'Silo effect’: Canberra doctors need more experience outside the ACT

Imagine asking urban planners and city councillors to build and run a city without having visited and experienced any other cities? Unfortunately, this analogy fits well into the situation for health care in Canberra. Many health practitioners here have had limited experience outside the ACT. This leaves our health system lagging behind some major hospitals in other capital cities. And the ‘silo effect’ contributes to the tremendous challenges in improving the culture of medicine in Canberra.

Many of our doctors train through medical school at Australian National University where their teaching is predominantly at The Canberra Hospital. When they graduate most of them work in Canberra as junior doctors, and many stay on as practitioners in the ACT. This is a good thing for Canberra as it has improved the reliability of our workforce, a workforce that is enthusiastic to live and work in Canberra.

However, in so many areas of professional life there are great lessons to learn from comparative experience in different locations. How does a junior doctor know if their medical system offers the best care unless they have experienced other models of care and different systems? How do we know what new advances in health care have been adopted without exposure to other systems? In NSW and Victoria all junior doctors will work through a variety of different hospitals through their training. It is impossible to train at one hospital alone. In the ACT this happens more routinely. Unfortunately, there are many examples of where contemporary health management practice have not been adopted in Canberra because our local system fails to appreciate the advantage of adaptation and change, in part due to inadequate local experience.

In early 2000 the NSW government recognised serious systemic problems at several hospitals in Sydney. Their solution was to integrate hospital training networks across Sydney and regional NSW, allowing skills, and different perspectives to be shared across hospitals with different strengths. This has been successful in improving quality of healthcare and working environments in many places. In the ACT we are at a significant disadvantage not having these established relationships with quaternary level hospitals to ensure we are doing our best locally, and appropriately referring our patients on when they need skills outside our area of expertise.

Having worked for years outside the ACT, in Victoria and NSW, I see serious systemic problems within ACT health. I also see many of my wonderful colleagues working hard to address this. I call on the government to crack open the silo that has been created in ACT Health, allow perspectives from other health system to formally help with training and patient care. We are a small region, and we should not assume we can provide all health care locally; this assumption detracts from the quality of our medical practice. Making this structural change to training and networks could revolutionise healthcare in ACT, improving the work environment, and the quality of medicine we deliver. By breaking the silo effect we can create a wonderful health care city for all Canberrans.

Dr Arnagretta Hunter is a Canberra-based cardiologist and physician.

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