Sally Langley: Different pace

In a period like no other, Royal Australasian College of Surgeons discovers ways to operate more efficiently while keeping to its promise to protect the well-being of members and their patients. President Sally Langley shares her leadership story.

Medical associations have been hugely impacted during the Covid pandemic. What did that impact look like for your members?
When the pandemic hit us, our initial priority was the health and safety of our fellows, trainees, specialist international medical graduates (SIMGs), and staff. We worked quickly to adapt to the rapidly changing situation and implemented daily communication updates.

We had to cancel all our training and educational programmes, including examinations for our trainees. This change required us to allow them extensions of training where necessary for mandatory requirements to be met. There was also additional uncertainty for many of our trainees whose training rotations required that they cross national, state and territory borders.

We were fortunate to secure exemptions from travel restrictions for the purpose of commencing their new training term and from post-travel quarantine on the basis on being essential health workers providing frontline surgical care to the public.

In late-2020, we were able to hold the fellowship exams for our trainees in modified format. It was important that our stakeholders heard from us and knew that we were being transparent about what was going on and what we were advocating on their behalf.

How did that change the needs of your members and the way you served them?
From the outset, we followed a set of overarching principles to guide our decision-making. We agreed that we would act in the best interests of patients and the community in consultation with our stakeholders and the healthcare systems in which we work.

For our members, we wanted to conduct our activities and services consistently, transparently and fairly across all our training and educational programmes.

The main change for our members was that we could only hold events virtually for a period of time, but this transitioned to a hybrid format and face-to-face where possible.

Were there any unexpected areas or developments needing attention?
I think no one expected the various shutdowns across Australia and Aotearoa, New Zealand to last as long as they did. This required constant adjustments to ensure that we were as responsive as possible to the changes.

While not unexpected, one area we had to manage proactively was the cancellation of elective surgery in hospitals. We were part of a collective voice that called for an urgent freeze on all non-critical elective surgery. We felt that continuing non-emergency elective surgery was unnecessarily putting patients and staff at risk of Covid-19 infection, while using personal protective equipment (PPE), which was then in short supply. This also allowed health staff to be retrained and freed up intensive care units and hospital beds.

As expected, the suspension of elective surgery had a serious implication for many surgeons’ livelihoods and delayed surgery for many patients who were suffering and understandably upset by the uncertainty over when they could have their surgery. I am pleased to say that our surgeons acted with total professionalism adhering to the restrictions and setting an excellent example for our community.

Associations usually rely on conferencing as a major source of income. But the pandemic not only made many meetings unviable, there was also a reluctance for hospitals to allow their medical staff to travel and participate in in-person events. How did this affect revenue and what did you change to cut costs?
In 2020, we had to cancel the Royal Australasian College of Surgeons (RACS) Annual Scientific Congress due to travel restrictions and health concerns. This event usually brings together more than 2,500 surgeons from around the world. It is an excellent opportunity for professionals to learn and network. So, it was disappointing that we couldn’t hold the event.

Fortunately, we were able to hold the event in 2021 in Melbourne and in hubs around the world in a hybrid manner, with some activities held onsite and others virtually. We had a record 3,706 delegates attending the congress. This was our highest turnout in the history of the event.

To survive the changes 2020 presented us with, we had to find creative ways to adapt our practices and to be constantly agile. This realisation allowed us to come up with the theme for the congress: Celebrating the art of surgery in a time of disruption. This was an acknowledgement that our surgeons not only rely on the art of what they do, but also the science; something that feeds the creative element that drives surgeons to continually improve and innovate.

Have you been able to strategise with other ways of raising revenue?
The pandemic brought a period of sustained economic crisis that will have a lasting effect on the economy, communities and the way we work. We were not immune to these changes and have worked hard to avoid or minimise these outcomes.

The governments in our two countries enabled workplaces to take decisive steps to protect jobs and organisational viability. We explored these options and managed our expenditure and cash flow diligently. For example, we have a team of honorary advisers with specialist financial investment expertise who meet during the year to monitor our capital and expenditure, and help us navigate a fluctuating stock market. Thanks to their efforts, we were fortunate to have our portfolio tracking better than benchmarks.

How differently will you need to operate, going into the immediate future, as we gain a better understanding of the pandemic’s impact on our hospitals?
We learnt a lot during the early days of the pandemic. The constant challenges posed by Covid-19 made us change many things in our operations as a college and membership organisation.

While we are not responsible for operations in hospitals, I can say that managing the requirements imposed by the pandemic has been a key lesson for us. For example, having adequate stock on PPE and cancelling elective surgery to meet the more immediate needs of our patients.

We also recognised the paramount importance of collaboration – with governments, our specialty societies, members, staff and other stakeholders in the healthcare systems. We could not have managed to continue to operate without their support. What will always remain a constant for us is the critical importance of putting our patients first as well as ensuring that our healthcare workers are supported as best as possible to continue doing their important work.

I think being agile and responsive to changes – expected and unexpected – will continue to be the norm for a long time to come.

How are you a different association today compared to pre-Covid?
We are a different association today compared to pre-Covid. A good example was the challenge of transitioning an entire workforce over two countries to remote working – something we achieved in a short timeframe with amazing success. We implemented new systems such as Microsoft Teams that paved the way for digital collaboration.

Our workforce now has the option of working onsite as well as remotely. This digital transformation also offered our staff the opportunity to be productive across a broader range of hours, meaning they could also engage with our members in a more flexible way.

The pandemic experience has certainly given us the ability to innovate and adapt much more quickly than we may have otherwise.

The last year has been most challenging for many leaders of organisations. What was your biggest personal learning in leading the RACS through this period?
For me, the travel restrictions and the rapid adoption of virtual technology enabled one of my goals of achieving less domestic and international travel… The fact that we were able to hold many meetings, including the RACS Annual Scientific Congress, in hybrid formats… is also great for the environment as we expend less resources.

What are your plans for upcoming events, if you are confident about the ability to meet, and your outlook for conferencing in the next year?
We have learnt that we are nimble and can adapt rapidly to changing circumstances, and have the ability to hold events virtually, face-to-face or in a hybrid format. We anticipate that we will continue to manage our events in accordance with the prevailing circumstances.