Gisborne Hospital Report - Health and Disability Commissioner

Gisborne Hospital 1999 – 2000
Introduction and Environment
The Chief Executive did, however, agree that THL “similarly to all health care
providers, can still improve its relationship with Maori”.
4.9 The New Zealand Public Health and Disability Act 2000 provides mechanisms
for District Health Boards to enable Maori to contribute to decision making
on, and to participate in the delivery of, health and disability services.
4.10 I believe that the Tairawhiti District Health Board needs to respond to the
themes as well as the specific issues raised at the hui. Accordingly, I am
delivering to Tairawhiti District Health Board a copy of the hui reports
prepared by my investigation team, for the Board’s consideration.
5. OPINION
5.1 As stated by the Privy Council in Roylance v General Medical Council [1999]
3 WLR 541, 559, “the care, treatment and safety of the patient must be the
principal concern of everyone engaged in the hospital service”.
5.2 It is notable that staff at Gisborne Hospital appeared to be diverted from being
totally focused on patients. Patients were very rarely mentioned in interviews
with staff. While there was an underlying theme of concern for the patients,
the staff interviewed by my investigation team did not present the patients as
their first concern.
5.3 Management and staff relations at THL contributed to an endemic atmosphere
of distrust. This level of distrust got in the way of the organisation embracing
change and moving forward. The result was that sensible and forward looking
plans became stymied for the wrong reasons.
5.4 I endorse the following statement of Professor Grant Gillett:
“Health care managers have a duty to provide the conditions in which
clinical activity can flourish and provide maximal benefit to the
maximum number within certain fiscal constraints.”
(Gillett, G, Gastrogate: The ethical responsibilities of doctors and
administrators. NZ Medical Journal 2000;113:232-233)
5.5 Conversely, although clinicians owe their primary duty of care to their own
patients, if they work within a hospital service they have a duty of loyalty to
their employer. These duties should not conflict. Clinicians should be vigilant
to ensure that patient care is not compromised, but they should as far as
possible support the organisational endeavour to provide health services of an
appropriate standard.
5.6 There is a need for ethical leadership both professionally and managerially
within the restructured New Zealand public health and disability system (cf
Bryson, J, How should our public hospitals respond to increasing ethical
challenges? NZ Medical Journal 1999;112:47-49).
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