It has been ten years since Targeting Zero, the review into hospital safety in Victoria that followed the deaths of several babies at Djerriwarrh Health Services in Bacchus Marsh. The report led to a lot of change across the state’s health system, and a decade later most of that change is still in place. What hasn’t moved as much is the way clinicians are prepared to lead.

When the review was released in 2016, it made the point that patient harm usually comes from the system around clinicians rather than from one person’s mistake. Since then Victoria has set up Safer Care Victoria, put more focus on how hospital boards oversee quality and safety, and improved the way health data is shared. These were important steps.

But the people who actually run wards, departments and quality programs every day are mostly still learning how to lead as they go.

How most clinical leaders end up in the role

In most hospitals, people move into leadership because they are good at their clinical work. A nurse who has been on a ward for years and knows how everything runs gets offered the nurse unit manager position when it comes up. An experienced allied health professional is asked to take over a team. They say yes, and from that point they are responsible for staff, rosters, incident reviews and safety culture as well as patient care.

Very few of them are given any real training for that side of the job. They learn by watching managers they have worked under, by asking colleagues and by trial and error. Some people pick it up quickly and others find it stressful for a long time. Either way, it is a lot to expect of someone who is also dealing with busy shifts and a stretched team, which is the reality in a lot of Victorian hospitals right now.

Why leadership matters so much for patient safety

Good clinical leadership is what makes the systems set up after Targeting Zero work properly on the ground. A reporting process only helps if staff feel comfortable using it, and that comes down to how their manager responds when something goes wrong. The same goes for incident reviews. When they are run well, the team learns something and the process improves. When they are run badly, people get defensive and the same problem tends to come up again.

Auditors looking at Victorian health services in 2021 found that some were still struggling to put their clinical governance frameworks into practice, and staff capability was one of the reasons given. That lines up with what many people working in health already know from experience.

Where education fits in

Training in healthcare leadership and clinical governance gives new leaders the skills they would otherwise have to pick up the hard way. The Australasian Institute of Clinical Governance (AICG), based in Melbourne, focuses entirely on this kind of education. Its courses are designed for people working in health, from those just starting to lead a team through to executives and board members.

A few things about how AICG approaches it stand out:

• Nurses, doctors, allied health staff and managers learn together, which reflects how they work together in practice
• The focus is on practical skills people can use in their own workplace
• There is a clear pathway from introductory courses up to board level
• Courses are developed and taught by experienced healthcare leaders

For anyone who has recently moved into a leadership role, or expects to soon, AICG’s online healthcare leadership courses are a good place to start. People who want a formal qualification can also go on to the Certificate in Clinical Governance.

Looking ahead

The goal set out in Targeting Zero, that no one should be harmed in a Victorian hospital when it could have been avoided, hasn’t changed. With a state election coming up on 28 November, there will be plenty of talk about hospital funding and waiting times. Making sure the people leading our health services have been properly trained should be part of that conversation too.