Gisborne Hospital Report - Health and Disability Commissioner

Gisborne Hospital 1999 – 2000
Introduction and Environment
Major changes
2.3 The Ministry of Health, in its final clinical review of THL’s Business Plan, in
November 1998, noted the breadth of the planned changes, and referred to the
following examples:
“The amalgamation of four wards into one; downsizing medical/surgical,
maternity and A,T&R bed numbers; changes to the staff’s employment
conditions; the introduction of a number of clinical pathways; ambitious
targets for reducing the average length of stay; and there will be some
redundancies.”
2.4 The Ministry’s clinical review highlighted the critical importance of gaining
the support of staff for such a raft of changes:
“The HHS [public hospital] advises that there is variable support for the
above changes amongst the clinical staff and in particular, the clinicians
are concerned about the planned reductions in bed numbers. You will be
aware from our previous clinical reviews that the Ministry is concerned
that the HHSs involve staff in the development of major initiatives, such
as those proposed by THL, and ensure that the initiatives are supported
by staff. We consider that support from staff will be critical to the
success of the initiatives, and we are concerned about the effect on staff
morale when a number of operational changes are implemented in a
short space of time. We note that the HHS also recognises this as a risk
and has made some efforts to engage the clinical staff in the changes.”
2.5 In the event, staff were not supportive of the changes that occurred in 1998
and 1999. As in many organisations undergoing a major change management
exercise, senior management - in particular the Chief Executive (Ms Sheryl
Smail) and the Group Manager (Community and Support Services) (Mr Mike
Grant) - became the focus of concerns and unhappiness about the process of
change and the decisions that were implemented.
Strained relations
2.6 The position of Chief Executive in a New Zealand public hospital setting is
demanding. There is a large, highly skilled workforce to manage along with
the infrastructure associated with delivering safe and effective health care and
meeting the expectations of the community. The staff and the community look
to the Chief Executive for leadership.
2.7 Relationships between management and senior medical staff at THL were
strained. The issues include clinical staff leadership, the difficulties
experienced in recruiting and retaining staff, debate over the appropriateness
of the current management structure, the role of Clinical Directors in the
management of THL, and issues associated with some significant management
decisions, for example, the reconfiguration of wards, the reduction of beds and
the nursing restructuring.
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