Gisborne Hospital Report - Health and Disability Commissioner

More documents

Recommendations

Info

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.” 11
Gisborne Hospital 1999 – 2000 Introduction and Environment 3. NURSING ISSUES Introduction 3.1 The decision by THL to redevelop the medical and surgical wards, and restructure the nursing workforce, was linked by many interviewees with the events that sparked the terms of reference for this investigation. 3.2 The following themes consistently emerged in interviews with nursing and other staff: • the lack of professional leadership and its impact, particularly during new initiatives such as the Clinical Career Pathway development and implementation of the redesigned nursing structure • changes to the nursing structure (particularly to key leadership positions) and the impact of these changes • consultation processes (eg, around the redevelopment of the physical layout) and the effectiveness of these processes • the combined effect of the restructuring, the millennium and accreditation • the non-responsiveness to concerns raised by nursing staff (eg, to the disestablishment of the Clinical Nurse Leader role in ICU) • the nature of the work environment. 3.3 In response THL stated that “the Commissioner could uncover similar levels of complaint at any hospital under going major reconfigurations”. THL pointed to the success of recent configurations of other services at Gisborne Hospital, in the medical unit, ambulatory services, and the A&E Department. Finally THL noted: “No configuration will suit all user groups. It is all a question of compromise given the physical and financial constraints.” Ward reconfiguration 3.4 THL faced declining occupancy and what it identified as inappropriately configured ward spaces. To address these challenges THL proposed a single floor inpatient unit (SFIU). There was significant opposition from clinical staff to the reconfiguration of the medical and surgical wards. 3.5 The Chief Executive stated: “Even with an ideal process it would have been a near impossible task to get endorsement by staff to reduce beds. This reluctance to accept a 12
Page 1 and 2: GISBORNE HOSPITAL 1999 - 2000 A rep
Page 3 and 4: Table of Contents Page Executive Su
Page 5 and 6: 1. BACKGROUND EXECUTIVE SUMMARY 1.1
Page 7 and 8: 3. THE ENVIRONMENT 3.1 My investiga
Page 9 and 10: pathologist, staff shortages and pr
Page 11 and 12: Gisborne Hospital 1999 - 2000 Intro
Page 19: Gisborne Hospital 1999 - 2000 Intro
Page 29 and 30: Chapter 2 Quality Assurance Systems
Page 31 and 32: Gisborne Hospital 1999 - 2000 Quali
Page 57 and 58: Gisborne Hospital 1999 - 2000 Incid
Page 71 and 72:
Gisborne Hospital 1999 - 2000 Incid
Page 73 and 74:
Page 75 and 76:
Page 77 and 78:
Gisborne Hospital 1999 - 2000 Opera
Page 79 and 80:
Page 81 and 82:
Page 83 and 84:
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93 and 94:
Page 95 and 96:
Page 97 and 98:
Page 99 and 100:
Page 101 and 102:
Page 103 and 104:
Page 105 and 106:
Page 107 and 108:
Page 109 and 110:
Page 111 and 112:
Page 113 and 114:
Page 115 and 116:
Page 117 and 118:
Page 119 and 120:
Page 121 and 122:
Page 123 and 124:
Page 125 and 126:
Page 127 and 128:
Page 129 and 130:
Page 131 and 132:
Page 133 and 134:
Page 135 and 136:
Page 137 and 138:
Page 139 and 140:
Page 141 and 142:
Page 143 and 144:
Page 145 and 146:
Gisborne Hospital 1999 - 2000 PSA T
Page 147 and 148:
Page 149 and 150:
Page 151 and 152:
Page 153 and 154:
Page 155 and 156:
Page 157 and 158:
Page 159 and 160:
Page 161 and 162:
Page 163 and 164:
Page 165 and 166:
Page 167 and 168:
Page 169 and 170:
Page 171 and 172:
Page 173 and 174:
Page 175 and 176:
Page 177 and 178:
Page 179 and 180:
Page 181 and 182:
Page 183 and 184:
Gisborne Hospital 1999 - 2000 Patie
Page 185 and 186:
Page 187 and 188:
Page 189 and 190:
RECOMMENDATIONS Quality Assurance S
Page 191 and 192:
Gisborne Hospital 1999 - 2000 Recom
Page 193 and 194:
Gisborne Hospital 1999 - 2000 Recom
Page 195 and 196:
APPENDIX NZNO LETTER TO MINISTER OF
Page 197 and 198:
11. The anaesthetist had a practice
Page 199 and 200:
THE ANONYMOUS LETTER The anonymous
Page 201:
GLOSSARY ABBREVIATIONS A&E A,T&R AQ
show all

Gisborne Hospital Report - Health and Disability Commissioner

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?