Sharee Johnson [00:00:13]:
Hello and welcome to Recalibrating with me, Sharee Johnson, where you'll hear healthcare professionals and others sharing their stories of recalibrating life when the unexpected happened. As a psychologist and a coach, I've been listening deeply to people's stories for 35 years and I've come to believe two things about people. The first is having witnessed so many incredible stories of hope, adaptability and human capacity, I truly believe that we are all capable of so much more than we really think we are in times of challenge. Humans have demonstrated that over and over again. Here on the Recalibrating podcast, you'll get to hear amazing stories of healthcare professionals and others pivoting, overcoming and recalibrating their lives. The second thing that the research and my experiences as a psychologist have shown me is that humans need each other. We need people. When we have support around us, when we tell each other our stories, when we connect through the reality of of living our lives, we do so much better than when we pull back and hide what's really going on for us. Together on this podcast, we're going to unearth and amplify what helps us as humans, individually and collectively, to recalibrate in ways that help us change, grow, adapt, even surprise ourselves when life throws us a curveball. This podcast offers you the chance to be inspired and and encouraged to meet the unexpected in your life with grace, skills and a belief in your own human capacity. Life is full of opportunities to recalibrate with agency, the right mindset, the right resources and the right community. Today, it's my absolute privilege to introduce you to Duncan Brown for what I know is going to be a very important conversation. Duncan has 20 plus years experience in organisational culture and development. In August 2022, Duncan's life was shattered with the tragic death of his 18 year old son Kewan, from a series of cultural and systemic failures in the health system. Duncan's grief is now a powerful source of motivation to enhance patient safety and improve the quality of care in a meaningful way. Since the passing of Kuhn, Duncan has been focused on healthcare environments to ensure the needs of those providing care are considered. His research explores the role of the care environment in the quality of patient care and safety. He is actively involved in Prosocial World and we'll talk quite a lot about that, so you'll get to learn about that. Looking to combine his research with the process of conscious cultural evolution to enhance the cooperation and collaboration and strengthen an organisation's capacity to respond to complex adaptive challenges. Now I know that Sounds like a whole lot of big phrases and words, but I assure you, Duncan and I will help you think about these big ideas. He's a non executive executive director of the Multicultural Community Council of Illawarra and a subject coordinator and lecturer for difference and leadership in Charles Sturt University's Master of Social and Organizational Leadership program. Duncan is currently the co chair of the Global Sepsis Alliance, Families and Survivors Committee, providing a structured platform to collaborate, share best practices and amplify the voices of sepsis survivors and families. Duncan, welcome to recalibrating with Sharee Johnson.
Duncan Brown [00:03:54]:
Thank you so much Sharee. Thank you for inviting me.
Sharee Johnson [00:03:56]:
Oh, I'm really looking forward to that.
Duncan Brown [00:03:59]:
Sounds like a lot that you read there.
Sharee Johnson [00:04:00]:
It does sound like a lot. I agree. I'm sure we'll have some somber moments and some fun. So Duncan, you worked in the financial services industry for a long time and it's fair to say today that you work in healthcare. I wonder if you'd tell us a little bit about your working life now, including the study that you're doing in your professional doctorate.
Duncan Brown [00:04:19]:
Sure, yeah. I think getting into finance, financial services industry for 20 years, if I look back, I wouldn't have chosen that. You know, it's one of those things that you studied accounting and law at university and that gets you a job and that job gets you the next one and then, you know, 20 years later you look back and I suppose, oh, this is what I do. So I left at the end of the day 2019 to start study and research. And that was in response to the Royal Commission into financial services misconduct. I was fascinated by this idea of good people because I knew good people doing things or making decisions that were not aligned to who they were personally. So I was fascinated by that. So I started researching around morality and how it influences culture, corporate organizational cultures influence, all of that. And it was going well. And then it was about two years in when Kuhn passed and so that, that shifted, shifted things completely and obviously for a year or so didn't do anything, but then got some very strong messages to say, you know what, you need to carry on with that study. Because what I was looking at was actually very similar to what we had experienced in the cultural perspective. And so that's, that's how that study has come about. It was easier not, not getting sort of full time employment as such, but being a sessional lecturer and doing contract stuff here and there so I could have that flexibility to be able to, to carry on with the study and the research and that's been fascinating for me because it's given me, I've had some variety and I think that is what I needed. I suppose I got to a point where I said, I don't know if I could ever go back into that sort of corporate world because what I thought was important to me just wasn't anymore. You talk about how defining moments in your life, you just go, wow, what was I thinking? So, you know, that sort of industry doesn't. Has no meaning for me anymore, which, I mean, I have huge respect for the people who work there and I've got some great friends in there, but I just, I couldn't. And also the, this idea of having four weeks annual leave and having to ask permission to spend time with your family, those sorts of things. I don't know if I can go into that again. You talk about my last sort of work time has been very much about flexibility, being available, being able to do what I needed to do at that time. And that's been part of the healing as well. Yeah.
Sharee Johnson [00:07:07]:
Let's go back a bit to just for a bit of detail into all of that. You told me some very interesting things when we were getting ready for the podcast today about your previous working life. You didn't grow up in Australia. Can you give us a little bit of the backstory of Duncan Brown, where you grew up, how you moved countries, a little bit of those, those stories?
Duncan Brown [00:07:24]:
Yeah, absolutely. Talking about defining moments in your life. And I've had a few of those really. So I was born in South Africa and early 70s and lived there in the heart of apartheid, which is probably where my journey started. Going to public school, you were taught segregation, you were taught racism, you were taught all of those things. And I was very fortunate. I know more progressive parents, which was fantastic. From the uk so myself, my two brothers went to a all boys private multiracial boarding school. And probably the most defining moment in my life at that time, I was 11 years old because I met some people, some great friends and we're still great friends. And I went, you are nothing like I was taught back in those days. When you're 9, 10, you know, you don't question it was in the classroom. And then I went, no, that's all wrong. You can see now I'm part of the multicultural side. I lecture on difference in leadership. It just became. I went, no, that is not what it's like and that is not what it's about. And so that was, I had one of those really defining moments at 11,
Sharee Johnson [00:08:37]:
was that unusual, Duncan, to have a multiracial boarding school at that time.
Duncan Brown [00:08:41]:
Absolutely. I mean, there were a few around South Africa, these private all boys, all girls sort of boarding schools that were multiracial. But yeah, absolutely. This was, you know, early 80s.
Sharee Johnson [00:08:50]:
I feel encouraged even to learn that they existed at that time. There were people in the world who had a different. That had a different view and were able to somehow express it.
Duncan Brown [00:08:59]:
Yeah, there were private kids, came from all over Africa. It was in an environment where there was complete separation. Black schools, white schools, complete separation. So it was. I'm so grateful for that because that shifted my view completely. Was not necessarily confronting, but it was one of those moments where you go, how can I, how can I be so wrong? I mean, I was only 11 at the time, but it was just like, wow, you know, and then it's fascinating to have that experience that has clearly shaped my worldview and the way I approach things. And that's what I'm involved in now. It's just part of my identity, I suppose. So, yeah, we traveled a lot, the usual thing from South Africa, once you've finished university, you go and do a couple of years in the uk. I parents were British. I had my UK passport, which was great. So went over there and that's where I met my wife. So the usual story, you know, 12 South Africans living in a three bedroom house, you know, sort of thing. And.
Sharee Johnson [00:10:00]:
And I think the Australians had that idea too.
Duncan Brown [00:10:03]:
Yeah, we had a couple of. Back in the day, we did a lot of traveling and came to Australia in 99. We backpacked around Australia, went back to South Africa, thought that's what we were missing and just didn't have the same experience in South Africa, just in terms of the violence, the crime. And we thought, well, you know what, we can get all of this in Australia. So we never left because anything happened to us, which is often the story of many South Africans. It was a case of you're giving up some really fundamental rights to have a good life. And so we left. And while we were waiting for our residency status, we managed to go to the Caravan Caribbean for four years. So that was, that was great. Loved that. And I look back now and I go, why did we leave? But we did. And as I said, I think I was telling you earlier, Kieran lived there for the first two years of his life. That was like, he was the. He, the real village kid. Like you would take him to a bar and you just plonk him on the bar. You know, remember those little bombos the kids could sit on.
Sharee Johnson [00:11:03]:
Yes.
Duncan Brown [00:11:04]:
He would just be passed around and we'd fetch him at the end of the night and an incredible life. And then we left. Then came to Australia 2006 in Melbourne for six years and you were working
Sharee Johnson [00:11:16]:
in the finance industry and I think you said you were working with PwC and your wife was working on a yacht when you were in Caribbean. So that's also pretty interesting.
Duncan Brown [00:11:25]:
Yeah, it was good. She used to cook on that, used to do the weekly charters and then got a job on the island with the yacht charter company and so. Oh, it's one of those life. You go really like, wow, that was us. Yeah. Why. Why would you leave? Why would you do that?
Sharee Johnson [00:11:39]:
So you told me that you were coming to Melbourne or you came to Australia because you thought you should get more serious about life as young parents now with children and responsibilities. So then life carried on on the train tracks of do what we're supposed to do now, get our children into school and. And so on.
Duncan Brown [00:11:54]:
Yeah, yeah. It's amazing how that is important. But you know, we probably didn't need to do it as early as we did, if you know what I mean. He was 2. We could have probably waited a little bit longer. But I suppose you've also got a way up starting a new life in a new country. You certainly don't want to be starting from scratch at two later stage.
Sharee Johnson [00:12:14]:
There were lots of recalibrations, weren't there? The different weather environments and the different communities that you were living in and the two having two incomes or working out who was going to work or who wasn't going to work. There's a lot of those things in our early life, in our 20s and our early 30s, I think that still exists. Certainly when we think about our healthcare workers, they're rotating through different hospitals and moving off and moving, moving towns or states to get onto a program and so on. So that's very much a part of that phase of life. When you look back now at this phase of your life, to that younger you, what do you notice that you learned or that you still bring with you as things that orient you in the world.
Duncan Brown [00:12:53]:
When I look back at that time and you don't realize it when you're in it because you just focus and you need to do things. I was reading about something about. I knew you would know. Is it. Is it the six or seven most traumatic things that can happen in a life and it's changing a job, having a baby, doing all of this stressful rather than Stressful. And we realized that we had done, I think, all five or all six. So we changed country. My wife was eight months pregnant when we arrived, bought a house, started a new job, all within a few months. And we were able to navigate that. We were able to pull through because that's what you knew.
Sharee Johnson [00:13:39]:
You had some skills, didn't you? And you also had the support of each other. You were doing that together. Was that important? Was that helpful?
Duncan Brown [00:13:45]:
Oh, absolutely. You realize that not any one of those moments you could do without that support. I think it was really, it was just understanding that we were both trying to achieve this. It wasn't me dragging Joe along or Joe dragging me along or anything like it was a case of, right. This is a decision and it makes sense to both of us. And it's a journey and a vision.
Sharee Johnson [00:14:08]:
Each day had a different perhaps vision, but there was a sort of vision, a reason to something that you were imagining was going to happen if you made this next step.
Duncan Brown [00:14:18]:
I think that is important, you know, that is important. As you say, we talk about being in the moment at present and what's happening now and not, not necessarily spending today planning tomorrow because you're going to enjoy today, but, but just understanding that there is something that you're working towards that was helpful. It wasn't. Not easy along the way. Very, very fortunate to be here. And it's worked out really, really well.
Sharee Johnson [00:14:45]:
What do you notice in a sort of general kind of way, and we'll get into these specifics as we go along, but what do you notice generally about the industries, the industry of finance and the corporate kind of world that you've learned about the healthcare industry? Are there things that have surprised you? I know when I started working more deliberately inside of health, as opposed to just having counseling clients who came from different industries, I was really surprised by a number of things. Are there things that you think, gosh, this wouldn't happen in the finance sector or the other way?
Duncan Brown [00:15:17]:
It's difficult to say because when, when you're in it, that's all you know at the time. So nothing was unusual. Each job that I, that I went to, what I observed, nothing, nothing was unusual at the time. Right. It was a long stage, was 12 and a half years in the financial services until end of 2019. It's when I left and I was doing my research and I was at home and I had all of this time to myself. And that's when I realized, as I said all those things that I tell you what. No, let me. Let Me go back. What was, what was absolutely critical, hugely defining for me. Prior to me leaving, there was a change in the senior leadership. So I've been with a senior leader group and the CEO resigned and a new CEO came in and progressively the CEO restructured, disorder came in and sort of got rid of everything that was related to the previous senior leadership. So I had given 12 and a half years. I was dedicated, loyal, and was told one day you are no longer needed. Complete restructure. And that really rocked me. That really, really rocked me. All of those core values of dedication, loyal commitment, that actually doesn't mean anything. It was a real defining moment to the point where I got, I got stuck in that resentment every time I would read about this organization or see something. So I actually went and spoke to someone about it and they took me through this journey of making me realize that it wasn't actually my capability. It wasn't necessarily as a result of me. It was that these things happen. And he was absolutely incredible because he gave me case studies. He's going to read this case study of this particular leader and then he goes, draw some parallels. And then we would discuss that and that realization of, yeah, there are leaders that do that and it's happened elsewhere. And then he quietly introduced me to Paul Atkins. And that's how I got in, in 2020, into pro social, through that and read the book. And I went, this is where I need to be. It was a really interesting time.
Sharee Johnson [00:18:09]:
I think it's quite a beautiful reflection that you are able to describe that you got stuck in the resentment that, that there was a series of events, part A, and then there was the learning of a new way, a different way, another kind of world, part B. And somehow you needed to be able to move between understanding the world of part A to looking at the world as part B. And that there was. You had to make some mental changes. You had to understand the world differently to get to that place. And your, your story also describes as someone else who helped you. There was someone who in a way is a bridge or creates. Helps you construct your bridge to get from one understanding of how the world works to a new understanding of how the world could work.
Duncan Brown [00:18:56]:
He was fantastic and really just asked the right questions, didn't do the work for me, which was amazing. Would go right, oh, I understand. How about you go and read this until if there's anything that strikes you there. He chose these things that were absolute examples and case studies of what I was experiencing. Because my big thing, you know, being in that resentment wasn't a case of, oh, you've got rid of me and you shouldn't have done that. It was the conflict with my values of, as I said, commitment and loyalty, going, will I ever do that again? So my next 20 years, am I ever going to be committed, loyal, dedicated, or is it just going to be a job? And I went, that's horrible, because that's not, that's not who I am. I. I invest fully. And then I went, I can't go through the next 20 years just doing a job because I'm too scared to give myself. And that's when we started going down that pro social route and then went, right, yes, pro sociality, and how do we embed that? And that's the journey that I've been on ever since.
Sharee Johnson [00:20:15]:
Put Paul's book and some of these resources into the show Notes. Before we get there, let's talk about Kyuan. You were having these things happen at work, in work and, you know, some identity shifts or some, some general kind of review of your own life that some of the things that we do in midlife. Where am I now? Who am I now? And then Kieran becomes very unwell unexpectedly. Can you, can you share that story with us, Duncan?
Duncan Brown [00:20:45]:
Yeah. It happens so quickly, Sherry. That's the thing that is hard to get your head around, even still. I mean, he was, he was incredibly fit. We were actually living in the Southern Highlands at the time in New South Wales. He. He was incredibly fit, played state hockey at school, got into. Into football. Quiddite, for whatever reason, was passionate about that. So finished year 12 and 21 in 22. That was going to be sort of. He was only turned 18 in January 22, and that was going to be a year of dedication to football. And. And because that's where he was going with the plan of playing college football in 23. And it was one week. He went to football practice on the Monday and then on Tuesday said, oh, I'm not. I'm feeling so good, I don't know what's wrong. And that was fine. He actually, he went to the local coffee shop and he would phone on the Tuesday, phoned my wife, Joe, and said, oh, got a real headache, you know, or not feeling well. Have you got some. Some stuff? So she went and I think she gave it to him. And then he stayed at work. And this was the Tuesday. On the Wednesday, he said, I'm really not feeling. I feel very weak. And then Wednesday afternoon, diarrhea started, vomiting started, and then the cold shivers Hot, cold, hot, cold. And, and then Thursday morning again vomiting, diarrhea right the way through the night. They went to emergency at 6:30 on Thursday morning, seven and a half hours and discharged with, you know, diagnosis of gastro and was given Neurofen and Panadol. You know, when you're not medical and if you can get those drugs, you know, from aisle three at Woolies, it's a clear sign that that is okay. Now if the prescription is Neurofen and Panadol and it was interesting because he never, he never necessarily improved and those obviously too helped a little bit, but he didn't deteriorate, so he didn't deteriorate, didn't necessarily improve. And then Tuesday morning it all deteriorated. He was gray. So later that afternoon couldn't get him to see the gp, unfortunately. But then Joe took him straight there and said, I have to. They immediately took one look, called the ambulance and two and a half hours later he was dead. Literally Tuesday to Tuesday.
Sharee Johnson [00:23:29]:
Yeah. So a week in, one week from
Duncan Brown [00:23:32]:
being at football practice the day before. I mean, it's actually just you sit there and you go, wow. It wasn't nowhere, nowhere in any of that does that eventual outcome ever cross your mind. Oh, wait, did any of us ever think, you know, sometimes you, you either have an illness or you're in an accident or you, you might pull through, you're not doing this was, oh, you sick. Oh, but it flew a bit of this and then having the discharge on the Thursday. Oh yeah, you'll be fine. To go from that to he's gone. That, that was, that was huge.
Sharee Johnson [00:24:16]:
Yeah, it's, it's, it's incomprehensible that notion. I think most parents would have had an experience where, you know, I'll have a Panadol and go and have a sleep or you know, come home and have a rest or, you know, we don't, we don't leap to these grave outcomes that can happen. Can you talk us through Duncan a little bit about the seven hours, seven and a half hours in hospital on the Thursday? What, what was happening was were you sitting, waiting to be triaged? Was, was, was Kuan on a bed? What was actually happening in that time?
Duncan Brown [00:24:51]:
A full seven and a half hours was in the waiting room. He never left the waiting room. Look, I, I know you have doctors and nurses listening and I've spoken about this a bit and I never mentioned place. I don't mention it, but I don't talk about. Because they are good people there and if I do, they will get, you know, but. And that's when we can talk about some of the cultural and systemic issues that we found that he met two yellow sepsis flags. Blood tests were done. Results that were done were probably not red because that was another red flag. And he was getting so weak that he would go and line the car and then, and then my wife will go, hey, back now you can come back in. But he was triaged Category two when, when he arrived, but it was only three and a half hours later that a doctor actually came to see him. And you don't know what's happening at the time. Right. And you realize that when you, when you get this horrific report, you know that junior doctor unsupervised, hadn't done any of the ED orientation learning modules. The senior doctor who was meant to oversee patients because she was a standard one or status one, workload pressure prevented him from physically. So, you know, and an important point that was in there, we talk about a cultural thing. The report said that the junior doctor gave false reassurances. And then you go, why do you feel you need to do that? Or did they give a reassurance that turned out to be false? Or. I wasn't too sure of that wording, but it was really fascinating that, that interaction.
Sharee Johnson [00:26:54]:
Duncan, when I've heard you speak about the logistics and what was the environment, what was happening that day, I can't remember what the numbers were, but I think you've made a comment before that that particular ED was set up to handle X number of patients in a day and it was actually fielding twice as many patients as what its capability was. Is that.
Duncan Brown [00:27:12]:
Yeah, right. Because I found that really, really interesting. So in the report they spoke about having a full complement of clinical, non clinical in the night. I'm sorry, and the next day. Yet workload pressure and the timeline. So a question, I said, so what is the, the capacity of that unit? And the interesting thing is that you can't necessarily manage capacity because you're not in control of what's coming in the door. You can't just go, we've got 10 doctors, 10 nurses, we can see 20 people, 40 people. We're stopped, you know, and, and so what was happening is they must have been 50 odd people in the emergency and it probably should have only been 20. When you've got emergency departments doing primary care and when a category two waits three and a half hours, if you've come in there for stitches, I mean, you shouldn't be there. But, but I think that's that's been the biggest impact. And you could just the stress on those nurses because the people having a go. And I've been waiting for so long, I've been this and that. And you could just see the frustration playing out almost to the point where they were, they were unapproachable, you know.
Sharee Johnson [00:28:37]:
Yeah. I really want to acknowledge this, that you just pointed to that the nurses and even any, any clerical staff that were there and the one junior doctor in that environment, they're almost set up to fail. And I mean, gives me chills to think that will actually. And it did fail. It did fail for your family. How can we be continuing to endorse or allow these systems and units to operate without the surge capacity or the kinds of things that they need in order to provide the care that we say as a community, we want them to be able to provide? I think these are very questions. I know you thought a lot about them.
Duncan Brown [00:29:17]:
I mentioned that I wrote that junior doctorate a letter afterwards.
Sharee Johnson [00:29:22]:
Yes.
Duncan Brown [00:29:23]:
Yeah. Because I, having read that report around, hadn't done modules, hadn't done this. And, and I went. The way it was worded was, was they seem to play a lot of responsibility on the junior doc. And I went, no, that, that's, that's unfair. That's unfair. The, the environment in which he was working created this. I said, so she's on a shift in ed, not having done already. That's not her fault. A lot of it wasn't her fault. And so, yeah, we just wrote it there to say, look, we don't. You're young, we don't hold you accountable. You know, you, you were let down. And I think that's an important point is, is that you've got these guys trying to navigate when actually the system put her in a position that is, I think, incredibly irresponsible and unfair.
Sharee Johnson [00:30:15]:
I've coached doctors who've left systems because of that, both junior and senior, senior doctors, where they've left hospitals because they feel unsupported and unsafe, unable to provide the support that needs to be provided to those reporting to them, and junior doctors too, where they've said, I can't stay there, there's no senior doctors. It's not safe. It's not safe for the patients. It's not safe for me. And they're in distress. It doesn't matter if they're junior or senior, if they're in a situation where they feel like they can, they can't provide safe care, they are operating under, under significant stress. And I would Actually say in distress some of the time.
Duncan Brown [00:30:52]:
Yeah. And you've got the outside authorities coming in going, you need to be more compassionate, patient, more kind. You need to be. We don't take into account the expectation you're 17 hours in, but gee whiz, hey, you, you need to be smiling. You could have done that night. And you go, wow.
Sharee Johnson [00:31:10]:
Yeah, yeah. Can we, there's a few things to pick up here, Duncan. Can we, I want to talk a little bit more about Q and if we can, but before we do that, can we talk about sepsis a little bit? Because not everybody listening understands that language. So just remind those who don't know and if you're a healthcare worker and you do know, stay with us because we know that we need refreshing. Everybody needs refreshing, don't we, with some of this stuff. So can you tell us about what you've learned about sepsis?
Duncan Brown [00:31:36]:
Well, what I've learned is a lot of people don't know about it. That's, that's the biggest thing I've learned both from, you know, parents, but also in the medical field as well in terms of the clinicians actually recognizing and diagnosing and going down, down that treatment path which, which I experienced when I, when I joined the health service. I think for, for people, for parents, you know, it's only afterwards I've never heard of sepsis either. And then I read and got involved and it's just so obvious like, like we, we saw it, all of those symptoms, you know, the vomiting, the diarrhea, the mottled sort of gray skin. And interesting. One of the symptoms is you feel like you're going to die. Actually asked my wife that, she said, mom, do you think I'm going to die? And what's the mother's reaction again? Of course not. So you look at that, those symptoms. Now those symptoms manifest because sepsis is your body's reaction to the infection. And so instead of attacking the infection, it sort of attacks the parts of your body.
Sharee Johnson [00:32:49]:
We just take one step back, Duncan, just to say that sepsis is in fact blood poisoning really, isn't it? Your blood is poisoned within, has an infection, infected blood, if you want to say it that way, it's probably a very non medical way to say it is traveling all around your body.
Duncan Brown [00:33:03]:
Absolutely. And it's your body's reaction to it and impacts the organs. And then 11 million people a year
Sharee Johnson [00:33:12]:
have sepsis or die from sepsis, from
Duncan Brown [00:33:14]:
sepsis in the world. There are more people around the world dying from sepsis than all of the cancers combined, it's really, really hard sometimes to, to detect it. Some hospitals are still struggling to embed pathways and treatment programs. What I have found though is on working with sepsis groups and working on designing pathways, there's just still a lot of debate, there's still a lot of debate what the treatment is. And the question is, right, why is it that it presents and often they diagnose and comes out as gastro. And I said, paul, but it could also be sepsis, because the same. Yeah, so we'll treat the gastron. If you deteriorate, then come back as opposed to why don't you treat it for sepsis and go down that route.
Sharee Johnson [00:34:01]:
Is there a low cost, standard blood test? I'm listening to you think I need to get any doctors who are listening, who want to come in, educators about sepsis. We'd love to hear from you. Please come on the podcast.
Duncan Brown [00:34:11]:
I'd love to hear. Yeah, because it is not something that I, that I, I understood to you and I to be logical. Ego, right. If you suspect it, why would you not enact a pathway? There's all sorts of reasons why you don't, clinical reasons why you don't. And, and, and I appreciate that and I accept those. But the reality is that a lot of people, too many still dying from sort of undiagnosed sepsis potentially is tropic. But you know, if it gets to a point, post sepsis syndrome is horrific as well. And you know, amputees, I mean, there's another defining moment. One of my first meetings with sepsis Australia online, there was 10 of us and it was my first one. We shared our story and there was a mother there who's 2 year old had lost all fingers and toes. And then we got introduced to the quad squad and there were these four people there that quad amputees and I mean just incredibly inspiring people. After that meeting I, I literally broke down because nowhere did I ever contemplate Q in surviving this because he was a sportsman, that's what. And I went, I can't imagine Kuhn not being able to throw a ball, catch a ball. I wouldn't want that for him and he wouldn't want it. And it was, it was this. Him not being here anymore was actually the best outcome for him. And that was an enormous realization for me. To go, so all of this heartache, all of this I'm going through is because I physically want to see him, but actually he's in the right place because the alternative would have been worse. For him, better for me, worse for him. That was a. There was a lot I had to go through there.
Sharee Johnson [00:36:15]:
You're talking about huge identity moves in your own psyche and in your own being in the world. And you know, the psychologist in me could spend a long time here.
Duncan Brown [00:36:27]:
Bloody fabric. Wow.
Sharee Johnson [00:36:28]:
And also I'm noticing in myself this deep gratitude for these moments where we do reorient, where we find a new thought or a new experience or we meet, we have an interaction with another human being. I think these are very human experiences that shows us another way or shows us another way to think or believe or be in the world that, that allows, you know, a growth. This post, this post traumatic growth kind of process where, you know, you're still missing Kiwan, everything still distressing, it's still outrageous. Horrible thing that's happened in your life that you wouldn't wish for. And at the same time you can have this really powerful expression of parenthood maybe that I want. I want what's right and best for my son. And this is a whole new reframe, a whole new way of holding this.
Duncan Brown [00:37:27]:
It's. Yeah, you've got to take some positive out out of it. I think I'm a fundamentally different person to, to what I was, you know, before Kieran. And I think I'm a better person because I think I'm able to connect with people at a much deeper level and quite quickly because there is no human emotion that frightens me anymore. Like, I'm not frightened of offending you. I'm not scared because the worst that could possibly happen has happened. So, so anything in comparison to that. So I'm happy to share my story and talk about deep stuff and crying and, and because that's who I am now. And, and, and it, it allows me to connect. And none of this is no time for the superficial stuff and we walk away. Go, oh God. And. And I've enjoyed that aspect of it because I've got to know people at a much deeper level than I would ever have imagined, you know, imagined going to before because. And doing that actually is actually healing. It is healing.
Sharee Johnson [00:38:43]:
I feel like we should just have a moment of savoring of what you've just said. You know, that this full, rich experience of emotion, you know, the acceptance, commitment, therapy idea of a rich, full life involves all of the emotions. And that's really what you've just described, that you've been to hell and back, that you've had every emotion that a body can experience is the loss of your son. The Sudden loss of your son in a way that the reports said this death was avoidable, really leaned in and experienced and fully felt all kinds of emotions. You were saying, and I have this really rich, textured life.
Duncan Brown [00:39:24]:
Yeah. It's not a lap I choose, if you know what I mean. It's my response to it. I think that was an incredibly hard thing. So. And I'm not, I don't in any way want to diminish the grief and the loss of somebody through an accident, but you can almost reconcile that. And I don't know if that's the right word, but when you read a report that workload pressure prevented this and his death was entirely avoidable and everybody has it, that's different, you know, and, and, and so there is an anger. You go, wow, okay. He pays the ultimate price. We have to live with the consequences of workload pressure and junior doctors, you know, been put in, in vulnerable positions unfairly. And now I have to live with that for the rest of my. So, so I don't ever want to be an angry person. And you know, I think we've spoken about that where I needed to do something with that anger and, and, and that's when I, I went to go see again. You ask who helped me, who helped me? And there's this beautiful lady, Maureen Callister, kinesiologist, and she's just come out with her first book, which is amazing, the Gift of Self Worth. She talks about rewriting your not good enough story. And she said something defining going, you, you need to carry on doing what you were doing because there's enough protection for others. And I was thinking about that, and that's when I realized that there was meaning in the work I was doing around that, that culture and that protection for others is beyond patient advocacy. It made me realize that we are not going to improve the quality of patient care until we improve the work environment or the quality of those that are giving the care and expecting people just to be better and smile and be compassionate. And I mean, there are some patients that are, you know, it's fair to say there's some not nice people. And, and yet you have to. But their work environments are, are unreasonable related to the expectations or the outcomes that, that are being expected. And so I realized that the only way that will improve the quality of care is, is really helping those that are giving the care and making it better and easier. And so that's when I picked up that research and I went, right, I'm going to run with this now because the Role of the care environment. It's not the individual that needs to be better and go on more leadership and you need to. The environment plays a significant role.
Sharee Johnson [00:42:34]:
I think we share something here in our experience and it's what struck me the first time I heard you speak about Kieran's death, that we might start from a place of patient advocacy or what it's like to be a carer or family of. Of a patient. But we've both ended up with this more systemic view. And certainly a lot of my work is still with individual clinicians, which is there is a difference there in our work. But this idea that clinicians can make change and deliver change if we're addressing the conditions and the environment as well. Let's move to your research. I want to pay my deep respects to you and join and your daughter. With the loss of cure, it's unfathomable. I feel like I could just burst into tears and we could stop talking right now.
Duncan Brown [00:43:24]:
Studying the research. This is his legacy. This is. This would never have come about.
Sharee Johnson [00:43:29]:
Well, yes, and it's. I. I understand that very deeply. I wouldn't be doing what I'm doing if. If we hadn't lost him either. These are conscious choices. We make a conscious choice. And you're role modeling that unbelievably well, Duncan, you know, you made a conscious choice very early on to not name individuals, to not name organizations to say how can we be useful? How can we add something? How can we help this be better? I just think that's a very powerful example of active intentional choice. And it's really demonstrating the pro social ideas, which I know I keep saying we'll get to them. We will. But before we get there and deep respects to Kyun, this episode will be in his memory. We want to dedicate to him and to all of you, let's talk about your actual research and what you're finding. And I'll probably interrupt you a couple of times to keep breaking down what it means for people who haven't heard these ideas before. But tell us about your inquiry into healthcare and what you're finding in your study.
Duncan Brown [00:44:35]:
Where it started was just assessing the overall environment. I could see things were. And even in that report, things were captured. Where you go to. It doesn't look like a healthy place where people you know are asked who did this? You don't have that in place, you know. And so what it made me realize was as a health clinician, as a nurse, as a doctor, your perception of. And you mentioned it earlier where people have left because they didn't have support. So that's what was my starting point, was to go, your perception of whether that hospital cares about your health and well being must influence the behavior that you adopt. Now if you care about me, and I know that, and I truly believe it, then I would be inclined to be more kind to you. But if I had the opposite impression, that was my starting point to go right, what do these guys actually think about the hospitals and the workplace? Let's look at that. And then where does that go to in terms of citizenship or some sort of deviant type, maladaptive type of behavior? Does, does it influence it? Interestingly, from the data, your perception, my perception of the work environment, my perception of whether you care about me didn't have a really significant direct effect on whether I behaved well or I behaved badly until I looked at entering basic psychological needs. That is where the key is that sense of I know you care about me, I know deeply that you care about me and I truly believe that. But I'm not going to behave kindly or nicely because I'm so deeply frustrated. You say you care and I believe that you care, but why do I feel like this? Why is the environment like this? Why am I frustrated? And it was only until we entered the satisfaction of basic psychological needs and the frustration. And what was fascinating is that they are two very, very separate things.
Sharee Johnson [00:47:09]:
That is so important, this inquiry. Can you just, for people who don't know what the three basic psychological needs are, just say what they are, please?
Duncan Brown [00:47:16]:
So basically, I mean, comes from self determination theory, your basic psychological needs. You've got to have a sense of being in control, having choice, autonomy. You are your own being. There's a competence need, the sense of adding value, being valued, that you're making a difference. You need to feel that. And then there's a relatedness need. You know, we often talk about that sense of belonging, that you're actually part of something and you're accepted. We are very social, aren't we? So those three basic psychological needs sort of influence the full development and optimal functioning. Now any one of those that are not necessarily fully optimized has an impact on the way you perform. And I want to perform your job, performing as a human, you know, and then what has been identified is that you can be fully satisfied or you can have low satisfaction and that is a continuum. But actually you can be deeply frustrated and that changes behavior completely.
Sharee Johnson [00:48:27]:
Just pause there, Duncan. What I think you're saying is that one single human person can have in their own experience at the same time a sense of satisfaction and a sense of frustration. So for instance, they can be satisfied about their competence level in their job at work. They can feel skilled and competent and able, and they can also feel frustrated by their lack of autonomy and decision making that they have to check something or get something approved or whatever all the time. So they can hold both of these things at the same time. Just, just for beginners, for the people
Duncan Brown [00:49:01]:
who are starting Absolutely.
Sharee Johnson [00:49:02]:
For the first time.
Duncan Brown [00:49:03]:
Yeah, they can coexist. They can coexist within you. They can be experienced together. And that combination can then manifest in a combination of good behavior and bad behavior. So you will see people doing the right thing, behaving well, cooperating, but at the same time engaging in poor behavior. And it's that process that being played out. It's not a case of if you see poor behavior, I think there's a tendency to look at the individual go, oh, bad person, you know, what's wrong with them? Actually, it's a product of that environment and the factors that exist there. There'll be critical factors in that environment that either promote the satisfaction of needs or need thwarting in the sense that are suppressing that satisfaction. Now, that frustration is not the same as low satisfaction. I think that's an important point as well.
Sharee Johnson [00:50:10]:
Help us with that a little bit more.
Duncan Brown [00:50:11]:
Let me go back a bit because when this data first came out, I went, oh, this is counterintuitive. This doesn't. How does this work? And how does high frustration also link to the demonstration of citizenship behavior and good behavior? Like how does that work? You'd expect it to be more, I'm frustrated, so I'm going to behave badly. I'm satisfied, I'm going behave good. Right. And then I started thinking about what I'd actually observed and in the last year and a half and it's sort of started.
Sharee Johnson [00:50:42]:
Sorry, I'm going to interrupt you again. So go back to tell us about your data. Who's the sample? How many are they and what do you ask them? What did you actually ask them to do so that you could find these measures?
Duncan Brown [00:50:53]:
So remember I was saying that frustration is different to low satisfaction. So satisfaction, you highly satisfied, you behave and you're fulfilled. When there's low satisfaction, you find the behaviors man, like people withdrawing. You might find poor handover notes. You might find little things like that. The care factor isn't necessarily there anymore. But when you step into that frustration part, then you see behaviors that are potentially more deviant in publicly humiliating the organization or doctors or interpersonal conflict. And it just takes that little bit more ugly turn. So where this data came from, I was very fortunate to get a role in a public health provider in Victoria in patient quality and safety. And so when I was there I got to know a lot of people and do a lot of chatting and managed to collect data from across their public service. So clinical, non clinical Doctors, nurses had 292 responses which was amazing. How I ended up there, that's another story how I ended up with the research. It covers all roles, clinical, non clinical senior, down to, to team member age groups and, and all of that. What I've been able to do is look at, create this profiles. You spoke about how you can experience satisfaction and frustration at the same time. So there are these profiles around citizenship and sort of bad behavior and you can be high citizenship, low, bad behavior, low, good behavior high. There's four profiles around need satisfaction and frustration in various degrees and then overlaid, you know, with age and tenure and all of that. All the groups, seniors as well, comfortably participating in good behavior and bad behavior, highly frustrated but also demonstrating sort of citizenship behavior. So it's introduced this, this notion of there is a compulsion to behave in a certain way despite that frustration. So via junior doctors or nurses or feeling that they have to demonstrate and they have to participate and I have to be nice to you. Meanwhile, underlying and underpinning all of that is frustration. And so I play out badly in other areas of possibly my work or something like that. But because I'm expected to behave in a certain way, there is this sort of compulsion. It's not self directed, it's. You feel forced to be nice to the senior doctor because your career depends on it. But it's not coming from a good place. It's coming from a place of pressure and a place of frustration. Self determined in any way. Yeah. So you might think your environment's nice, you might think your culture's nice, but that's not necessarily being driven or motivated. You know, by being satisfied.
Sharee Johnson [00:54:15]:
Your work is essentially looking at the individual psychological needs and whether they're being met or not and how that's being then expressed and how that lives in the individual person. I noticed my mind very quickly going to the cultural impact or noticing the cultural things too that if the culture can bring useful things and unhealthy things things. So if the culture is a way of behaving, this is how we do things around here, then that can be really useful in terms of People being, I want to say, kind rather than nice. I think Amy Edmondson's work certainly says we want to be creating psychological safety through kindness rather than being nice. Nice means I never give you any genuine feedback. It just means I smile and put up with whatever's going on.
Duncan Brown [00:54:54]:
It's like a nothing word, isn't it?
Sharee Johnson [00:54:57]:
I am thinking about if all the individuals feel satisfied about their competence and about the meaning in their work, that they want to help patients, that they want to care for patients, that they're able to deliver that at some level, that they're satisfied with useful place for me to work. If other people feel like that as well, that's potentially generating shared satisfaction in the culture. This question then, of what's the frustration doing and where's the frustration coming from? There's a whole lot of extra questions that's just sort of self generating my mind about that. Can you tell us what you understand so far or where you think this is heading? As you understand a collection of people and you have these profiles of their levels of satisfaction and frustration, where's the research taking you? You know, research tends to create the next question. What's the next question? Where are you going? What. You'll find
Duncan Brown [00:55:56]:
the hardest thing with this is knowing actually when to stop. Yes. Otherwise I'm going to boil the ocean. Yeah, yeah. But I just want to go back to an interesting point that you raised where people might feel satisfied in wanting to help and do the right thing and careful. But I think inherently that is what's in healthcare, in the people that's generally, I believe, are amazing, compassionate and caring people. And wanting to provide the level of care that you deserve and that I want to provide, because I am that person, is very different to being able to actually provide that level of care. That's. That's the impact of the desire to give a level of care and not being able to deliver. And I don't know if it's a value system or whatever, but not being able to deliver or give you the care, the level of care that I want to do as a person because of environmental constraints or critical factors in my environment that prevent me from doing that, that has. And I don't know where that fits in. You know, we talk about burnout, tutorial, all of that. I think that's an area that is really, really important. Is that disconnect between what, as humans, you would like to do versus those critical factors that you are enabled to do?
Sharee Johnson [00:57:31]:
Is your inquiry pointing specifically to anything consistent about the frustrations? Are you naming. Is there a pattern or a theme about what these frustrations are? If they're the barrier or if they're the thing in the environment that's causing the problem?
Duncan Brown [00:57:45]:
No, no, I haven't, I haven't gone down that at this stage. Where I'm at the moment is clearly the moderating and mediating sort of influences of those needs in, in the behavior. What I've got to is that needs satisfaction, you are not going to improve any culture or behavior by simply doing nice things. So any initiative, any sort of bit of leadership engagement or some sort of intervention around culture, just by doing, focusing on that is not going to bring about the change. Because that shift from the psychosocial safety climate to the choices of behavior has the two paths, but those two paths are not necessarily distinct. You can't just improve behavior by satisfying needs. You also have to address that frustration. So what I'm looking at next though is to say, well, what is it about frustration that links so closely to deviant type of behavior? And what is it about the satisfaction that increases the citizenship? Because I think to say it's a specific thing within the environment. All the environments are very, very different and every human's different. And you might want to be able to work on your own, not talk to anyone and make all your decisions. I might be more of a team player. So you satisfied autonomy because you can just do your own thing. Having that autonomy is frustrating me because I want to be part of a team. So people have these various combinations. It's about finding the factors within that environment that are. Could be very specific, I think, to. To each of those environments. I think if we can just find the connection. I suppose the big message is that when you see these sorts of behaviors playing out in a team or don't immediately jump to think you've got a problem child. You know, I think that I'd encourage people, the starting point is to sit down and go, well, what's behind this behavior? What, what is it that we are doing here that that might. Might be shifting or causing that behavior? Because as much as you can promote factors that increase satisfaction, the whole idea of psychosocial safety climate is to create the conditions that suppress frustration.
Sharee Johnson [01:00:38]:
It was a lovely segue to talk about pro social because I think we're really talking about leadership now, right? We're really talking about leaders having enough insight to understand that this might be something in the person that we should make the inquiry. If you like it, what's the psychological need that's unmet for this person, you might not ask them like that, but that might be what you're thinking is, and then this other. What's happening in our environment, what's happening psychosocially, collectively, as a group in, in this environment that we can attend to. So let, let's make that step now into how pro social ideas and frameworks might help us come together, even around what seem to be intractable problems. And how might that be useful for leaders and followers? Where would you like to start? Perhaps you can tell us what your understanding of pro social is.
Duncan Brown [01:01:27]:
I don't want to get technical. It's really hard not to with pro social. But it's a combination of sciences, the evolutionary science combined with contextual behavioral science and the science of participatory active learning, all of that. One of the things that is fundamental in pro social is about multi group, multi level selection of behavior. So you change behavior and that relates to the system and the broader environment. So you know, we talk about the act matrix. I think you mentioned that you can do that at the individual level. But then what does that look like at the group group level in terms of what's most important to us in terms of pro social? There are two types of systems. And I think that's, that's the important thing because you look at healthcare and you go, right, this is it. There's an incredible book called, I think I mentioned it to you, Black Box Thinking, the comparison between and people I know are sick of it. And they'll go, oh yeah, here he goes again. Airline industry against healthcare. But it's a good illustration because you have two types of systems. You have system one depth system one where the actual whole system changes and evolves. And that could be your small environment or the bigger system based on change. You can see how the airline industry shifts as the whole industry. And then the second one is a system in which the individuals within the system are following their own adaptive strategies and the system doesn't actually shift. And so that you can see in healthcare, each person is doing what they need to do to survive, to persevere. And the problem is that the system absorbs those individual changes. And so you see it so often in leadership programs and other team and cultural development. You come back and go, oh gee, well Sheree's been on a course clearly, and within two weeks you've reverted to what you were doing before. The hype and the excitement of the, of the team building exercise we went on a week later. Because the change is at the individual level. You are expected to change. And we're doing with healthcare, we're doing with the nurses and the doctors going, you need to be more resilient, you need to be more kind as opposed to what are the factors in the system that are suppressing or allowing the status quo to continue. And I think that is the, that's the biggest thing that I want to be focusing on because it's not just about being kind. Of course we want to be kind, but kindness alone, you can be the kindest person in that type of environment and it doesn't necessarily, it might have an impact on me, but it's not going to bring about that systemic change that is needed.
Sharee Johnson [01:04:36]:
I want to remind us of both and thinking I think we can come at these things from both this Systems 2 idea of everybody's making their own individual adaptations and it's not affecting the bigger system. I think that's really demoralizing for clinicians and healthcare workers because you know, some of them are working really very, very hard to try and keep their own personal growth happening. And I really value that because I think that gives them the capacity to see more, that gives them the capacity to notice. Well, I've been doing this for 10 years and nothing's changed. I need some allies, I need to find some champions, I need some sponsors. I need to get this up the chain a bit more. To me that individual development is important because you can't really become a change agent if you can't see. So for me there is still real value in that. I just want to say that for our listeners so that people don't feel overwhelmed.
Duncan Brown [01:05:29]:
Oh no, absolutely no. No, absolutely no. What? Yeah, I'm not saying that, you know, stop it. Look at the airlines, I mean those pilots, continual education simulations. You've flown for 10 hours, you need to rest, you know, you've been here for 16 hours, you can now go and operate or you've been here for 17 hours, you can now go look after that. So there's absolutely that development at the individual level, but the system. And so that's why we've seen burnout in health care. Really? People, people suffering because they doing all of those things.
Sharee Johnson [01:06:02]:
Yes, it's a huge source of frustration. I totally agree with that. You know, we've had various inquiries. One that I can think of straight away is the inquiry we had at a hospital in the west of Victoria around a number of baby deaths over a 10, 10 year period. You know, we can ground a 747 for a period of time while we Find out what happened. Why did that one crash? Let's ground them all and then make systems wide change. You know, it's, it's harder to do that in healthcare. We've had an attitude that we can't do that. Well clearly we probably can in some of these circumstances. My point is let's keep a both and process and the reason that we do our recalibrate program the way we do is exactly to your point that if you go and do a week residential, it's all fabulous while you're there, very inspired. But when you come back into your system it's very hard to really make anything happen and even to keep your own commitment to making it happen after a couple of weeks. Our programs happen over months and months and months for that reason, to try and really embed things. And I continue to be frustrated at the lack of systemic take up from colleges and employers in that regard. But are there now I'm getting on soapbox so we'll just park that.
Duncan Brown [01:07:11]:
Yeah, really good thing from the tagline on that book. That black box thinking was the difference between the two. Their success is in the way they respond to failure. I think that that's critical because the airline is, they're happy to share healthcare. We bunker things down, we don't share, we don't share mistakes. And so that's why we getting these repeats.
Sharee Johnson [01:07:36]:
Talking about intelligent failure that Amy Edmondson talks about. To me, pro social is really a very basic acknowledgement that humans are social and that we affect each other and that we need to be together and that we do better when we are together. And so for me the kind of ground of pro social is really how can we come together. I love that pro social process that certainly Robert Stiles talks about and his colleagues that let's get together and really define what we are trying to achieve, where we're trying to go and how we can do it in our group. And certainly the Mayo Clinic research with Tate Shnevelt which I've referenced on the podcast before, says that it's unit specific. We need units to come together. We need the actual people in their unit to say what would work for them. I think that's to me the critical element of pro social. I don't know if that lands for you.
Duncan Brown [01:08:34]:
Yeah, absolutely. I, I think that we are inherently, we are inherently social. Pro social is linked with the work of Eleanor Ostrom. Where communities, the tragedy of the commons, where people cooperated and collaborated and shared and worked together. Those are the communities that thrive and the ones that allowed self interest to find its way in. Didn't these principles of having a shared understanding of what's most important to us and healthcare providers have that, you know, and then connecting on that and then agreeing that we're going to hold each other accountable to that. So absolutely, because we have to thrive and work together.
Sharee Johnson [01:09:17]:
Do you see those hopeful ideas and that framework that gives us a way to go forward in a positive pro social way? Do you see that as having a direct bearing on your research? When you're thinking about satisfaction and psychological
Duncan Brown [01:09:30]:
need and frustration, there's a very, very strong link, certainly from the motivational side of it. What is it that is going to give you satisfaction or what is going to frustrate you? And also the understanding that if you are going to be shifting culture with this information, how do you do that in a way that is sustainable and the principles of pro sociality are there. I think, you know, my daughter found this word and I want to share it because it resets everything for me whenever I get into these. You talk about environments where you want to be pro social and it's a beautiful word. It's called sonder. Have you heard Sunda? It's old, all the rarely used. But it's the profound realization that every passerby has a life as intricate and colorful as your own. It's beautiful. And you sit and you go, we've all got stuff going on. And you go, yeah, so you don't know anything about me and I don't know anything about you. So compassion and kindness have to be the only responses because I don't know what's going on with you. And chances are you have had just as colorful and expensive and I think when you just remind yourself of that going everyone has stuff going on. It's just pause. That's a good starting point.
Sharee Johnson [01:11:10]:
It's a real, you know, I'm human in your human moment, isn't it?
Duncan Brown [01:11:15]:
Let's start there and then, and then we'll. But we sometimes don't even consider that before we get into the fixing side of things.
Sharee Johnson [01:11:24]:
I think in the interest of time we'll, we'll bring this part of our conversation to a close. Duncan, it's exciting to me to think that we've got this framework to go forward. I'm really on the edge of my seat with you and your research. I want to understand much more about satisfaction and frustration. I know many of our clinicians, and I'm sure many of our administrators and executive in health as well are frustrated by Some of the things and satisfied by some of the things. And so to build our skills and our capacity to be able to hold these things and work through these things. It seems like a great endeavour to me and good luck with the rest of it and with getting published. I wonder if there's anything. I wonder if we could do a little kind of rapid fire for about four or five questions, if there was something that you wanted our healthcare executives to hear out of the things you've been learning. What do you want them to know? The healthcare executives?
Duncan Brown [01:12:24]:
There is so much, I think, that the hierarchy is not serving the system well.
Sharee Johnson [01:12:31]:
And what about doctors, senior doctors? What would you like them to know?
Duncan Brown [01:12:37]:
Be compassionate to junior doctors. Give them time. You were once there.
Sharee Johnson [01:12:43]:
And junior doctors, what would you like them to know?
Duncan Brown [01:12:48]:
Have the courage to speak up.
Sharee Johnson [01:12:52]:
And our nurses, what would you like nurses to hear?
Duncan Brown [01:12:58]:
I have the deepest respect for nurses. What I want them to know is they are absolutely respected and appreciated and are probably not told that often enough.
Sharee Johnson [01:13:11]:
And what about all those other people in health that make the place work? All the administrators, all the techs, all the porters? What about all of those people? What would you like them to know or hear from you?
Duncan Brown [01:13:27]:
The system doesn't function without them and they are just as critical. I don't like it when people say, well, I'm just the porter or I'm just the nurse. You know, I'm just the cleaner. Just nothing. Everyone is. Is critically important in delivering an experience in the health service. So everyone is valued.
Sharee Johnson [01:13:50]:
And what about the families and the parents who are caring for patients in our big, unwieldy, confusing healthcare system? What would you like them to know?
Duncan Brown [01:14:03]:
That their voice can make a difference. They are not insignificant. I think that there's a difference between a constructive approach and simply complaining. I'm not saying you shouldn't complain if there's. If issues arise, but I think the manner in which it is approached often reflects how people respond to it. So, absolutely, lived experience is vital. Share your experiences. Have the courage to speak up. Do it in a way that benefits everyone. Yeah, it's tough. I mean, I've had a horrible experience, but I know there's people out there that have had worse. You know, there was another big moment where I had to recalibrate because I got into patient quality and safety, right? So that's taking complaints and doing all of that. And I realized that an experience is your experience. That's your. That's your reality. I didn't let it affect me. But every now and again I would go, really? Is that what you're complaining about? You know, I'll go. Knowing what I'd been through, I've gone. Seriously. But I had to stop myself from thinking that way because whatever you experienced was your experience and it is as important. It wasn't for me to diminish an experience because it wasn't severe as what I had gone through. And really you say your toast was cold? Yeah. That was a. Interesting perspective.
Sharee Johnson [01:15:37]:
Taking a very important perspective. Yeah. Okay, I think we better wrap it up. Duncan, it's been amazing to have all of this time to talk with you. Is there anything in the conversation today that you feel like was unsaid or untied that you just want to point back to or do you feel like, no, we're okay, we can say our goodbyes.
Duncan Brown [01:15:55]:
I want to say goodbye to you. Sure. Look, there's so much to talk about. There's so much acceptance. Awareness is a big part. I think that that is something that's important. You talk about things that can actually just save lives. Now. Sepsis awareness is critical. Is, is critical. That's one thing people can start doing right now, get a sepsis brochure and just read about it and go, right, okay, I've done it. That could be the one thing. The rest of the stuff we're talking about is longer term fixes. But we can save a life today. But giving that message, yeah, such an important message.
Sharee Johnson [01:16:32]:
Thank you very much, Duncan, and thank you for ongoing demonstration of recalibrating and the capacity to recalibrate. And you know, that is what life is about. The rich, full experience of life means reassessing, adapting, reorienting, thinking about what's important, what matters. And you've really demonstrated that in so many ways today. So really appreciate your time, your wisdom, your generosity, and may you be well.
Duncan Brown [01:16:55]:
Thank you so much. Appreciate that. Bye bye.
Sharee Johnson [01:16:59]:
Well, Duncan Brown has given us so many examples of recalibration. He has immigrated, he's changed industry, he has faced the shocking identity challenge of being a parent whose child has died. And he has now adopted an identity of researcher. Really inquiring into what is it in the conditions of health care that promotes satisfaction and frustration? How is it that healthcare workers are meeting or not meeting their psychological needs in their workplaces? I think this is a really a frontier kind of research. It's hard to get our heads around it. Perhaps now it's not fully clear what the research is going to show us or help us change in the way our environments operate. In healthcare or in our behavior. And it's a really nuanced inquiry into this idea that we can feel satisfied in our work, in this endeavor to care for other people, be a part of healing, and at the same time be very deeply frustrated by what people call in healthcare the system or systems. So I, I really want to support Duncan. I hope that you can stay curious about what he's discovering in the work. I have deep admiration for his ability to take something really awful in his own life and stay above the line, if you like, in leadership terms, to keep inquiring, what responsibility can I take? What value can I add? How can I help without taking a sort of blame and shame attitude? And, you know, I think, wow, the stress of what's happened for his son in what the inquiry named very specifically as an avoidable death. I think he's a role model of Grace. And I hope that you've felt that as you've been listening to him talk today. He made a very clear statement about his shift out of the financial sector and now into healthcare and said, that's who I am now. I think that was a real. I had the feeling, listening to him say that of kind of shedding past identities. And that certainly can happen in many of our lives. And that's a moment of recalibration in the way that I think about that. Those choices, those active, intentional choices are open to us all of the time, even when we're facing distress and deep grief. And I'm very grateful for Duncan coming to tell his story and show us about that. And then the last part of our conversation today was about the pro social world. I think you'll hear a lot more about that on this podcast. It's really inviting us in this kind of AI world where people are very isolated and lonely, to remember the commons, to remember the collective, this need, survival, need for humans to be socially connected. So I hope that there's some inquiry, some thinking that's happened for you while you've been listening to our long conversation today. Thank you for if you're still here. Thank you for being still here. I will put a number of references for all of those topics in the show notes and until now, may you be well. The content in this podcast is not intended to constitute or be a substitute for professional medical or psychological advice, diagnosis or treatment. Always seek the advice of your doctor or other qualified healthcare professional. This podcast represents the views of the hosts and guests and do not necessarily reflect those of any entity we work with or for.
