khayam’s last fixed-term contract Navitas determined not to offer him a further contract due to concerns it had regarding his work performance. Mr Khayam make an unfair dismissal application and contended that this constituted a ‘dismissal’ at the employer’s initiative. Mr Khayam was unsuccessful in the first instance but was successful on Appeal before the Full Bench. The Full Bench determined that when assessing if a ‘dismissal’ was at the employers initiative for a fixed-term employee, consideration must be given to the following:

ASMOF – THE DOCTORS’ UNION

•T he employment relationship as a whole and not just the employment contract that operated immediately before the cessation of employment; •W hether the contract had been varied, replaced or abandoned by way of written or oral agreement between the parties after it was executed; •W hether the employment arrangements included a series of standard-form contracts which operated for administrative convenience and did not represent the reality or the totality of the terms of the employment relationship; •W hether an action on the part of the employer was the principal contributing factor which resulted in the termination of the employment; •W hether the terms of the contract are inconsistent with the terms of an award or enterprise agreement which regulates fixed-term employment; and •W hether the employer made representations to the employee or engaged in conduct that would make the terms of the contract invalid. This decision is significant for fixed-term employees as it provides an opportunity for employees to bring an unfair dismissal claim at the expiration of their fixed-term contract, where the above factors exist. This is particularly relevant where an employee has had series of contracts during their employment relationship and there is an ongoing requirement for the position to be filled by the employee.

Syvannah Harper and Joe Kennedy Hall Payne Lawyers

NEWSLETTER | SUMMER 2019

MEDICARE BILLING Medicare billing is a complex issue and the responsibility of accuracy of the billings falls onto the treating doctor. Whilst ASMOF can only provide generic advice on the subject matter, the Union has prepared some practical information in the form of an ASMOF position statement as an aid to assist our members. If you have concerns regarding Medicare billings, we would encourage you to seek detailed advice from the relevant authority (being Medicare Australia) who employ medical advisers with expertise in this area, to handle specific questions raised in concern to billing requirements, item numbers and categories. Time invested in corresponding with Medicare ensures you can be supplied with written instructions that can then be referred to your employer should there be any audit issues.

ASMOF - THE DOCTORSâ&#x20AC;&#x2122; UNION

Safe and secure? The latest review of hospital security must prompt action.

NEWSLETTER | SUMMER 2019

We have known for some time that doctors are at increasing isk of violence in hospitals, with Emergency Departments at particularly high risk. The 2016 shooting at Nepean Hospital brought increasing hospital violence to public attention, and a roundtable of union and health representatives, including ASMOF, was tasked with coming up with a plan to address it.

“…far too many of our doctors continue to experience and expect violence as a normal part of their job.”

The resulting 12 Point Action Plan, endorsed by the Ministry, is now being scrutinised as part of a fresh review of hospital security, which has been prompted by further violent incidents at Blacktown and Nepean Hospital where staff have been harmed. In early December ASMOF met with the Hon Peter Anderson, who is leading the review, to discuss progress on the 12 Point Action Plan, and what still needs to change to make doctors safe. We will be following our meeting with a written response to the review. In 2016 we called for improved managerial adherence to zero tolerance to violence, amongst other recommendations, to improve the safety of our doctors working in EDs. To inform our advocacy we conducted a survey with 75 staff specialists working in Emergency Medicine and found that 93% of our members did not believe current anti-violence measures in ED were adequate. If we repeated the survey now, it is unlikely that we would see these results change significantly. Despite the Ministry’s ongoing commitment to zero tolerance, and the introduction of suite of policy documents and plans, far too many of our doctors continue to experience and expect violence as a normal part of their job.

ASMOF – THE DOCTORS’ UNION

ASMOF believe that urgent actions are warranted to address the ongoing risks to staff safety, including increasing the number of security staff in hospitals. In response to union pressure, Lismore Base Hospital will already see it’s security presence beefed up from Christmas eve. NSW Labor has also promised to make hospital security a priority, committing to employing an additional 250 security staff in its first term if elected, as well as:

“…our members do not want band-aid fixes, which is why the Review must also seek to address fundamental resourcing issues which see our EDs understaffed, overcrowded and without adequate space to de-escalate aggressive patients…”

• Upgrading all hospital security officers to “Health Security Staff” with additional powers similar to special constables who can carry weapons such as pepper spray and batons. • Providing extra training for Health Security Staff, including skills to defuse hostile situations. • Creating a specialist Secure Hospitals Unit within NSW Health to oversee the activity of new health security staff and conduct safety audits of the state’s more than 200 hospitals – including the 80 emergency departments. Whilst extra security for hospitals is certainly necessary and welcome, we know that it is only one part of a raft of changes needed. External and internal security audits already undertaken have revealed vast inconsistencies in hospital’s adherence to security policies, but recommendations are yet to be fully implemented. Recurrent funding will simply not cover the cost of implementing the safety improvements that are needed to ensure doctors feel safe going to work. We also know that our members do not want band-aid fixes, which is why the Review must also seek to address fundamental resourcing issues which see our EDs understaffed, overcrowded and without adequate space to de-escalate aggressive patients, and the state’s mental health and drug and alcohol services stretched to breaking point. ACEM have recently reported in their analysis of mental health presentations to emergency departments, that our health system is failing to meet the needs of a large number of people who seek help from EDs for serious mental and behavioural conditions. New models of care currently being implemented in Victoria and WA, which integrate mental health and drug and alcohol services, are one way forward for NSW. In 2016 the Royal Melbourne Hospital introduced a Behavioural Assessment Unit, co-located with ED, that provides a safe, therapeutic environment for behaviourally disturbed patients of any aetiology. A recent analysis of their BAU’s effectiveness has

NEWSLETTER | SUMMER 2019

found that it reduces the ED length of stay significantly, and result in fewer Code Grey events and episodes of restraint and sedation. The Royal Perth Hospital has also opened Urgent Care Clinics last year to treat patients with acute behavioural disturbances. If the Ministry is serious about making our hospitals safe and secure, we donâ&#x20AC;&#x2122;t need another strategy. We need to ensure the existing plans and policies are acted upon, and that the findings of safety audits are actually implemented consistently across the State including in rural and regional areas. With greater community awareness of the issues and a political appetite for change, now is the time to invest the resources required for more security and clinical staff, appropriate safety training, functional reporting systems, properly designed, purpose-built environments, and new, best practice models of care.

ASMOF - THE DOCTORS’ UNION

SERVICE STANDARD POLICY Earlier this year, Council adopted a new policy which defines the standard of service that members can expect when they approach the Union for information, advice or representation. The policy also includes members’ obligations such as providing the Union with all available relevant information, a positive collaborative approach between members and ASMOF staff, following ASMOF’s verbal and written advice and dealing with staff with dignity and respect. I would highlight one key Standard that is incorporated in the policy: • For all ongoing matters related to enquiries from existing member(s) the relevant Industrial Officer will communicate with the member(s) via email or phone call/message, at least every four weeks to keep the member(s) informed as the matter progresses. Thus, members who have referred a matter to ASMOF should no longer experience prolonged periods of no communication from their allocated Industrial Officer. Where members have issues with the service provided to them, they can refer the issue to the Executive Director (Andrewh@asmof.org.au) for review. The complete Service Standard Policy Statement is available on the ASMOF website at http://www.asmofnsw.org.au/180821_ServiceStandard.pdf

Dr Pesi Katrak, AM ASMOF (NSW) Council member

NEWSLETTER | SUMMER 2019

STAFF SPOTLIGHT ASMOF welcomes our new Policy Officer, Carolina Simpson. Carolina joins us from Carers NSW, where she advocated for greater recognition and support for family carers in health and social services. Carolina will be supporting ASMOF to amplify the voices of our members on a broader scale and respond to a wider range of consultations which have implications for our members and the public health system. Carolina will also work alongside ASMOF Council, staff and members to help shape an active agenda for health policy reform. What drew you into working in policy and what issues are you passionate about? In my final year of my Social Work/Arts degree I undertook a 6-month internship at the Australian Human Rights Commission in the Aboriginal and Torres Strait Islander Social Justice Unit. This was my first proper look into the world of policy and it was a great experience working with Mick Gooda and his team. I’ve carried with me the perspectives I learnt there and a commitment to keep Aboriginal and Torres Strait Islander equity in my mind through any work I do. I am passionate about mental health, not just accessible mental health services but the everyday living and working environments which support positive mental health. I am also interested in promoting gender equity e.g. through policies which support sharing of care responsibilities. What do you find most rewarding about working in policy? You don’t often get the instant, feel-good factor that you do when you work one-on-one with people, but there is also the potential to have a widespread impact. I think I have a natural tendency to think ‘big picture’ so I find it rewarding to work at that systems level. I enjoy facilitating opportunities for people to share their perspective. I am often the conduit between specific communities and governments, and you can provide a platform and collective voice for people who might otherwise not be heard. It’s an opportunity to inform governments and the broader community, but it’s also a role which can empower people to learn about systems and understand their rights better.

ASMOF - THE DOCTORSâ&#x20AC;&#x2122; UNION

What made you apply for the role at ASMOF? I was looking for a change in my working environment and a new challenge. I felt that the Union aligned with my values and that it would be a unique opportunity to advocate for a stronger public health system guided by the expertise of doctors. The role also has a strong communications focus which appealed to me as communications & media are a part of the role I really enjoy. What have you enjoyed most in your first month at ASMOF and what are you looking forward to? I have really appreciated seeing how active ASMOF are in fighting for members rights. ASMOF have a tangible impact on members from the everyday advice and support to the big collective wins, which makes me feel proud to be working for this Union. I look forward to meeting and speaking with more members to find out what is most important to them, as well as progressing some of the issues which have already been identified. How do you aim to achieve work/life balance? I work a 4-day week which goes a long way to help me achieve the balance between working, spending time with my family & friends and pursuing my own interests. I am aware this is a privilege that not a lot of doctors have! Do you have any hobbies you like to indulge in outside of work? I am one of those people that like to dabble in lots of thingsâ&#x20AC;Ś I love music and will usually see some form of live music once a week. I do weekly dance classes which has yet to result in any tangible improvement in my dancing abilities, but I remain optimistic! I also enjoy painting and am trying to paint more regularly.

Feeling the ‘Holiday Squeeze’ already? With 90% of households throughout NSW overpaying on the cost of energy*, there’s a good chance yours is one of them. That’s where Union Shopper’s partnership with energy specialists, Make it Cheaper can help. Through a 100% obligation free energy bill comparison, you could be making the switch and putting money back in your pocket over the holiday season.

Simply Click Here and upload your recent energy bill and one of Make it Cheaper’s Energy Consultant will call you to discuss your options. Otherwise, contact (02) 8880 1452. *Analysis across 3,523 individual business meters; Jan18-Dec18.

CONTACT UNION SHOPPER Phone Union Shopper from any where in Australia on 1300 368 0117 w w w.unionshopper.com.au UnionShopper Inc. is committed to compliance with the Spam Act, 2003. Your messages are never sent unsolicited. You have arrived on the Union Shopper Mailing List either by entering our competitions, submitting your details on our website, as an authorised person of a union member, or requesting more information about our service by email. To Update Your Profile, please LOG IN at www.unionshopper.com.au/profile. You can REGISTER at www.unionshopper. com.au/register. All use of the Union Shopper Services are governed by the Terms of Use located at our website at www.unionshopper.com.au/terms-of-use as varied from time to time. Please refer to those Terms of Use prior to engaging any service provided by the Union Shopper. All prives, offers and supporting information contained in this newsletter are correct at the time of distribution.

ASMOF - THE DOCTORSâ&#x20AC;&#x2122; UNION