Francine Douce - Chief Nurse and Midwifery Officer

In this episode of the One Health Podcast, Dorian Broomhall gets to know Francine Douce, Chief Nurse and Midwifery Officer in a conversation recorded in 2023.

Francine speaks growing up and starting a career in West and North West Tasmania, and she explains the role of the Office of the Chief Nurse and Midwifery Officer.

She shares stories of her own mistakes and demonstrates the importance of accountability.

Francine also tells us how important the North West Maternity Services Transition Project is to both her personally and to women on the Coast.

Transcript

Dorian Broomhall:

Welcome to the One Health Podcast. This episode was recorded on the land of the palawa people. I acknowledge and pay respect to all Tasmanian Aboriginal people and to their deep history of storytelling. My name is Dorian Broomhall, and I'm the Manager of Culture and Wellbeing for the Department of Health in lutruwita / Tasmania. For this episode of the podcast, I got to know Francine Douce, our Chief Nurse and Midwifery Officer. In our conversation recorded last year, Francine speaks about the influences that guided her into a career in health and how growing up on the West Coast and in North West Tasmania helped shape who she is today. She talks about the role of the office of the Chief Nurse and Midwifery Officer and about the significance of the North West Maternity Services Transition Project both to herself and to women on the North West Coast. She also speaks about the importance of creating an environment where it is safe to be accountable for our mistakes. We start every chat with the same question, so let's get into it.

What did you want to be when you were in kindergarten?

Francine Douce:

What did I want to be when I was in kindergarten? I wanted to be a professional tennis player.

Dorian Broomhall:

I had no idea that you were into tennis.

Francine Douce:

I was into sport coming from a large family with lots and lots of boys who played sport. Yeah, family was very much into sport, and so I could see myself as a professional tennis player travelling the world and doing all of those wonderful things that I thought tennis players did. But of course, that was a bit of a dream, but how did I land in health when I wanted to be a professional tennis player? My dad had chronic disease. My father was a return serviceman and had always been plagued with health issues. So being in an environment where my father's health was a very large proportion of the focus of our family, I was naturally drawn into understanding the types of challenges that he had during his life and also how it impacted our family, but also the fascination with medicine, with anatomy and physiology, and the things that were going on in his life. Sadly, he didn't make a long life. He died at 68 as a result of his chronic disease, but I'd always been passionate about trying to fix what had happened to my dad. So that's how I landed in health.

Dorian Broomhall:

So you're a Tassie girl, right?

Francine Douce:

I am.

Dorian Broomhall:

So, it is.

Francine Douce:

I'm very proud to say that my almost 40-year career as a nurse and midwife has been dedicated to the Tasmanian community. But in saying that, it hasn't limited the opportunities that have been available to me, and so I do now work in a lot of the national context and also in the international context. I feel very proud to say that my 40-year career as a Tasmanian has now taken me beyond Bass Strait and certainly beyond the borders of Australia as well.

Dorian Broomhall:

Did you grow up on the North West Coast? Is that right?

Francine Douce:

I actually grew up... I was born in Launceston, and we moved to a country, Deloraine, when I was, I think, seven years old. But essentially, I landed in the North West and lived not only in Burnie, and then moved to the West Coast when we were first married, and then found ourselves living at Port Sorell which... We still maintain a home at Port Sorell, and I still very much connect with my identity as a coaster.

Dorian Broomhall:

Wow. Again, that connection with our rural and remote community, that's brilliant. Now, obviously, you sit here in the role that you have today, but you've still got that tie back to your original roots.

Francine Douce:

Oh, look. Seriously, the time I spent on the West Coast, which was seven years just after I registered, was very important, very important to who I am today as not only a practitioner, but also as a health leader, the challenges that the West Coast community faced, and I worked there at a time where it was a thriving community. The mines were flourishing, employment opportunities were huge, and we had quite large communities relatively to where we're at today. So it was a bumper time, and certainly, what I learned about being a health practitioner, but also working in the community. I worked predominantly in general practise, and then moved to working at the Rosebery Hospital which, of course, doesn't exist any longer. But certainly, the skills and knowledge that I gained over that time, but also the way to communicate with vulnerable communities and just to operate as a really valued part of that community was really formative.

Dorian Broomhall:

I think we're almost returning to that model of care in some of the work that's going on with these things such as nurse practitioners now and paramedic practitioners, and these sorts of different opportunities to have that critical and primary care operating together in the community. So I think it's interesting.

Francine Douce:

Yeah. I think change is born out of opportunity though, isn't it? Whilst my colleagues and I talk time to time again, if you're around long enough, you'll see something come back. That's not necessarily a negative. I think it's just that we have such a strong toolkit that we can draw in our experience so that as the environment changes, or the landscape changes, or the needs of the community change, we can actually draw in our toolkit from experiences in the past, contemporize them to the needs of today's community, and actually then build, enhance, and complement what we know is really effective.

Dorian Broomhall:

Way to think about it. So you did seven years then as a baby nurse as we often call them on the West Coast to kickstart your career. Did you train to be a midwife initially as well, or did you pick that up a little bit later?

Francine Douce:

No. I actually did meet a little bit later. So we were living on the West Coast and wanted to relocate with... My husband was working with the hydro at the time, and as you know, that industry was winding down, so we were collectively looking to our next chapter and decided that we wanted to make our home in the North West. So I actually did my midwifery education training at Mersey Community Hospital.

Dorian Broomhall:

This is something that I've always known and respected about you is that whilst you sit as the Chief Nurse, you're very passionate to remind people and midwife. It is both roles, and it is a profession that you absolutely identify with.

Francine Douce:

I think it's really important for both of my professions to be identified. We know that the education and training pathways are quite separate now, and yet, there's still a relationship between the two professions. But as protected titles, I'm really passionate about ensuring that I actually meet my obligations in my leadership role to both professions. So whilst the position is Chief Nurse and Midwifery Officer, I draw back to my title around protected titles under the national law which is Chief Nurse and Midwife. Certainly, I still maintain passion across both of those professions.

Dorian Broomhall:

Yeah. Brilliant. I remember a great colleague of both of ours now, I suppose, Kat Schofield, the Executive Director of Nursing and Director of Services at Statewide Mental Health, is another long-standing passionate nurse and advocate in the community. She picked me up on something once around how I was describing you and said, "Hey, don't forget that she's a midwife too and wants to identify as that." She was quite onto that, and it was a moment of me go, "Yep, the language really is important."

Francine Douce:

That's fantastic. It may be a subtle point for those who actually work outside of our professions, but I think it's really important that we hold our ground in that regard, and we make sure that the titles are correct, our respect for both professions is correct. It's great to see a colleague advocating in that way as well.

Dorian Broomhall:

Yeah. So you then, obviously, continued your career on North West Coast through the Mersey Community Hospital which is still a wonderful institution that we have today.

Francine Douce:

Absolutely. Great people.

Dorian Broomhall:

When did you sort of... I'm not quite sure how to frame this question right, but when did you step away from direct care nursing and more into that sort of leadership role, that next level up of how you might impact?

Francine Douce:

Yeah. So not dissimilar to the story I shared with you about my dad and chronic disease. We had a little bit of bad luck fall on our family, and my husband was involved in a serious workplace accident. At the time, it was very clear that to continue in a shift working role was not going to be in the best interest of our family as he recovered from his workplace accident. At that time, the opportunity to stay in a clinical role as a day worker was not available to me, so I said upon embarking upon further education and taking up opportunities away from the bedside, and initially, they were in fixed-term contracts or fractional appointments just to get a little bit more in terms of not only my knowledge and capability, but also in networking. So making sure that I was a little bit more visible to those working in areas outside of direct clinical care.

So that actually led me on a pathway then to find some courage and put my hat in the ring for more senior positions, and I was really grateful to be given those opportunities and also be mentored in a way where my trajectory was still actually quite scary. Anything that you do for the first time is quite scary, but to feel really well-supported and I guess to have the appropriate environment available to me to be successful as I embarked on these different areas of practise. So it was a little bit of a journey, but found myself... At the time, Mersey Community Hospital was under private sector responsibilities, and so there were some interesting opportunities that came my way, including being the day nurse manager, so essentially what we would call an aid-on in the public sector.

So I picked up that in a 12-month role capacity, and then found myself as the Acting Director of Nursing as Mersey transitioned back to the public sector all those years ago in 2004. So when I talk about fear in terms of picking up new roles, that just went through the roof, but again, you pull yourself together, you draw back on what you know, your skills, your knowledge, your understanding of systems, and you give absolutely 200% and find the support around you in order for you to perhaps be successful in a very unfamiliar space.

I think the first opportunity I took was a 0.2 position in infection prevention control. So I maintained a fractional appointment as a direct care midwife, picked up the infection control role, then a space became available in the Quality Improvement Team, so I picked up a 0.1 there. So, again, I was working across three departments in a very different way. So as soon as then that full-time equivalent position became available in a different space, I was able to say, "Yes, I'm ready. I've got enough confidence now to move into that area." Thankfully, it came my way.

Dorian Broomhall:

So then, you've come into the public systems where you've been now for close to 20 years, I suppose, since Mersey were transitioned over, and I imagine you've held a number of different positions. How long have you been in your current position?

Francine Douce:

So I came to the Office of the Chief Nurse in 2009, picking up a fixed-term six-month contract. The incumbent actually left the position in 2014, so I actually acted as the Chief Nurse for a period of two years before I'm finally appointed in 2016. So I've been within the unit now for around 14 years which... Gosh, time goes so quickly.

Dorian Broomhall:

I would love for you to explain what the role of your team is. I suspect that not everybody understands what the role of your office actually is and what you do. Would you mind just talking through it?

Francine Douce:

Yeah, and look, that's something that we're trying to work really hard on is to share what we do, but also to perhaps broaden the thinking of nurses and midwives in terms of having a voice right across the health system. So we focus very much on bricks and mortar in health, what's actually happening inside hospitals, what's happening inside community-based health services, but we forget there's another area of practise which is called health policy. So where we talk about health policy and how the health system operates, it's really important that nurses and midwives have the opportunity to be part of that area of the health system as well. So that's where we're positioned. We sit within health policy, and so we undertake a broad range of functions, but essentially, we get to perhaps infiltrate areas of the department that you might normally see us infiltrating. Things like infrastructure planning.

It's great to think that nurses, midwives have a voice in that space, but essentially, our portfolio covers workforce planning, education training, professional regulation, practise policy, career planning. Everything that you might expect to see within the health system for all health professionals, we pick up that captured scope for nursing and midwifery, and notwithstanding. It's really, really important as the largest workforce within the health system that where we can add value, we take those opportunities where we can influence policy direction, we take that opportunity, but also, we strengthen the capability across our workforce to make sure that we truly are realising the value that our workforce is intended to bring to health outcomes for our community.

Dorian Broomhall:

So I think it's interesting as people start to understand who our senior leaders are, who our executive are, and something that you'll notice quite quickly as you start to plot who the different people are and their different backgrounds. Yes, we're a health service, and that doesn't mean that we're led exclusively by health practitioners. In fact, the balance is possibly a little bit more the other way with different sorts of backgrounds of people who are in our senior leadership roles and to sit on our executive. Noting, of course, we do have a standalone executive for clinical issues, and that's important to acknowledge as well. But if we think about our overarching department executive, you sit on that team, and you are obviously a clinician, and you bring that sort of voice. How do you find that collaboration occurring between clinical and non-clinical professionals where ultimately, we've got patient outcomes at the heart of what we do?

Francine Douce:

I think it's fascinating, and it's really an area that gives me a lot of energy. It's interesting to note, as a health executive, I probably have the longest experience in health at the table. So I'm really grateful that my colleagues around the table actually draw on that and value that, but the beauty of a health executive in terms of the diversity and the backgrounds of those at the table mean that we can actually really engage in robust discussion with a whole range of perspectives, bringing richness to the discussion, but also landing us at a place with decision-making where it's not come from just a single lens. It's actually been quite a diverse decision-making framework with which we've used to arrive at a decision.

I think I'm really fortunate I'm one of the few chief nurses around the country that actually sits at the executive table, and I have to acknowledge Kath Morgan-Wicks for her leadership in this regard when she invited me to the health executive almost two years ago. I was very grateful for the opportunity. There've been a period of time where nursing hadn't been represented at the executive level, so to restore that I thought was a great part of Kath's leadership when she first came to the department. I'm really grateful for that.

What do I bring to the discussion? I bring a lot of experience. I also bring, I guess, that community perspective from the practitioner's perspective. Of course, we had the Deputy Secretary of Clinical Quality Regulation and Accreditation/Chief Medical Officer up until recently. So between the two of us, we're able to bring, really, a different perspective to practise and how that impacts and influences health system decision-making. Of course, now, with that change of leadership role across the CQRA area, and I'm learning more also about the other business units within our CQRA division which then also allows me to bring another perspective to the contribution executive table. So I'm finding it a really exciting time. Again, you learn something new every single day, and where we're coming from now in terms of the challenges that health executives will need to manage moving forward, I'm excited about the contribution that I can make.

Dorian Broomhall:

I think that the way that you just spoke about diversity is really important there. Often, we think about diversity in quite a different lens which is, obviously, important as well, but that idea of simply having diversity of thought no matter what your background might be, that you've got different skills that everybody brings a level of diversity with different skills and experiences, and how that can enhance decision-making, I think, is something that we can all learn from that because-

Francine Douce:

The beautiful part about the experience for me at the moment is I feel very respected and valued at the executive table. Again, I don't take that for granted. I think it is really important that that level of respect is not only something we talk about, but it's how we operate at all levels of the health system. So it's important for me to feel respected and valued at the executive level and that we operate in a respectful way.

Dorian Broomhall:

You talked about the transition when you were at the Mersey back in 2004 from private to public, and we're going through, in some regards, a similar transition in the North West at the moment with our maternity services which is a fairly massive undertaking. I think it's so significant that we're putting community at the heart of that and women at the centre of everything that's going on there. I know that that's a very challenging piece of work. What are you most excited about when that piece of work is done and that we do have that transition with the private coming into the public service? When the work of done and dusted, which I know is going to continue to be challenging and rightly so, when that's all done and dusted, what are you most excited about?

Francine Douce:

I'm excited about the possibilities. As you can imagine, having been educated as a midwife in that region, having worked for 20 years as a practising midwife in that region, having had my children in that region, I think the possibilities for not only the service, but for the clinicians, but also for the women is just endless. Our job is to make sure that we transition over a service that is strong and sustainable, and I really believe that that's what the project will deliver. But to look at a regional maternity service moving forward, we need to ensure that we're contemporary, we're dynamic, that we can meet women's needs in a state-wide network of maternity services where we're working collectively for better outcomes for women and families. So I think that as we transition over and we really have that solid foundation for the maternity service, the possibilities for a bespoke maternity service that meets rural and regional needs for our community is a very exciting project.

Dorian Broomhall:

That's a great way to look at it. Despite sometimes some of these changes needing to happen for reasons that perhaps aren't the most positive ones, there is still so much that we can gain from going hard and making something really brilliant of a challenging situation.

Francine Douce:

The important thing for that community... That community is quite challenged. Families are quite challenged in the North West, and so it can't be a one-size-fits-all. So it is important that we have the right models of care, that we support clinicians to deliver that care, that the women actually have a voice in how that service is established and evolves with time, and that we continue to work in partnership, medicine, nursing, midwifery, and the community as a collective. I'm really encouraged that the philosophy of the project very much aligns with what I've just described to you. So, yeah, excited by the possibilities.

Dorian Broomhall:

Yeah. Great. So we're introducing this set of values under the acronym of CARE because, of course, we care for the health and wellbeing of all in Tasmania. That's what we're here for. That's our purpose. So we've got this acronym of CARE being Compassion, Accountability, Respect, and Excellence tailing off from the North West Maternity Services. How important do you think it is for that service to have a set of values, which they will have, as a starting point for how they're going to operate together?

Francine Douce:

I think it's critical. I think it's absolutely critical. To bring that service together, to meet the needs of the community, but also, to actually take the journey into the future, we need a collective vision, and values are a foundation stone of what that collective vision might be. I think it's also important that we work in unison, and values allow us to do that. Remember, we have a workforce that will be coming over into the public sector, and it is a slightly different world in the public sector. The community expect a lot from public servants, and as nurses and midwives, we are public servants. We are working within the public sector to the State Service Code of Conduct, et cetera, et cetera. Nurses and midwives are traditionally seen as the most trusted profession, so it's inherent in our own professional regulatory framework. Those expectations align very nicely with the State Service Act, et cetera.

Values are a real cornerstone. It's what we live ritual. It is grounding us in terms of meeting the needs of the public. If we truly are working with the public front and centre, and the focus of care, it is our values that will recalibrate our thinking all of the time as we actually build that service and move forward. I can't stress enough how important it is that we meet the expectations of the community as public servants. That's very important to me, and that lends to the values that you've just described, particularly around accountability and respect as we strive for excellence in everything we do. But we can't forget that we're dealing with people, people coming from all walks of life with different journeys, different stories, but to care with kindness and compassion is also really fundamental. At the end of the day, we're dealing with our public who expect a lot of us. That can be challenging, but it's probably not negotiable.

Dorian Broomhall:

How do you think this then will apply? Because I think to an extent, what we're seeing and what we're hearing is that we actually do patient care really, really well. We don't always do that same care for one another so well. How do you think that we might be able to use this new set of values across our entire organisation, the whole Department of Health encompassing the Tasmanian Health Service? How do you think that we can leverage these values for each other?

Francine Douce:

Isn't that the challenge? That certainly is the challenge. I think it's important that we all buy into the values, and that will mean that we absolutely unpack each of those elements, and as employers, regardless of where we sit in the organisation, that we actually understand what would be the behaviours that are associated with those values, ensuring that we've actually got a safe environment where if we fall short of the behaviours that model those values, that we can call that out safely and that we can work with people to fill in the gaps, A, in the understanding. B, the challenges you bring to work every day might actually let you down on a particular occasion, and you fall short of what you might normally model your behaviour on around those values, but I think it's the commitment of all of us saying, "I signed up to these organisational values. I want to be able to model and behave in a way that's consistent with those values, and I want to ensure that my colleagues, my peers, those who walk the journey with me have the ability to do that safely as well."

This is a big undertaking, and I think in the past and probably rightly so, we've tried to create values that have been marketed on all the merch, but what have they really meant to everybody working within our system? As you described, the 15,000, 16,000 of us that will actually be working with these values front and centre, that will be the challenge, but it's up to us as leaders to ensure that we model the right behaviour, that those values mean something to us, that they can filter right through the organisation. But it'd also say, particularly when I think about nursing and midwifery, you don't have to be in a leadership position to be a leader. We have leaders in every part of the system, and it's not necessarily related to the role that you undertake. I draw on the words of a colleague who says, "To be a nurse or a midwife is to be a leader, to be a leader clinically for your community within the service and certainly, to espouse the values not only of the organisation, but of our profession as well." So therein lies the challenge, but I'm certainly up for it, and I hope my colleagues are too.

Dorian Broomhall:

Out of the four that we've got, the compassion, accountability, respect, and excellence, what one most speaks to you as a personal value that you actively hold yourself to, and how do you do that?

Francine Douce:

So, accountability. I feel as a health professional, professional integrity is the one thing that for me is a non-negotiable, can't be abrogated, and it's certainly something that I've held from my entire professional career. I say that quite realistically. There've been times across my career where I've made mistakes, and I remember one time, particularly, if I could just indulge for a moment, I was working clinically, and I got a call a time on a day-off from a colleague who had taken over from my shift on the Sunday afternoon. I remember very clearly it was a really, really busy Sunday shift. At the time that I was about to hand over, we had a baby who deteriorated in the nursery, and we had to do what we call a septic workup. We had to do a full suite of investigations.

We started a drip for that baby. Baby is only a few days old, and my colleague was ringing me to tell me that the bag of IV fluids had an expired date on it. Now, two of us had checked that, but the father had noted that later in the evening, and so she was ringing to let me know. So I'd asked her what she'd done, but obviously, I felt absolutely devastated that we had made that clearer, and everything was okay with the baby which I was really, really grateful for. But she had prepared the documentation herself, and so I wanted to make it very, very clear that I had a set of accountabilities against that particular action, and so I automatically rang my nurse unit manager, and I spoke to my nurse unit manager about my role in that particular event. I went in on my days off, and I completed the documentation as well, and then I also engaged in some additional professional development.

So I say that because making an error shouldn't be something that we fear in terms of our accountability, but also sharing that experience and moving forward because none of us are immune from making mistakes. So I just wanted to share that with you as an idea about professionally, that's where my baseline is. For me, that's not negotiable, and even as I've gone through more senior roles, I do make mistakes. But I think the important part about being an authentic leader is actually not necessarily fessing up, but being really open to understanding that if we fall short, we need to take accountability for that, and we also need to move forward with that experience because it makes us a fulsome practitioner and leader.

So, for me, accountability sits really neatly within the CARE Values. I think compassion is a personal attribute that I try to work with all of the time. No one is perfect, but I do try to work through a lens of empathy, emotional intelligence, and compassion. But I think respect and excellence really then are born for me out of my strong sense of accountability as a public servant. So I feel they wrap really nicely, but it's the big A for me that is the non-negotiable.

Dorian Broomhall:

Thanks for sharing that story. I think it's really important that we hear stories like that from people with your experience because "mistake" is not a popular word in this organisation and rightly slow because it often will indicate some sort of adverse patient outcome which is exactly what we don't want. However, we know they happen every day, and the focus should not be on the mistake. It's what happens next, and that's the starting point of putting your hand up and taking accountability as well as others looking to support you in holding you accountable, I think, is such an important story.

Francine Douce:

That's what quality improvement is all about. I might add we added an additional process of audit around that, and I hope that my experience prevented other incidents, similar incidents, but I just think it's important to share that story because there'll be mistakes made every single day in the healthcare system, and they're not on purpose.

Dorian Broomhall:

That environment where we are, safe and okay to say, "Yeah, I got that wrong. What can I do differently next time?" and be supported, not persecuted for making that mistake is what's essential. You know what? I challenge anybody to say, "Well, have you actually seen an example of anybody in the organisation where they have owned up to a mistake and they were persecuted for it? Is that actually happening? Therefore, if that's not happening, if people aren't going down that path of persecution, why aren't we putting our head up every time?

Francine Douce:

But again, creating that environment is everyone's responsibility. We all create the environment where it is actually safe to be authentic and transparent in our practise, and to actually have that reflection in our practise by peers, by external parties, but also, a culture of self-reflection in practise is really, really healthy.

Dorian Broomhall:

Yeah. I think why I'm so glad that you shared that story is that one of the key ways that we can do that as leaders at all levels of the organisation is to share those stories where we've got it wrong because actually, that's important too.

Francine Douce:

100% valuable.

Dorian Broomhall:

Yeah. I think it's fascinating. Look, Francine, you've given me so much to think about as always, and I will say, having known you for a couple of years now, I absolutely see that you role model compassion in everything that you do. No matter how full your deck might be, you've always got a smile on your face. I really appreciate that you take the time to say hello, and I observe this here, there, and everywhere. Having worked with your team, I know how much they value your leadership directly, and having seen you operate at the senior leadership level too, I appreciate that, that compassion that you bring. Certainly, for me, walking into that room a few times going, "Oh, I'm not quite sure how this is going to go today," but to have you there with that smiling face and that compassion that you bring has certainly helped me personally. So I did just want to give you that thanks because it's important to note you might not realise the impact that simply by smiling and saying hello at the very start of an interaction, even if you don't know the person, can make all the difference for them. So I thank you for that. Thank you for having the conversation with me.

Francine Douce:

Look, thank you, Dorian. Look, I just would like to close by saying I feel privileged every single day to lead the Tasmanian nursing and midwifery professions. It is a privileged position. I don't take that for granted, but certainly, when my career comes to an end, I'll look back very, very fondly on not only my time within the department, but also the executive level and also some of the small things that we may have been able to achieve through that time. So thank you for taking the time to chat with me today.

Dorian Broomhall:

Great. Awesome. Thank you.

Thanks to Francine Douce, the Chief Nurse and Midwifery Officer, for taking time to speak with us and to you for listening. I hope you found something in our conversation that you can take away and apply into your own work. You can read more about the North West Maternity Services Transition Project by clicking the link in the show notes that will take you to the final report. 

Join me again for our next episode where I speak with George Clarke, the Chief Executive of Public Health Services.