Prof. Dinesh Arya - Chief Medical Officer, Chief Psychiatrist & Deputy Secretary CQRA

In this episode of the One Health Podcast, Dorian Broomhall, Manager of Culture & Wellbeing, gets to know Professor Dinesh Arya, Chief Medical Officer, Chief Psychiatrist and Deputy Secretary for Clinical Quality Regulation and Accreditation.

In our conversation, Dinesh speaks about being inspired to follow in his grandfather’s footsteps and become a psychiatrist when he was growing up in India. 

He talks about being a lifetime learner and about the importance of putting the proper time into developing one’s skills. 

He speaks about realising that in order to be effective in his role, he needed to develop his skills in many areas, and so has conducted study across academia, practice, management, administration, law, data science and more. 

He argues that understanding our environments when managing systems is just as crucial as developing our associated skills. 

Dinesh talks about how he views leadership and management as being just as scientific as medicine, and that our practices therefore should be guided by evidence.  

He also shares his thoughts on how we can consider trauma in our workplaces and suggests appropriate ways in which we can offer support – starting with caring. 

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. I'm Dorian Broomhall and I'm the Manager of Cultural and Wellbeing for the Department of Health here in lutruwita Tasmania. For this episode, I got to know Professor Dinesh Arya, the Chief Medical Officer, the Chief Psychiatrist and Deputy Secretary for Clinical Quality, Regulation and Accreditation. In our conversation, Dinesh speaks about being inspired to follow in his grandfather's footsteps and become a psychiatrist when he was growing up in the north of India. He talks about being a lifetime learner and about the importance of putting the proper time into developing one's skills. 

He speaks about realising that in order to be effective in his role, he needed to develop his skills in many areas and his conducted study beyond his original psychiatry profession to include psychotherapy, pharmacology, management, administration, law, data science, and much more. He suggests that understanding our environments when managing systems is just as crucial as developing any associated skills. Dinesh talks about how he views leadership and management as being just as scientific as medicine, and that our practises therefore should be guided by the evidence. He also shares his thoughts on how we can consider trauma in our workplaces and suggests appropriate ways in which we can offer support starting by simply caring. I start every conversation with the same question, so let's get into it. What did you want to be when you were in kindergarten? 

Prof. Dinesh Arya: 

I wanted to be a truck driver, then obviously that changed. Then I wanted to be a pilot, then I wanted to be a teacher, and I think these were all people who influenced me growing up. But I think by the time I was about 10 or 12, I was pretty clear in my mind that I was going to become a psychiatrist. 

Dorian Broomhall: 

Wow. 

Prof. Dinesh Arya: 

So from that point on, that has been the trajectory that I have followed. 

Dorian Broomhall: 

So I'm a little surprised by that for perhaps a few reasons, but one being that psychiatry wasn't enormously well known, I wouldn't have thought, when you were around the age of 10 or 12. What was the influence that gave you that? 

Prof. Dinesh Arya: 

Yeah, especially at that time and my grandfather was a psychiatrist. 

Dorian Broomhall: 

Aha. 

Prof. Dinesh Arya: 

I think that was the real influence and determining factor for me in terms of what I wanted to do because I saw him, what he did, I saw the changes that he brought about in people's lives and how he helped families, and it was just pretty clear to me that's exactly what I wanted to do. 

Dorian Broomhall: 

Wow. Were you close with your grandfather? 

Prof. Dinesh Arya: 

Very close. Yeah. We lived in the same house. 

Dorian Broomhall: 

And where were you at this time of your life? 

Prof. Dinesh Arya: 

So this was in India near New Delhi. 

Dorian Broomhall: 

So you had a lot to do with your grandfather, obviously living in the same house. What is it that you noticed around him helping people and bringing that change in people's life that really struck you at that early age do you think? 

Prof. Dinesh Arya: 

He was really a saint, that's the best way I can describe him. He lived his life to serve others very selfless, very devoted, very spiritual in his approach. So care, compassion, giving, looking after others was the life that he lived, and that is a life that I wanted to live as and when I grew up. So I think that was the driver at that age. 

Dorian Broomhall: 

That's an amazing foundation to carry that forward. Becoming a psychiatrist is no easy feat. What was your process? How did you go? Where did you go, okay, through school and then straight into university in India or what happened? 

Prof. Dinesh Arya: 

Yeah. So I did my degree in medicine and then I specialised to become a psychiatrist. And then I did my first research doctorate that was in psychotherapy, and very quickly followed that with my second doctorate, which was actually in psychopharmacology. So completely opposite sides of psychiatry, if you like. But it was very clear to me that I wanted to be really well-prepared both for academic psychiatry and also for practise of psychiatry. So that was the trajectory that I was progressing on. I wanted to become a psychiatrist that was really skilled, had the competence to really do the best possible thing that I could do and the best possible care that I could provide. 

Dorian Broomhall: 

When you were studying your medicine degree, what was the attitudes toward psychiatry like within your peers at that stage? 

Prof. Dinesh Arya: 

Yeah, still evolving as you rightly said earlier. Psychiatry is not a specialty that is as popular as it is now. The recognition of mental health problems, mental disorders was pretty low then. So very few psychiatrists, very high demand, but that's how psychiatry was then. 

Dorian Broomhall: 

So done your undergraduate, your medicine degree, you've got your double PhD, your double doctorate by research, what next? 

Prof. Dinesh Arya: 

Yeah, so that was the interesting change in some ways in my life and career and profession. I was in the United Kingdom then, and that was a time when Griffiths reforms were taking shape and Griffiths reforms, you may or may not remember, were about NHS transitioning from being clinically led to being managed by businesses or being managed like a business. And I just happened to be in the United Kingdom at that time when this transition was happening. And across the Atlantic, that was also the time when United States was going into managed care and then into managed competition. Again, very much a business transformation. And as a sort of twenty-something year old at that time, I just could not believe that this was happening. And I was absolutely convinced in my mind that this business transformation will fall on its face and then NHS and health systems will again need clinicians to manage such very complex health systems. 

So that is when I started getting interested in health services management. So being a clinician, which I was quite happy that I had been able to achieve, but I said, "To manage health systems, to manage these complexities, I have to learn health services management." So that led me into qualifying in health services management and then in business administration and then public administration and so on. But it was very clear to me that to be able to manage health systems, you had to be an expert. You just can't manage such complex systems just by virtue of being a clinician, all by virtue of having years of experience in something, you just have to learn that skill. And I'm a great believer that unless you have gained the skills, your competence, the expertise, you just cannot excel. You can't really deliver. So that led me to that trajectory. Now, being a clinician was one thing, but I just needed to learn how to manage systems and that's what I did for the next many years and carry on doing now. 

Dorian Broomhall: 

Yeah, fascinating. That would've been a really interesting time as a young-ish clinician to have the awareness of what's going on in the system more broadly. Of course, we can look back at that retrospectively now and see that as a real watershed moment, not only in health systems, but in the way systems are being managed in the west sort of more broadly. So where did your career take you? When you in the United Kingdom and you've started this, what certainly seems like a lifelong journey of learning, where did your career take you? 

Prof. Dinesh Arya: 

So next I went to New Zealand and I went to New Zealand as an academic psychiatrist, but then did my MBA in New Zealand and very quickly got picked by the university to start teaching in the MBA course, which often happens to people. And there I was teaching total quality management and continuous quality improvement. And very quickly I realised that even learning the skills of quality improvement and total quality management is just not enough. You just had to learn other skills that were needed to manage health services effectively. So that led me to bioethics health law and more recently data science because I think these are, as times have changed, as our health systems have changed, as our needs and expectations have changed, these things have become really, really important. So in addition to learning how to manage systems, if you don't have understanding of ethics, if you don't have understanding of law, of how data can be manipulated, something is missing. So I just wanted to make sure that I'm covering all those things as I was developing myself professionally. 

Dorian Broomhall: 

I'm going to follow my own interest here because that's the joy of being the person asking the question. The approach to learning about systems I think is profoundly important. A lot of what is taught is what I would deem around closed systems or controllable systems, which we know we've got within our healthcare system. Absolutely, we've got bounded systems and we also don't. We've also got complex adaptive systems, we've got very open systems. What have you learnt that's been useful when it comes to working in that unknown unknown in that world of complexity? What have you really found there that lands? 

Prof. Dinesh Arya: 

Man, the most important thing is to learn about your environment, is that you are trying to make a difference, you're trying to implement things, but you are always doing that in context of the environment that you're in. So you need to understand your environment, you need to understand yourself, and then you need the third bit, which is the skills, the competence, and the expertise. And once you have all three, then I think it becomes easier for you to manage whatever system you're managing, A closed system, an open system, a diverse system, a flexible system. But if you miss out on any of these three components, I think that's when people land themselves in trouble. 

And I often say that you need about 10,000 hours of learning to become an expert, yeah. I often say in health systems, you actually need 15,000, maybe 20,000 hours of learning because health systems are so complex. Once you have done that, once you have invested that much time and effort into gaining skills, gaining competence, gaining expertise, and you have understood the environment that you're operating in, only then you can actually manage the system properly. If you miss one of those things, then you miss a lot. 

Dorian Broomhall: 

I really like that you put the environment as the first thing there because in many ways it's the thing that we can't control. I know we are talking about looking to manage it. Downside of that language, of course, is to control. That's what to manage is yet we can never properly control a health system or is that something that you disagree with? 

Prof. Dinesh Arya: 

Health system is always changing, isn't it? So needs and expectations of people are changing. And to meet those needs and expectations, we keep changing our models of care. We keep changing the way we do things. Then there is this complexity of new devices, new technology, new interventions that are coming in all the time. And then comes the challenge of, "How do you incorporate this new technology into your day-to-day practise, and to be able to do so safely?" I think all these things are day-to-day complexities. And you have to not only keep up with all these developments, but also make sure that you're examining your environment really quickly, really carefully. 

Dorian Broomhall: 

And I like that point too of as we get new systems on new ways of working, we've got that tension of needing the evidence to say that, "Yes, that's safe to do so." And also holding innovation tension there. Something that I've observed in our environment perhaps, is that we do that evidence base really, really well when it comes to the ways of working and operating as a clinician or other professional within the health system context, noting there's a broad array within there when it comes to that work that we do, the professional work, the evidence leads the way when it comes to managing or leading people, the evidence doesn't seem to lead the way. Have you noticed that? 

Prof. Dinesh Arya: 

For some people. But I think leadership or management or administration, I consider these to be as scientific as medicine or as any clinical profession. And that is the reason why I made that comment earlier that you have to develop these skills, these competencies in whatever field you are specialising in because that helps you to use evidence that helps you to understand what is best practise. Helps you to understand what kind of tools and methods you need to use to get the outcomes that you want to achieve. So it can be as scientific or it should be as scientific as you want it to be. And if I use the example of what we do day in and day out in the department of health, which is develop policy. 

Now, policy you can develop by talking to other people. You can develop a policy, again, by experience, but if you want to develop evidence-based policy, which is what we try to do, that requires that analytics, that requires you to go through the process of understanding what has happened in the past, what is likely to happen in the future, what is the evidence about some policy being successful, not being successful, what sort of interventions have achieved, what kind of outcomes, and then you develop that evidence-based policy. So even in policy sense, you can be very evidence-based in leadership, in management, in administration. I think you should be evidence-based. 

Dorian Broomhall: 

I quite agree. The fun part, of course, of all of that is that we can develop a wonderful evidence-based policy that then the environment rejects for whatever reason. 

Prof. Dinesh Arya: 

That's right. 

Dorian Broomhall: 

Whether it's- 

Prof. Dinesh Arya: 

That's why you need to understand the environment. 

Dorian Broomhall: 

Yeah. There you go. Yeah, full circle. No, I love it. So then how did you find yourself here in beautiful Nipaluna Hobart being one of the key within the Tasmanian Health Service and the Department of Health here? How did you find yourself down here? 

Prof. Dinesh Arya: 

Yeah, the most beautiful place on Earth. 

Dorian Broomhall: 

Agreed. 

Prof. Dinesh Arya: 

Yeah. So I've had the good fortune of having worked in many different jurisdictions in Australia, and I have been in similar roles as chief medical officer or chief health officer. An opportunity just came to come to Tasmania and I jumped on it because it is the most beautiful place on earth and a wonderful place to work. And I'm really delighted having arrived in Tasmania, how welcoming, how engaged, how happy everyone is, which makes our work delivery so much more fulfilling. 

Dorian Broomhall: 

Did you go from New Zealand to Australia? Was that your move? 

Prof. Dinesh Arya: 

Yep, I went between New Zealand and Australia a few times, but then, yes, more recently, last few years in Australia. 

Dorian Broomhall: 

Yep. And have you travelled to Tasmania much before coming and taking this role? 

Prof. Dinesh Arya: 

A few times. Actually, I used to be a surveyor for the healthcare standards. 

Dorian Broomhall: 

Yeah. 

Prof. Dinesh Arya: 

I did accreditation survey at Royal Hobart a couple of times long time ago. 

Dorian Broomhall: 

Interesting, having that lens of that audit lens, but then coming to help manage the system. What have your key observations been since you've arrived here in Tasmania? And I note that you've got a more diverse portfolio than many might realise with the different sort of hats that you wear. What have you noticed since you've arrived here? 

Prof. Dinesh Arya: 

I think overall the opportunities, the challenges, the issues are not very different. So these are, I think, very similar in all jurisdictions, but Tasmania being a small jurisdiction means that there are fewer people to deal with lot, many issues, and you refer to many different portfolios that I have had the privilege of leading. But I think that's what is just so wonderful about Tasmania, that you are in a smaller jurisdiction, there's a huge scope, huge potential to really deliver, make a difference, and do so quickly. And I think the benefit of being able to do things quickly and not lose time is just absolutely wonderful. 

Dorian Broomhall: 

I think it's such a great perspective and an easy one to forget when we take the lens that at health in Tasmania, we're the largest of all the organisations in Tasmania, so we feel big and at times for many of us working in it can feel cumbersome, but of course compared to others, we've got the enormous potential for agility and the ways of doing things quite differently. It's great that you bring that lens. So linking back then to the 10 or 12-year-old who wanted to be a psychiatrist, and those key values, as you look back now on that starting point, how do you think you've gone on keeping that as the heart of what you do? 

Prof. Dinesh Arya: 

I think that still remains at the heart of what I do and how I think and how I behave. Whether you are in clinical practise, whether you are managing a health service organisation, whether you are managing a health system, those values stay with you wherever you go. So the values that I have grown up with are to be caring, be compassionate, but also to prepare myself with necessary skills, necessary competence, necessary expertise. Whether you are looking after a patient, you are trying to provide the best possible care that you can to that person, isn't it? 

When I'm managing an organisation, I'm trying to manage the best possible way I can. If I'm supporting someone leading a team, I'm trying to look after team people in the most compassionate, most caring way that I possibly can. So I think the themes are the same whichever field you are in, whether you are a doctor or a nurse or an architect or an engineer, you want to be an expert in the field that you are in and you want to provide whatever service you are in a very caring, very compassionate manner. That's what all this is about, I think. 

Dorian Broomhall: 

So I actually really love that you've got psychiatry as the bedrock of what you first trained in and specialised in, because at the end of the day that puts people first, right? That's the point of the profession, is to support other people with their emotions much more than their physical being. And certainly in the Tasmanian context, we've been talking about this idea of trauma a lot more in the last perhaps couple of years. It's certainly started to come to the fore of mainstream culture a lot more. There's notable psychiatrists like Gabor Mate that have permeated the mainstream, which I think has been a long time coming. It's got some ideas that aren't for everybody, but so does any person who puts themselves out there. This idea of thinking about trauma at an organisation level maybe, what are your thoughts on that? How do we start to consider that idea that everybody who comes within our doors every day may have some level of trauma, including the people who work here? How do you think that we go about working with that? 

Prof. Dinesh Arya: 

Yeah, and I think trauma, or perhaps, let me widen that a little bit. Let's call it stress. 

Dorian Broomhall: 

Yeah. 

Prof. Dinesh Arya: 

People experience trauma, people experience stress. From an academic perspective, I actually don't think it is the trauma or the stress that should be our preoccupation. It is about how a person perceives that trauma or perceives that stress. So two people can have exactly the same stress, exactly the same kind of trauma. One may benefit from it because that gives them an opportunity to grow, to develop resilience, to develop strength. Whereas another person, because of other reasons, may be affected by that trauma, that stress to such an extent that their functioning may deteriorate. So I think when we are thinking about stress or trauma, it's really important to not just look at trauma, not just look at that stress, but look at the person and how that person has perceived that particular stress. 

Because that enables you to then devise the strategy that is right for that person that helps you to understand, "What does this person actually need?" Or what this person will actually benefit from so that we can then wrap around the support that this person needs. I think that's, in my view, is the best way to understand trauma and try to help people who may have experienced trauma. And in our organisational setting, I think that's what we need to do. Sometimes we come across people who have experienced trauma, but we don't invest the time into understanding what the impact of that trauma has been on that person. And if we do that carefully, properly, in a very considerate manner, I think we can develop some very good, very appropriate strategies for the person because that what the person will benefit from. 

Dorian Broomhall: 

Yeah. I really like that approach, and it strikes me as very similar to a quote that I think is particularly useful, which is slightly different, but you get the message that your problem is not the problem, it's your relationship with the problem that's the problem. 

Prof. Dinesh Arya: 

Absolutely. 

Dorian Broomhall: 

I love that idea of the perception coming into that. So noting that the last thing that we want to inadvertently do through some of the work that we're doing around educating our people within the organisation, the last thing that we want to inadvertently do is make people somehow think that because they know a little bit about trauma and how to operate with it, that all of a sudden they're qualified and they're counsellors and they can help someone find their solutions or whatever it might be. I want to make that really clear. I think that that's sometimes what happens. People start to think that that's actually their role, especially as a manager, when people start to them with their personal issues or work-related issues, depending what it might be. With that in mind and within what you've just sort of talked about, what are some strategies that people can employ if they become aware that somebody perhaps does have a perception that isn't helping them in relation to some sort of event? What sort of strategies do you think people could employ? 

Prof. Dinesh Arya: 

Yeah, I think starting point for everyone, you and I and everyone who works in the Department of Health or within the health system is the bits that we were discussing earlier: being caring, being compassionate, listening, giving people time, providing them support. That is what anyone and everyone should do. But then as you also flagged, providing support and treatment or therapy or counselling, these are very specialised fields. There are very specialised interventions, and I would go back to that 10,000 hour rule or 15,000 hour rule. If you do not have the skills and you do not have the expertise, you haven't invested that much time in training yourself to be able to provide that treatment, don't do it, because if you do it inappropriately, harm can come from the person. 

So you have to learn the skill, you have to have that expertise to be able to support people appropriately. And therefore, I think for us as managers, as leaders, as friends, colleagues, very important that we are there for people in a caring and compassionate supportive role. But when someone really needs an intervention, I think we should make sure that they are linked in with a specialist in that field who can provide them with the right intervention so that they benefit from it and not risk harm coming to that person. 

Dorian Broomhall: 

Yeah, I think it's a really beautiful way of articulating it. Often, it's just connecting to that next step and what might be important there. So I suppose the last thing that I'm curious before we wrap this conversation up is that now that you've had a little bit of time to get your feet under all of your desks, I might say, what do you think you're going to focus your attention on most over the coming months? 

Prof. Dinesh Arya: 

I mean, the priorities at the moment for us is to really study the system. The secretary is very clear that he wants the organisation to be led from a clinical governance perspective, which means that we must have very good systems to govern the clinical system. So I think that's what my focus and the focus of clinical quality regulation and accreditation branch is that all of us are very focused on making sure that we are putting the necessary scaffolding in place so that we are governing the clinical system appropriately, which means that we have good quality improvement processes in place, which means that we are looking at our performance, we are looking at our outcomes, we are making necessary changes. 

But as I suggested to you before, doing it in a very timely manner, in a very quick manner because I think if you lose time, if you do not implement improvements in a timely manner, you lose the opportunity. So if we have identified an issue now, and if you're going to take six months to implement a solution, we have lost time, we've lost the opportunity. So what we're trying to do is to set up the system, but set up the system in such a way that it is really efficient. We are not wasting time. We're implementing things very quickly, and I think that is going to be the focus for the next few months. 

Dorian Broomhall: 

And how do you think we can support our workforce to be prepared for that? 

Prof. Dinesh Arya: 

Information, communication, communication, communication. So I think that's what we need to do. And I think if we can do that, if we can package the information properly, then I'm sure everyone will come along and will come along quite easily. And I often give people an example that we have got hundreds of clinical indicators, performance indicators, that if we want, we can make available. We can say to people, "Here is our performance. If you're not performing well do something." But that's not the way to do it. If I'm a cardiologist, I only am interested in performance indicators or clinical indicators to do with my specialty. So we need to package our information in such a way that the person who is receiving that information is going to use it. At no point in giving a cardiologist 120 clinical indicators when they only want one or 1 or 2 or 10. So that's what our focus is. So we want to make sure we're packaging information properly, we are customising information for people so that they actually use it. They don't just see it. We want them to use it. 

Dorian Broomhall: 

Yeah, it's a really great lens and something that we can take away and think about how we might be able to support through our work. Dinesh, thanks so much for the conversation. It's been great. 

Prof. Dinesh Arya: 

Thank you very much. 

Dorian Broomhall: 

Thanks to Professor Dinesh Arya, the Chief Medical Officer, Chief Psychiatrist and Deputy Secretary for Clinical Quality Regulation and Accreditation, for taking the time to speak with us and to you for listening. I hope you found something in our conversation that you can take away into your own life. Join me again for our next episode when I speak with Ian Thomas, the Department of Health's Chief Risk Officer.