Gisborne Hospital Report - Health and Disability Commissioner

Gisborne Hospital 1999 – 2000
Introduction and Environment
THL also pointed to the numerous consultative committees for both medical
personnel and nursing staff.
2.33 The Clinical Directors were pivotal to the success of the organisational
structure. Changes to the Clinical Director role were agreed after consultation.
The Chief Executive noted that, in relation to the changes to the Clinical
Director role: “Medical staff felt that the changes did not go far enough and
they would have liked more budgetary control …. Non-medical staff were
however very apprehensive about the degree of control in medical hands.”
2.34 Several Clinical Directors expressed their frustration with the role: “The role
was supposed to be about partnership between management and clinicians but
that was not so. The bottom line was the budget. The Clinical Director was
very much the subservient partner.”
2.35 THL denied there was any management policy to refuse to listen to clinical
issues:
“Many of the decisions made were made with the agreement of nursing
or medical representatives, and even where decisions were not met with
universal approval, they were made after consultation with relevant
stakeholders. Overall, THL feels that the complaints which the
Commissioner’s investigators have heard from clinical staff tend to
derive from dissatisfaction with some outcomes, as opposed to process.
In the end, decisions have to be made based on all the usual constraints.
It is inevitable that not everyone will agree with the changes. However,
the board, through management, has the right to determine the
governance of the hospital. Obviously agreement or consensus is
preferred, but it cannot always be achieved, especially in an organisation
in extremely straitened financial circumstances as THL was at the time.”
2.36 In response to the statement that there had been a communication breakdown
that impeded the flow of information to clinical staff, THL commented:
“While obviously THL must accept some responsibility for this, the
responsibility is two-way. Many clinicians were involved in
management decisions or discussions. The purpose of having those
clinical representatives was that those people would be able to discuss
proposed changes with, or otherwise serve as a conduit of information
to, their respective constituencies. It may be that many of those
processes did not work ideally either. Information sharing is a dual
responsibility. When failures occur, responsibility must also be shared
for those failures.”
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