Gisborne Hospital Report - Health and Disability Commissioner

Gisborne Hospital 1999 – 2000
Introduction and Environment
2.8 Poor communication and consultation was cited as a reason for strained
relationships between management and senior medical staff. A middle
manager commented that previously Gisborne Hospital had a far better track
record of consultation and staff involvement. The effect of the lack of
consultation was described: “The reconfiguration of the adult medical surgical
floors was never endorsed by staff, was carried out at great cost and has
resulted in significant stress for staff, an inability to provide flexible services
and risk to patient care.”
2.9 The former Chairperson of the Board gave an insight into the consultation
environment at THL when she commented on the Board’s expectation that
nursing staff would be consulted over the ward reconfiguration. The
Chairperson stated that she “believes there was a level of consultation, but
how much notice was taken of people’s comments is what begs the question”.
She commented that “probably not a lot of cognisance was taken of concerns
that were raised, because of the key driver to break even together with the low
level of bed utilisation”.
2.10 The Chief Executive said that she was conscious of the need for effective
communication and consultation. She gave presentations to staff on the
proposed new structure, including a separate session for medical staff, at their
request, and the proposal was modified in response to feedback from staff.
She held monthly forums with “an open invitation to all staff … to meet and
hear directly from me the priorities the Board and management team were
working on, and to discuss any issues and concerns”. The Chief Executive
accepted that she was not “out and about in the organisation as frequently as I
would have liked or staff would want”, but noted that “this is the experience of
most if not all chief executives in the New Zealand health sector”.
2.11 However, the Chief Executive accepted that “with the quantum of financial
savings that had to be achieved and the timeframe available, the approach I
used was more top down than is ideal”. She did not accept that she was nonconsultative.
2.12 Despite the Chief Executive’s efforts, and the presence of Clinical Directors
on the Senior Management Group, senior medical staff felt increasingly
disenfranchised. One senior doctor commented:
“There is no forum for communication. Very few people want to speak
out because they think the system will come down on them. Those
people who want to stay are unwilling to participate in dialogue in an
honest way because they feel the system will not support them.”
2.13 A Clinical Director stated that the management style of THL led to an
adversarial relationship with medical and clinical staff and affected their
behaviour over the last few years. In his view, morale had been declining
progressively over eight years. He noted that the hospital was happy until the
driving force was to stay within budget and save money. This change
impinged on the quality of patient care and the focus and performance of
clinical services. Senior medical staff reported making attempts to tell
management of their concerns and said that often no action followed.
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