Dysfunction, mistrust, morale at rock bottom

01:43, Jan 31 2009
FACADE: Development of Wellington's new regional hospital has stretched the management team beyond its level of expertise.

Capital and Coast District Health Board is going from crisis to crisis - managers are doing jobs for which they are unqualified, staff morale is at rock bottom, departments fight each other for staff and patient records are in chaos, says a damning audit.
What the report says

The report - provided to The Dominion Post under the Official Information Act - found development of the new regional hospital in Wellington had stretched the management team beyond its level of experience and expertise.

"Crisis management has become the normal operating environment," says Telarc, formerly Quality Health New Zealand, which audited the board in July.

Chief executive Margot Mains - whose shock resignation came in August after revelations of a $13 million blowout in operation costs - refused to comment. She is likely to leave early next year.

The audit condemned senior management for poor communication and lack of recognition of the stress on hospital staff. "There is a strong sense of disconnection, dysfunction and mistrust between clinicians and staff groups and management."

The lack of a hospital-wide system to tackle staff shortages meant "each department seems to wage its own battle to fill vacancies on its staff complement".

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The DHB's slow response to a staffing crisis in the anaesthetics department had left the hospital exposed to significant risk. Three senior staff quit in March in frustration over conditions, though one later decided to stay.

While patient care was generally adequate, staff shortages "curtailed" some treatments. Of particular concern was the delay for renal patients requiring vascular or transplant surgery.

The auditors also criticised the shambolic patient record system, which is part paper, part electronic. In July, staff discovered about 20,000 electronic radiological reports had not been printed for the previous eight months because of a computer error. Auditors were further horrified to find patient records and clinical information stored in trolleys in public corridors - and accessed these freely, unknown to staff.

The high-profile death of a patient from a treatable chest infection, which led to Health and Disability Commissioner Ron Paterson taking the unprecedented step of referring the board for prosecution, had had a profound impact on the organisation.

But despite a systems overhaul and monthly reporting, it was impossible to tell if the changes would make the hospital safer for patients because little auditing was done of clinical data, the review team said.

Association of Salaried Medical Specialists executive director Ian Powell said Capital and Coast was "like a headless chicken running around looking for its head".

The board reacted to high-profile negative events by "dumping" on clinicians. "There's a difference between accountability - which goes with a `tick box' mentality - and responsibility, which is about stopping these problems happening."

In a written statement at the time of the survey, the director of nursing and quality, Cheyne Chalmers, said the board was under pressure from winter overload, a cluster of resignations by senior clinicians, a contract dispute with senior doctors, radiology problems and restructuring.

She said much progress had been made in the four months since:

The hospital was pursuing an alliance with Canterbury DHB for child cancer services - though the recent resignation of the last paediatric oncologist could put these plans in doubt.

The problems with radiology had been resolved "with no serious patient harm" .

A workforce development plan had been developed and the electronic reportable-events database was due for completion next month.

Board chairwoman Judith Aitken said: "We fully expect to be re-certificated but at this stage do not have this formal advice from the Ministry of Health."

A board spokesman said all DHBs went through the certification process.

A ministry spokesman said a decision on certification was expected within three weeks.

WHAT THE REPORT SAYS

Management at Wellington Hospital is stretched: "Crisis management has become the normal operating environment."

The relationship between management and staff is one of "disconnection, dysfunction and mistrust".

Patient records and clinical information stored in trolleys in public corridors.

Rules for management of dangerous drugs and narcotics flouted: "The nurses are administering medications prescribed by an unknown medical officer".

A "tick box mentality" makes it difficult to ensure clinical risks are well managed.

The Dominion Post