Vic Management Interns' blog

Blog posts by Victorian Management Interns of the Australasian College of Health Service Management. Views are those of the individual authors and not those of ACHSM or management interns’ host organisations or employers.

Tais Lildaree
Tais Lildaree

Health Management Interns, ACHSM

The Bell Curve Effect

Author: Caitlyn Brennan

Date: March 19

The best possible and highest quality health care is what we should be striving for in the health industry.

We measure, record, report and audit but still see some significant discrepancies in the quality of care and health treatment outcomes.

The Annals of Medicine published in 2004, ‘The Bell Curve, What happens when patients find out how good their doctors really are?’ (Gawande, 2004). This article explored what happens when organisations that believe themselves to be the best learn, in fact, they are not. If Specialists saw how their care stacks up in a bell curve distribution, would it encourage them to continually strive to get in that top 2.5%? The article found transparency to be the key. Health organisations are required not only to have healthy competition with one another but a camaraderie between all health clinicians, organisations and governmental bodies to overcome ego and focus on the common goal and to share the learnings to continuously improve the health systems’ overall ‘mean’ of quality.

In Victoria we have seen these same key themes:

  • 2016, Targeting zero (Duckett et al. 2016) calling for transparency and culture change in Victorian public healthcare
  • 2018, Safer care saves money (Duckett et al. 2018) another report (unsurprisingly) again calling for greater transparency in the accreditation results of Victorian healthcare.

As I reflect on my time in the ACHSM HIMP program I can’t help but notice familiar themes in my pattern of feelings during each experience a pattern I now refer to as the:  

The initial start (0.1%) Day 1: nervous of the unknown of what you’re walking into, a day of reading policy & procedures? Tours? meet & greets? early lunch? Meetings? Will I have a desk or computer?

The first week or so (2.4%) the new and overwhelming stage: new names, new faces, new workplace style this is the time you’re new enough to ask “sorry I know we’ve met but what’s your name again?” as you try desperately to sponge and absorb as much information as possible.

The next stage is, the stage I find the hardest!

Week 3 up to 3 months (13.5%) as a new HIMP your enthusiastic and want to demonstrate your value. This period is a struggle between being new to the organisation and having some idea what you are doing and what the expectation is, but new enough that you are still grasping style of organisation, content and expectations, so essentially feeling like your productivity is slower than where you think it should be.

Thankfully following this stage, you get closer to the ‘mean’ now.

Most of your placement month 2 to month 5 (68%) is in comfortable zone - knowing what you’re doing and aware of expectations phase.

Month 5 and 6 (13.5%) by this time you are comfortable, delivering and starting to focus on what’s next, what you need to finish up and get ready to hand over.

The final days (2.5%) the wrap up and farewells.

Throughout this bell curve of the HIMP placement journey, as with healthcare, transparency and a slight cultural shift is key. Being transparent with yourself, changing your view to overcome ego and learn from each placement’s 2.5% - strive for your own continuous improvement.

Whilst the bell curve of the HIMP placement journey pattern is similar for every placement it is important to remember how far your ‘mean’ has come.


Duckett, S., Cuddihy, M. and Newnham, N. (2016) Targeting zero, Supporting the Victorian hospital system to eliminate avoidable harm and strengthen quality of care, Report of the Review of Hospital Safety and Quality Assurance in Victoria file:///C:/Users/caitlyn.brennan/Downloads/Hospital%20Safety%20and%20Quality%20Assurance%20in%20Victoria%20(1).pdf

Duckett, S., Jorm, C., Moran, G., and Parsonage, H. (2018). Safer care saves money: How to improve patient care and save public money at the same time. Grattan Institute.

Gawande, A. (2004) The Bell Curve, What happens when patients find out how good their doctors really are? Annals of Medicine.


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