Gisborne Hospital Report - Health and Disability Commissioner

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Gisborne Hospital 1999 – 2000 Quality Assurance Systems Specialist was established to ensure that patients received appropriate care. This was a clinical leadership position. Currently no Clinical Nurse Specialists are in place in any areas, resulting in a lack of clinical leadership. 5.5 Moving through the CCP is voluntary so it is possible that no staff will choose to progress to the position of Clinical Nurse Specialist. During the introduction of the CCP, the possibility of difficulty in filling the Clinical Nurse Specialist position was not discussed. Nursing staff perceived there was no job description for Clinical Nurse Specialists and no extra money attached to the role. THL responded as follows: “The job description for CNSs was the same as for standard registered nurses, but the performance criteria were more rigorously applied. The selection criteria for CNSs was agreed with the NZNO, as was a remuneration package. There has always been an additional salary step available for nurses achieving level 4 of the CCP and this has been available ever since implementation.” 5.6 The main concern of the nurses interviewed was the lack of nursing structure. There was no positive nursing structure or leadership and no professional guidance a year after the restructuring. Nurses felt they were not listened to and felt undermined. Their morale dwindled and this impacted on the quality of their care. 5.7 Another key leadership change was the disestablishment of the ICU Clinical Nurse Leader position in 1999, without transferring responsibilities elsewhere. 5.8 In an external review of Gisborne Hospital’s intensive care services commissioned by THL in June 2000, Dr Jack Havill (Clinical Director, Waikato Hospital Critical Care Unit) and Ms Hayley McConnell (Operations Manager, Waikato Hospital Critical Care Unit) noted: “Despite the seniority and experience of the nursing team they can best be described as ‘rudderless’. Without the day to day support of one nursing leader the team covers only the day to day patient care and housekeeping duties required of them. There is a clearly identified lack of quality plans and assurance taking place. This has resulted in the poor maintenance of patient management guidelines, clinical audits, education programmes, in-service training, regular meetings, forums, research programmes and other QA activities.” In response, THL noted that many attempts have been made to fill the nurse leader position but it is “not an easy task” to get a suitable person. Medical 5.9 The Medical Director position was occupied by Dr Danny Stewart, Clinical Director (Paediatrics), from April 1997 until April 1999. There is concern that no one has occupied the position of Medical Director at the hospital since Dr Stewart resigned. One Clinical Director stated “nobody has wanted to fulfil this position (Medical Director) because it is an absolutely powerless 37
Gisborne Hospital 1999 – 2000 Quality Assurance Systems position”. Another Clinical Director thought credentialling would have progressed in the first three months of this year but for there being no Medical Director. 5.10 The Stage Two Clinical Audit report also noted: “A number of action points Tairawhiti Healthcare was to have completed stalled, because of the lack of a confirmed Medical Director. This has affected agreement on a formal reporting system for major adverse clinical events and the initiation of a credentialling system. Senior management and clinical director efforts needs to be directed towards annual reviews of individual senior medical staff performance.” 5.11 Lack of a Medical Director and Director of Nursing for extended periods of time diminished the senior clinical input to the SMG, the CQG and the Clinical Board. Nevertheless, the six Clinical Directors remained on the SMG, the CQG and the Clinical Board. 6. EDUCATION AND TRAINING Performance management: the ASPIRE system 6.1 The current performance assessment system is the ASPIRE system. The ASPIRE system is a system of performance analysis. It has been in use at THL for one year. 6.2 The system is intended to identify people’s needs and guide the staff training programme. The Human Resources Manager stated: “ASPIRE reviews are done three months after each staff appointment and thereafter on each anniversary of the ASPIRE review. The Human Resources Department generates the requirement for a review and sends forms to the appraiser, who will be, for example the manager or the team leader. Following review, the forms are returned to the Human Resources department where results are monitored. If 20 reviews are sent out, the department ensures 20 reviews are returned. The ASPIRE system is still reasonably immature. The ASPIRE system rewards progression through scales and offers opportunities for personal development. Staff complete a self-assessment form against competencies and their manager also completes an assessment form. Staff may elect to have peer review. Staff review their goals and set new goals. There is provision for staff to make their own comments throughout the ASPIRE form. Staff can obtain a copy of the completed form if they wish. The original is kept on their file in the Human Resources Department.” 6.3 As yet there is no formal system in place for performance of medical staff. The Chief Executive stated that the Clinical Directors on the Senior Management Group made it clear that they would only support the introduction of the ASPIRE system if it did not include medical staff. Clinical 38
Page 1 and 2: GISBORNE HOSPITAL 1999 - 2000 A rep
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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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