Nataša Tomić

Healthcare  Challenges: Best practices for medical expertise retention

When I was selected as 2015-16 Humphrey Fellow for Bosnia and Herzegovina I already had extensive experience in health administration, including the HR management. As Medical Director of the Institute for Rehabilitation Medicine and Orthopedic Surgery “Dr Mrioslav Zotović” Banjaluka, I coordinated implementation of variety of projects – from new service development up to the national certification in quality and safety in 2015. The Institute has 70 years long tradition and our doctors as well as other health professionals and (90 doctors and 500 allied health professionals) are clinical leaders in the region.

Orientation during Humphrey year, Virginia 

Patient satisfaction was traditionally very high and most of employees are proud to belong to such a successful organization. Management is a bit unusual for public health facility – inclined to lean management, responsive and always at disposal to clinical teams and patients. Regardless my formal education and many real-life opportunities to develop as a manager, the Humphrey Fellowship made a tremendous difference in my attitudes, my view, knowledge and soft skills. Through masters courses at Virginia Commonwealth University I learned novelties in the field of organizational behavior, safety and quality. Through the Humphrey program I had a chance to reflect upon my management styles and to realize my strengths and weaknesses.

TEAM AFTER THE INTERNATIONAL COURSE ON LYMPHOEDEMA

HUMPHREY FELLOWS, VIRGINIA COMMONWEALTH UNIVERSITY 

The professional affiliation in Virginia rehabilitation facilities enabled acquisition of new organizational models for best practices. I dare to say that I became better asset for my Organization and was really excited to go back home, to contribute with new ideas and experiences. I enjoyed support of Director and other team members and many small steps improved the working environment.

WITH NURSES FOR INTERNATIONAL NURSING DAY

Upon returning I was appointed as Assistant Director for Quality and Safety of Services. This position opened a space for pursuing my passions – cherishing the culture of quality and safety and investing in people as they are the biggest value and key of every success. 
After being able to compare health systems and what was done for our patients with limited resources, but with high professional dedication, my respect for health professionals back home increased a lot, to the point that it was almost palpable in every interaction with our teams. Such attitude was accepted by mid-level management, and on behavioral it reflected in more openness to suggestions and participative decision-making.  

AFTER THE CONFERENCE ON PULMOLOGICAL REHABILITATION

The second thing was the belief that continuing education is an investment, not expense and that should be available for all team members – not only doctors but also physios, nurses, psychologists. In our experience, the opportunity to learn and keep abreast in your profession was very motivating for people.
In last three years we managed to contract the international teachers and instructors and to organize many clinical courses in our Institute, enabling more people to obtain internationally recognized certificates. This practice was very well received and the prevailing attitude was that joint clinical trainings for medical team equal to rehearsals for an orchestra. Well trained team is the best present for the patient and families.  
Our departments have a significant degree of freedom which is linked with corresponding responsibility.  Horizontal and vertical channels for communication are well established and communication is rich, respectful and timely. The system in place ensures that patients’ thanks, suggestions and complaints are fed back to clinical teams and used for improvement.

I knew even before my Fellowship that quality of services occurs in the interface between the provider and the patient, on that thin line, and that safety is spine of the quality. However, I brought from States a new paradigm – Safety First, Every Day. In daily work, this paradigm is lived through question which clinical teams ask themselves almost routinely – OK, people how can we harm our patient today? 

As public facility, we are limited in paying for performance but many other benefits we use as incentives – e.g., the best clinicians get opportunities to present at conferences and  compare with practice of others, the Institute is paying for formal education (e.g., for occupational therapists, X-ray technicians), supporting academic studies and research, activities of professional organizations and various activities for team buildings. As University hospital, we have a wide recruitment base among students and can choose the best ones for our teams. Decisions on new team members and socialization are done in participatory and transparent manner. We managed to preserve our interdisciplinary medical teams and we are still among most desirable employers in health care industry in Bosnia and Herzegovina. Last year, not a single specialist left us, and nursing staff turnover was 5%. 

There is no magic answer to brain drain. When reflecting on my Fellowship, I am sure that the biggest benefit for my organization was change in my attitude towards servant leadership. Experience changes us, not words. Treating people with respect is always a good start. Investing in education and empowering people always pays off. It is a privilege to have any opportunity to help people to develop into competent professionals, genuinely believing they can make a difference. I was always optimistic but today I feel even more compelled to gently challenge dysfunctional criticism around us with my favorite sentence: It is better to light a candle than to curse the darkness. 

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