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Toby Hall, St Vincent’s Health Australia Group CEO

16 December 2020

Exploring the Future of Work

Exploring the future of work with PwC Australia - conversation with Toby Hall (St Vincent’s)

COVID-19 is rewiring a new world of work. In this episode we discuss how the healthcare sector has adapted as a result of the pandemic through rapid people upskilling and retraining, as well as reshaping how healthcare services are provided. 

 

Episode transcript

Ben Hamer: I'm Ben Hamer, and welcome to Exploring the future of work with PwC Australia. 

Amidst the COVID-19 health crisis, organisations in every sector have had to rethink how they get the job done. And now, it’s hard to even imagine going back to the way things were. So what have we learned? And what happens next? In this podcast series, we're going in search of some answers. 

In this episode, I chat with Toby Hall, group CEO at St Vincent's Health Australia. We go into several issues, including how health care workers are rising to the challenge of the pandemic and how we need to celebrate them. How digital innovation is a journey, not a destination, where good is good enough, making sure organisations have a workforce that is as diverse as the communities that they serve, and the importance of upskilling for leaders, not just employees. You're exploring the future of work with PwC Australia.

I'm joined by Toby Hall now, and with the health care being undoubtably shaken up from all directions with the pandemic, I'm armed with what feels like an endless list of questions. Toby, are you good to go?

Toby Hall: I’m definitely good to go. 

Ben Hamer: In St Vincent’s, you have facilities spanning public and private hospitals all over the country, aged care research institutes. And you must do a fair bit of travel in your role, particularly between New South Wales and Victoria. So I'm keen to get a view from someone who is quite in the know, what is the better city between Sydney and Melbourne?

Toby Hall: That is a cruel question. I would say the foods style and sports is probably better in Melbourne, but you can't really beat the harbour and the beaches in Sydney, which are just outstanding. Melbourne can't rival those, so both cities are pretty good. I think the one thing is different. Melbourne is very relational. Sydney is very business and they’re kind of different from that regard. And so you've got to learn how to behave differently in each city.

Ben Hamer: And we'll get straight into it, particularly with COVID-19, obviously, because the demand and the pressure that it's placed on the health care system has been undeniably huge, particularly when it comes to the workforce from more traditional desk-based jobs right through to the frontline doctors and nurses. Can you talk a bit about some of the key impacts that the pandemic has had on health care workers?

Toby Hall: I think the key thing is that our health care workers are trained to expect the pandemic, they're trained to expect emergency responses, but when it actually happens, it still throws them. And so they've got to act differently, think differently, behave differently. And that makes people tired. Behaviors change, but everyone wants to do very well. And it's kind of like I prepared all my life for this and suddenly it happens and it's like, whoa. And that is the thing which has been the biggest wake up call for us. But our people have just done outstandingly through this period in terms of being prepared to be agile, to change and quite often go beyond the call of duty at very short notice.

Ben Hamer: Yeah, absolutely. And I think one of the things that we've all observed from outside of the sector looking in is just in some areas in particular, really needing to scale up the workforce quite quickly. How did you actually go about scaling up the workforce and how might that have differed between your public and private hospital workers?

Toby Hall: Interestingly enough in a private space we didn't really need to scale up. What we did is we contracted pretty much all our private hospitals to deliver services to state governments and the federal government. And actually meant that all our people were kept employed and surgery got canceled as well at the same time as we had to scale up. So it's probably more a case of repurposing. 

In the process of repurpose we had to do a lot of training for people to say, OK, you might not have dealt with respiratory issues for a long period of time. You won’t have dealt with the severity of PPE issues for a long period of time because people don't wear the PPE in pandemic normally and actually saying this is how you use it, this is how you trained for it. Absolutely key. This is how you manage respiratory issues. 

Now to give you some context, you might have a clinician who's trained, become a doctor, moved into the field, but actually has not really dealt with respiratory issues for a long period of time. And so you almost have to go back to 101 and do training. And that was a real challenge for us, a wide scale roll out of training and retraining on respiratory issues. And we did that with a lot of online tools, really short bursts of one hour kind of training programs for people just to refresh them. And that was a big thing to get the people we needed ontrack. 

The other thing we did is we actually put a call out, particularly in Victoria, is right at the height of the pandemic to nurses around the country to say, look, if you're in New South Wales, it's kind of boring. There's nothing going on. We know you want to be where the action is. Can you come down to Victoria? And we had a great response of people who are prepared to travel down to Victoria and work down there, even though they knew they'd have to go in quarantine on the way home.

Ben Hamer: Yeah, that definitely is a real sense of purpose with people who do work in health care, which has been awesome to see. And one of the things is we've been talking about workforce reforming health care for a while now. And I would say historically, would it be fair to say that it's been quite slow in terms of how it's been taken up, but then old COVID-19 comes along and really forced the hand of a lot of change and a lot of change in a short period of time. I think about telehealth, for example. What do you think that we can learn from the pandemic and sustain as we start to embed a new normal?

Toby Hall: I think the key thing from the change we had through the pandemic, particularly when you look at stuff like telehealth, is actually people suddenly realised that you could get people to do new things very, very quickly. Now, they might not do it perfectly. And in health, to be fair to say, a lot of the time perfection is kind of important if you having an operation, you want perfection. But when you're dealing with the back end stuff, when you're dealing with the recording, the reporting, keeping records, that doesn't necessarily need to be as perfect every time. 

So we learned this concept of probably what we call is that ‘good is good enough’ through the crisis, which meant we didn't have to have perfect telehealth systems. We had a telehealth system that worked. That was a good thing. Let's get one working, train people on it and then we can adapt it and improve it. And I kind of look at it from the point of version one of an app is not very good, but version three point four is much better. 

We took people on a 101 and gave it to them and said, just work out how to use it. And most clinicians actually were about 20 minutes and we literally went from in Sydney from around one hundred and eighty clinicians using telehealth to over twelve hundred in a two week period. So that was pretty impressive. The other thing which is interesting is, again comes back to the thinking of in a crisis good is going to be good enough, we sent nurses from Sydney Public Hospital into New Much House and also in Melbourne did the same. 

We sent people into some of the aged care facilities which are all over the press. And some of those nurses wouldn't have worked in aged care before. They didn't know the environment. They didn't know the space, people had to learn on the run. And what we found is that people gained a real confidence, whether it was telehealth going into a new environment or new treatment model, they were able to adapt. A lot of nurses in our private system normally dealing with surgery. So they might be used to orthopedics, some were now looking after patients and very elderly patients. They repurposed, they worked, they had some training and we had to trust that people would do everything they could and they did. And they rose to the occasion and did brilliantly.

Ben Hamer: And I think the key lesson for me from what you were just talking about, if I think how we can try and apply that to other sectors, is with technology rollout. As technology evolves and it evolves so fast, it's always going to become out of date at some point in time. So this idea of good is good enough, is particularly useful. And then you can kind of look at the user experience and feedback in some of those insights to continually evolve, iterate and improve it.

Toby Hall: Look, I think we've had this kind of psyche in the workplace that we're going to put in the system. Everyone's kind of dreaming it’s going to be this perfect new system come out. It's going to work wonderfully on day one. We're all going to be happy. It's going to be this brave new world. And reality is for all of us. We know it never works that way. You get the thing on the first day. It's like, oh, my God, how do I use this thing? How does it operate? This tool, which is supposed to be the bee's knees, is kind of not that good. And there's other parts you got all this is really fun and it's good and you learn how to use it. 

But the reality is we've become used to being adaptive and particularly I think with the rollout of apps and first generation technology, mobile phones, classic. If you go back to your first mobile phone, I mean, compared to what you've got now, but no one trains you on using a mobile phone. You get it, you play with it, you work out how to use it. If you go and buy the new iPhone 12, you'll get it and there'll be new things on there that you have to learn. And the reality is, I think we can transplant that into the workplace and say it's okay to let people learn on the go on a range of areas. Now in health there are some spaces where you you cannot do that. But there is a whole range of spaces where you can do that and so we have to let that adaption happen, be prepared to let people learn as it goes, which means productivity might slip for a bit but it will pick up as people get good. They'll get better at it. I think that’s a better way to roll out technology. And I think that's going to be where the future goes. And the more you talk to people in the technology, space and staff, the kind of work that we're so used to it in their normal Day-To-Day life.

Ben Hamer: One of the impacts from the pandemic that I've observed again is that I really think that it's taught us that as a society, we've perhaps undervalued our essential workers. I'm keen to hear from you around, what do you think the pandemic has taught us about the importance of these roles in society? And how do we ensure that they receive and get the appropriate recognition for what they do?

Toby Hall: When you go into the nursing space, we had one hundred and twenty or so nurses and doctors catch COVID-19 because they were serving and caring for other people in very challenging environments prepared to put themselves at risk. And I'm not saying that's what you would expect from our workers at all. We would hope that would never happen. But we know there's the risk of that happening.

My probably favorite example of that in this space is New March House. I was stupid enough to call the chairman, who is a friend of mine, say, do you need any help? Now, when you do that as a CEO, the answer from the other person is supposed to be, ;no, no, we've got this all under control. Thanks very much.’ That's what I was expecting to hear. But what I heard was no we desperately need help, so we went to the hospital and said to our team, we can't ask you to do this but would any of you volunteer to come and help at New March House? Because they really need help on the ground from nurses.

Ben Hamer: And is that an aged care facility? 

Toby Hall: It's an aged care facility. They had significant problems with COVID-19. They were one of the first places that had a really big outbreak of COVID-19 in New South Wales. And we had 20 nurses volunteer within 20 minutes to go and work out at New March House. They went out the next day and they basically kept the place open for the next week. Now, all of them were doing that at a time right at the start of the crisis. They didn't know the risk, all they knew was it was dangerous. But they were prepared to put themselves aside to go and do that work. 

And those kinds of people are the ones that society should champion. They should be rewarded. We should be thanking them. And I think there's some wonderful everyday heroes out there in our society who, to be honest, time will pass and they won't get the recognition, but as a society we should be incredibly grateful for the work they’ve done.

Ben Hamer: Absolutely. And it's super inspiring to hear you talk about these stories as well. And I want to bring up something that you said in an article about halfway 2020 when it comes to aged care. You said ‘We've spent the last six months acknowledging and celebrating the sacrifice and dedication of frontline health care workers in the face of the pandemic, and rightfully so. But I'll never understand how, despite showing exactly the same, traits and often working under equally trying circumstances, we continue to largely overlook the contribution of the thousands of Australians who work in aged care’. Now, this is particularly worrying because we've done some research here at PwC that says that Australia will need an extra 400,000 more aged care workers in the next 20 years. How do you think we can actually go about attracting people to work in the aged care profession in light of all of this?

Toby Hall: I think firstly, it's a great area for people to work in. The joy of working with older people is an incredible thing. And in fact, one of the things we've got to relearn in Australian society, which I think Asian neighbours are excellent at, is loving our older generations and understanding the joy and the benefits of working with them. I think we've got to say to people that you are one of the most important workers in Australia when you're doing this work. You're looking after our most precious people, people who are often very, very sick. 

I think creating an environment where we can say to people, come and work. You can have, I think, pretty good work life balance. You can have meaning and purpose in your life. Plus you can actually deliver a whole range of health care outcomes for people with something we've got to start to promote to people. What I think has been challenging and I don't want to knock the work that’s come out of the royal commission. But the first report out of the royal commission had no recognition for the vast majority of workers in aged care for the great work that they do. 

What it did focus on was a very small percentage of people who did the wrong thing. And I think we've got to stop and say as Australia ‘That's the wrong thing to do’. Let us celebrate the wonderful care that many people in aged care have been given, celebrate the staff who are often very poorly paid, who are giving up their time to care for our parents or our family members. That's something we should cherish. Let us start to cherish that. 

That is not to diminish our health workers. I love our nurses and our doctors. They do wonderful work as well, but they get the respect. And it's interesting in the hospitals, we had gifts, food, drinks pouring in almost non-stop into our hospitals for our staff and for our doctors. I haven't heard of one case of that happening in our aged care facilities, and that's where I think we need to reset our thinking.

Ben Hamer: Well, let's start to lift our heads now out of COVID-19 because I'm keen to get onto the topic of Skills and at PwC Australia we recently asked our people about exactly that. So in our Thinking Beyond research, we heard that more than half of our people said that they think that digital skills are critical in the future of work. And one in five said that they think that the top priority was leadership and interpersonal communication as a skill. 

Now, health workers aren't immune to this either, particularly when we look at doctors and nurses who are traditionally more of a technical bunch, though, how do you think we can go about building and developing some of these skills, particularly with the clinical workforce?

Toby Hall: I think the heart of the clinical workforce is very interesting, people go into the clinical space because they care, they want to do good work, they want to have purpose, and they want to make a change for people. But the medical system does not train people to care. It trains people to give medical treatment. You've got a problem. I give you a cure. I fix you and I move on. That's how the training is done. 

And in fact, if anything, in some ways, the medical training system says, I want to take the personality out of the doctor, the personality out of the nurse, because I don't want them to be damaged by getting too close to the patient. Whereas actually what the patient wants is I want to be loved and cared for. And one of the key things I've learned in health is our people are highly competent. They know how to be competent. They know how to look after people. They know how to do treatment. And often they provide what I would say is a courteous level of treatment. 

If you go to the doctor, they're always kind of poltie and they'll engage reasonably well, mostly not always, but mostly. But do they really care? And I remember a conversation with one of our young nurses who's just delightful. We were chatting outside a patient's room, just talking about everyday things, about her children, about a pet dog. We had a really nice conversation and she went through the door and she switched on court and courteous. Because that's the professional thing to do. She was treating a patient, she had to be courteous, and so her personality took a step back. She moved into this professional person and what didn't come across as care. But actually what our patients want is care. 

And one of the key drivers that we've got to deliver and the changes we've got to make in our organisation and across the health system is to actually provide care, which is to say I care about you as a person and as you as an individual, because that is important for a healing point of view as the medical treatment. And that's something which we got to do a lot of work in. At the same time, you’ve then got to train leaders who've been through a system which kind of denies, to an extent a little bit of the process of care. To say to them, you've got to encourage people to give care. You've got to encourage people to have the extra time of day to smile, check in and say, how are you going? 

Not because it says on the list of things you should do because you care. And that is one of the things we've got to spend a lot of time working on in the health industry. I think also from a leadership point of view, health is not a natural space for people to learn leadership. In some ways it is quite an individualist field. Clinicians quite often they train working part time in a public hospital and part time in a private hospital where they run their own business. They're their own person, often very highly intellectual, highly gifted, and they don't need to lead anyone really apart from themselves. And yet, as we move towards more teamwork, more integration between different clinical groups, we're seeing this need to have better leadership of people from an influence point of view. So the next thing is that I think saying to our clinical leaders, how do we help you understand influence? How do we help you understand the human relationship in terms of how you connect with others, how you influence others for the benefit of the patients who you are working with. And I think that influence training is going to be a key thing.

Ben Hamer: Another thing is, we've heard from some of the other podcasts that we've been recording and some of the other executives we've been speaking to is about how as more and more gets automated. Those skills that make us uniquely human become super important. So care like you are talking about and I'm interested to hear from you around the announcement that St. Vincent's is building Australia's first virtual hospital. Can you talk a little bit around what is a virtual hospital and what does that mean for the kind of workforce that you need?

Toby Hall: This is going to be one of our biggest challenges because we're actually creating this paradigm change in health. In the health world, people come to us. If they're sick, they go to a doctor and the doctor sends them to St Vincent's, they come to our hospital, we kind of diagnose and they get their pathology down there. They get their imaging done there. If they need surgery it's done there and then they stay there to get well enough to go home. And that's kind of our cycle of treatment. 

That’s how it has been for a long, long period of time. But that's changing. We're in a position now where we can treat people at home. And so in Sydney, we actually set up what is a virtual COVID-19 ward where we had COVID-19 patients who were at home and were monitoring at home. We had nurses engaging with them in their the home and treated it like a normal hospital ward, but they were in their home. 

Now that culturally. Can you imagine going from a place where everyone comes to you, your staff come to you and suddenly you’re saying, well, actually, we're going to leave the hospital and we're going to start going to your house, which means you got staff who may never, ever come into a hospital delivering health care in the community at people's houses, monitoring them from a central point, or having a third party, monitoring them from a central point and then engaging with them.

You've got to keep the culture. So how do you keep the culture when you;ve got a person who might never come to the hospital, go out, deliver services into someone's home? How do you keep the St Vincent's culture and the same way of doing things in that environment?

Ben Hamer: I'm just going to follow up on that one, because that's obviously something that right now with remote working, a lot of corporate Australia is trying to grapple with and leaders are asking, how do I try and maintain a culture when I may very rarely see individuals in my team? Do you have any thinking or have you done any research around how you can try and maintain a culture in that dispersed environment?

Toby Hall: Yeah, I think this is where great leadership comes into play, because when you’ve got people coming into space every day, it can be relatively easy to lead. When you've got people you don't see very often you've actually got to make a conscious decision to lead. So you've got to make a decision as a leader to reach out to them. 

I can give you an example of an organisation. I was mentoring one of their leaders and I spoke to a couple of his people. And in the first six weeks of COVID-19, five of the team leaders had no contact from their direct leader, none, not not any. Not a phone call, not a discussion or anything. And I said to him, here's what I tried to do with my team. Firstly, I tried to consciously contact them far more than I would do normally. So like three or four times a week, but microlevel. So it's just a phone call. How are you going? Has everything for you? Is it working or not? If you need any help, let me know. So that is a kind of simple thing. But you have to consciously do that. You have to diary it and make it happen because otherwise you forget about it and it goes out the window. So you have to have this conscious process of engaging.

Again. I think you can have micro meetings where we've traditionally always had these meetings two, three hours long. You don't have to. You can have a 15 minute meetings and get a lot done in that time frame, which allows people to check in, see how they are going. And you can kind of see people eye to eye, see how they're looking and how they're feeling. The other thing, which I think is important is one of the key things for any worker is to know that someone cares about them. Now, a phone call can do that. But in the crisis, I actually rolled through regularly for my team, sent them small gifts just to say I'm thinking about you and I know it’s really hard for you in lockdown. This is just to know that someone cares. 

And one of the key things I think we have to do is as leaders is show that someone is cared for, they're part of a team and their leader knows they're part of a team. And then I think there is still going to be an important part of making sure there is some face to face happening on at least a regular basis so people have got that human contact with one another going forwards. But micro discussion, remember to check in, you need to do consciously more, I think, to reach out to people. To just know that you're there for them, I think is where people need to go.

Ben Hamer: Yeah, absolutely. Now, I want to change tack slightly because you're a male champion of change. And so I would love to hear from you about what made you decide to make that commitment and your thoughts on the importance of diversity within organisations.

Toby Hall: A part of my thinking around this is not to say I'm doing this because it's kind of trying to help promote people who've not had a chance in the past. It's actually saying we should be what society is. And if we want to reflect organisationally to society an organisation that can be successful, if we don't reflect that in our management team, in the cultures that we have, the people who are part of our organisation, particularly, when we care about our community. We can't do that because we don't understand it. So if I don't have women leaders in the workforce who are able to aspire to do well, able to lead their people. The women who are looking up are just going to see a bunch of blokes and no one wnats to see that they need to see themselves replicated. So I can do that.

If I don't have indigenous leaders in the organisation. The young indigenous people who are coming through, and we've got a great program of young indigenous people coming into the organisation, will look up and say, ‘there's no one like me, why would I be part of this organization?’ Same disability, same with people from refugee groups who’ve struggled. People have come from overseas, often struggle, trying to create spaces that actually say ‘You're welcome here, you’re included here, you can thrive here’ is kind of the outlook I've had. 

And I think it's an important thing. I kind of think we're making progress some days and other days you get punched in the face and realise we're not making progress at all. And you kind of just hear things that happen which are really sad in terms of particularly gender equality. I think racial equality is a really big issue and we've got a lot of work to do still.

Ben Hamer: I think that's a real call to action and probably a fitting note to end on. Toby Hall, a massive thank you to you and your organisation for everything that you do, particularly in 2020. And of course, for joining us on the podcast.

Toby Hall: Hey thanks. And all the thanks should go to my team. I've got great people and they've done a brilliant job thi syear.

Ben Hamer: Thanks for listening to this episode of Exploring the future of work with PwC Australia. Head over to www.pwc.com.au/futureofwork/thinkingbeyond where you’ll find our latest report ‘Thinking Beyond: How the Pandemic is Rewiring a New World of Work’. 

This podcast miniseries uncovers insights from industry experts so that together we can design a future that works for everyone. To make sure you don't miss a single episode, subscribe to this podcast series via Apple, podcasts, Spotify or wherever you get your podcast from. And while you're there, feel free to give us a rating or review. 

And 2021 is already looking up because we have season two in the works for you. So stay tuned for that. My name is Ben Hamer and you've been listening to Exploring the future of work with PwC Australia. Thanks for joining us and goodbye for now.

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Dr Ben Hamer

Lead, Future of Work, PwC Australia

Tel: +61 437 159 517

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