The equity issue

"How do we address the concern that practice owners don't acknowledge equity as an issue and don't invest in addressing equity issues?" 

This question was raised by a nurse during the recent Pinnacle nursing conference when the speaker was focussing attention on the importance of equity for all New Zealanders.  

Whilst this was a reflection on one practice, there was apparently "widespread agreement" from attendees that this was an issue in many practices.  

I have been asked to reflect on how to deal with this concern in my role as medical director, and am finding it a bit challenging!  

It must be awful to be working in a surgery where you believe your values are not being reflected by the practice team. A mismatch of values is a core reason for staff unhappiness and staff turnover in all businesses.  

Having said that, what I believe is happening here is an issue of perception rather than a mismatch of values.  

I believe that all owners and managers of practices understand equity issues.  

It is unlikely that anyone working in the health system believes that people living with disability, or those living in rural communities have ideal access to care. We know and understand that gender, age, language, all and any aspects of diversity result in different outcomes and inequities.    

Unless someone has been living under a rock for the past 25 years, none of us can have avoided picking up the fact that the health system significantly disadvantages Māori and Pacific Islanders.  

Outcomes for people from these communities are so significantly awful in comparison to others that it is shameful to our national identity and deserves to be called "the" equity issue.  

We all get this, owners, managers and staff.  

I believe we all want to do everything we can to address it. Not only do we want to do something about it, but our whole health system has been reformed with addressing "the" equity issue in mind. 

If any practice has not understood this, or is still of the mindset that "we don't have an equity issue, we treat everyone the same" - please let's have a cup of tea and a chat, I don't bite and would love to learn from you if you have solved this problem.  

If we accept that everyone of us in all of our teams wants to do the right thing, how can we address the perception that owners (and managers) of the practice "don't acknowledge this as an issue, and much less put money to it"?  

The key issue I think, is communication and understanding common values.  

Staff would be less likely to hold this opinion if they understood the values of the organisation they work for, could see they were aligned with their own, and that the people running the business of the practice are doing their best to address them. 

How do we get there?  

Firstly, think about the practice culture

Practices with a culture where staff are able to raise questions about mismatched values without fear of reprisal, where being able to have an open conversation with the practice manager or leaders within the practice are more likely to have common understanding across all staff.  

Secondly, have shared values and practice strategies  

Some practices have annual strategic planning meetings involving the whole staff. 

In these meetings they will consider core values of staff members, and the shared values of the practice team. 

Strategic planning will involve setting realistic goals for patient outcomes, for staff wellbeing, for health and safety, and for financial sustainability that match the values. 

Teams who are involved in setting values and goals are more likely to feel happy in their work. 

As an aside, owners should not be shy about discussing financial goals. Money is a sensitive topic and owners may not feel comfortable sharing the full details of practice finances with the staff, very few small businesses do this and it isn't necessary.  

General practice's part of the health system in Aotearoa New Zealand has always been reliant on the small business model, where shareholders get some return on their investment. This is nothing to be ashamed of or that we should hide. Owners getting a 10-20 per cent return on a very high-risk business investment is not only reasonable, it is essential for the practice to be sustainable. Some shareholders will want a higher return, some may accept a lower return.  

Staff don't need to know the details of the financial goals, but knowing the business is "on track" or "off track" can be helpful.  

Thirdly, keep your values and goals alive and visible. 

Many practices have a poster on the wall of the staff room, some have artwork in reception that encapsulates their values.  

Keeping the values visible using a common screensaver across all the computers can be helpful.  

Structure practice meetings around your values and continually refer to them in conversations with each other - it may seem a bit weird at first, but the least valuable shared values are those that are developed and ignored until the next strategic planning day.  

Practices that openly hold themselves collectively to account to their values are happier places to work.  

If your staff are carrying concerns like this, it is far better to bring them out, put them on a table and poke them around with a blunt stick for a while rather than leaving them to fester.  

Unhappy staff lead to unhappy patients and unhappy outcomes.  

So, how do we address the concern that practice owners don't acknowledge equity as an issue and don't invest in addressing equity issues?  

We talk about it and reach common understanding. 

Pinnacle has partnered with Diversity Works New Zealand, the national body for workplace diversity, equity and inclusion to provide training to our teams on DEI. Diversity Works exist to help organisations do workplace inclusion well, and do well because of it. If you are interested to attend a virtual one-hour session on 2 December, please email your expression of interest to learning@pinnacle.health.nz.