By Soumya Shah 1st Year Management Intern My first placement with ACHSM was at a rural Victorian hospital, where I had fortunate experience of learning from leaders across the organisation – from department managers to the board of directors. This gave me a unique insight into high-level strategic and operational decisions required to: (i) run a quality health service; (ii) provide quality care that met the needs of the community and; (iii) address issues that are most prominent to a rural setting. These are my key takeaways from my 6-month rural placement: It’s a (really) small world after all! The reality of that small-town cliché: “everyone knows everyone” hit home when working in a rural hospital that served as both a major provider of health services as well as the largest employer in the area. The hospital was rarely the only connection between staff members and their patients. A majority of the hospital’s employees and consumers knew each other from various aspects of their personal lives – from multiple generations of the same family working together, children attending the same schools to recreational activities such as team sports. This had widespread implications, such as: Maintaining confidentiality – while stringent zero-tolerance policies were in place, the risk of exposure to confidentiality breaches between staff and their patients was intensified in a rural setting. Confidentiality also presented an added barrier for employment of external services for the hospital. For example, managers had to consider risk of confidentiality breaches among staff members in hiring community-based mental health support for the Employee Assistance Program. This presented a unique consideration in attempting to provide support to hospital staff during the pandemic. Stating conflicts of interest – members of interview panels were likely to come across candidates known to them outside of the hospital, therefore emphasis was placed on managers to declare any conflict of interest prior to the selection or interview process. This was also applicable in high-level decisions made at the executive and board of director levels. The wider community approach During my placement, severe workforce shortages often led to the redeployment of frontline staff to other wards while beds were closed and services limited to focus on critical cases. Whilst it was evident that a significant level of organisation-wide coordination was required on a daily basis, I quickly became aware of the importance of inter-service coordination where other health service providers were engaged to address immediate staffing or patient needs. Efficient utilisation of external resources ensured adequate access to healthcare services and a manageable flow of patients. Metropolitan health services are highly sought by healthcare staff, therefore several measures were undertaken to attract and retain talent in the rural hospital. One example is the Observership Program for international doctors to be mentored in emergency and acute care scenarios. Those who fulfilled practitioner requirements and assimilated into the organisational culture were eligible for sponsorship by the hospital and received working visas for themselves and their families. Whilst this is not an uncommon practice in the wider healthcare system, staff-led initiatives emphasised personalised support and community integration to retain talent. I learned it was common practice for staff members to welcome their newest international doctors by decorating provided accommodation with donated furniture and toys for their young family’s upcoming arrival. This culture leveraged community support to attract and retain staff. When compared to their urban counterparts, rural hospitals have fewer organisational levels separating frontline staff to executives and directors. Coupled with workforce shortages, this provides several opportunities for employees to branch out to other specialities, and take secondments in projects that are beneficial to professional development. For example, I worked on a project aimed at the integration of electronic medical records (EMR) throughout the hospital. The many members of the team came from a multidisciplinary background, resulting in a fluid project management experience. In fact, it was a frontline nurse who saw the opportunities intrinsic to the project and took on the role as project lead for the hospital. This experience may be more prominent to a rural setting, where skills and personal abilities transcend a specific job, and are applied more holistically to meet organisational needs. ‘Building’ for the future. A long-standing challenge of this rural hospital was the improvement and extension of existing aged infrastructure, which is no longer fit for purpose. This was due to an amalgamation of ongoing rapid population growth to the area, ageing population and rise in chronic conditions. This has consequently led to several petitions for state government funding to build a new hospital, spanning over several years. Meanwhile, the hospital is forced to prioritise (and reprioritise) existing funds to meet prevalent community needs. Being an election year, senior health leaders highlighted the importance of raising awareness and lobbying for essential funding required to provide quality healthcare for growing community needs. I was incredibly fortunate to gain exposure to high-level strategic discussions required to ensure all internal and external communications represented a succinct, apolitical narrative tied to system needs and the funding required to achieve it. This process of working through a strictly organisational lens when dealing with media, politicians and governmental agencies was new to me, and it emphasised the importance of language and tone in public communications. This ACHSM placement allowed me to understand how a rural community experiences, interacts and works in healthcare settings. The vast differences between my previous experience limited to metropolitan Melbourne has broadened my understanding of how a rural health service functions, manages limited resources, and makes strategic decisions to improve outcomes for patients, staff members and the wider community.