Editorial: Management test

OPINION: Understaffing at a hospital is a matter for concern, particularly if it is a chronic problem.

While temporary shortages of staff may be worked around, anything that lasts for a significant time is likely to raise serious issues and run the risk of poor outcomes for patients. According to junior doctors at Christchurch Hospital, too few junior doctors have been on duty on recent weekends.

The shortage, they say, has come to the point of creating a risk to safety not only for patients but also for the doctors themselves. The complaint has been supported by the out-of-hours clinical co-ordinators at the hospital.

The junior doctors' union says that the problem has occurred over the past four weekends.

Last weekend, for instance, only three out of five junior doctors deemed necessary in the acute area were on duty. The situation had got to the point, according to the union that doctors, worried that they might make a slip under pressure, are declining requests to cover weekend shifts.

There may be an inclination to dismiss the doctors' concerns as exaggerated. There could be the perception that they and their union have been prone to talk up complaints of overwork and the like, particularly when pay is at issue, and, in order to shut off argument, to dress their complaints up with the assertion that patient safety is at risk.

In this case there may be at least some substance to the complaint.

Presumably the numbers who should be on duty are those that the hospital's clinical directors have decided are what is required as a matter of best practice. While there may be some flexibility, the various departments, when they have the appropriate number of doctors rostered on, are unlikely to be overstaffed. In its response to the doctors' and co-ordinators' complaint the hospital's chief medical officer, Dr Nigel Millar, acknowledged their concerns.

In his response to them he indicated that the shortage was a temporary one that had arisen because an intake of resident doctors from overseas had not yet arrived.

This situation may be tolerable for a short time, but it should not be allowed to become prolonged. If nothing else, the junior doctors' complaint, and the publicising of it, is a warning shot that the hospital is testing the limit of the doctors' toleration for it.

The underlying question to the complaint is, of course, either a claim for more money or the proper management of the money the hospital already has available to it. As to more money, the health sector generally, over the last couple of decades, has done reasonably well in the sums it has available. Through good times, and more particularly, through bad times the increases in its budget have been ahead of inflation.

While it has had to cope with steeply rising costs (particularly in salaries, which account for about 80 per cent of the sector's costs, from foreign competition), further rise can only come at the expense of other big-spending departments (principally social welfare or education) or higher taxes.

Given that situation, proper management is imperative.

- © Fairfax NZ News

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