Gisborne Hospital Report - Health and Disability Commissioner

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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. 7
Gisborne Hospital 1999 – 2000 Introduction and Environment 2.14 Senior nurses also felt disenfranchised, having no Director of Nursing to take their concerns direct to the Chief Executive. For example, some surgical nurses described feeling stymied in their efforts to be heard: “Nurses are at a loss about whether they should take their concerns up another step because they are then told to take the matter back to their line manager. Systems seem to be in place that are designed to stop communication and other systems that do not promote it. Communication is a key issue. The nurses do not feel part of the process. Nurses are unable to approach other disciplines without going through their line manager.” Suspicion and mistrust 2.15 A sense of not being supported by management led some clinical staff to develop negative perceptions of their organisation. The investigation team heard the organisation variously described as destructive to a person’s wairua, unappreciative of nursing staff, a dysfunctional family, lacking strong leadership and bureaucratic. 2.16 A senior doctor stated: “The atmosphere at the hospital is one of suspicion and mistrust. Doctors and nurses do not feel supported by the system that exists .… Clinicians [feel] fatalistic about having an impact upon the system. There is no place to solve problems. There is no sense of ownership. To get the system to work I have come up against one barrier after another. The system was a) disorganised b) void of leadership amongst medical and management staff and c) communication is absent.” 2.17 Poor communication and consultation patterns were linked to the lack of trust between some senior managers and the workforce. In one doctor’s opinion this lack of trust was linked to the workforce’s unwillingness to fill out incident forms: “The problem in Gisborne is lack of trust between workforce and management …. Basically people did not have any faith in incident reporting and it was not due to the system – the system was robust enough.” 2.18 The Chief Executive responded that although she accepted “there were events which did not generate an incident form and should have”, she did not believe that staff at THL in general had this approach to incident forms. 2.19 Concerns were also expressed about the use of discipline at THL. It is inevitable that large organisations have a certain amount of disciplinary activity. However, a number of interviewees suggested that THL had used the disciplinary process in situations where good management practices may have prevented the breakdown in the relationship. THL responded that disciplinary action had been used sparingly and was reserved for serious situations where all other avenues of resolution had been exhausted. Targets for criticism 8
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RECOMMENDATIONS Quality Assurance S
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APPENDIX NZNO LETTER TO MINISTER OF
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11. The anaesthetist had a practice
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THE ANONYMOUS LETTER The anonymous
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GLOSSARY ABBREVIATIONS A&E A,T&R AQ
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Gisborne Hospital Report - Health and Disability Commissioner

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