North Shore Hospital report - New Zealand Doctor

Opinion 07HDC21742affirms that patients are legally entitled to this standard of care. 72 But the experienceof these five patients demonstrates the gulf between the rhetoric and the reality ofpatients‘ rights.The patients‘ and families‘ experiencePatients and families do not complain lightly about hospital care. 73 The multiplepatients and families who complained to HDC about ECC and medical wards at NorthShore Hospital in 2007 painted a consistently unhappy picture. Some of the familiesand patients whose cases gave rise to this inquiry described their experience in vividterms:―People deserve better treatment in our hospitals. [My partner] and I have workedin hospitals for the best part of our lives. … I have never seen an admissiondepartment in such a messy and overcrowded state as that at North ShoreHospital. I would never wish what happened to [my partner] upon anyone.‖ 74―There was a constant need to repeat [my mother‘s] history which became quitefrustrating. … No one was reading the notes before seeing [her]. Staff didn‘t haveknowledge of individual patients due to time constraints … leading to piecemealcare, unnecessary suffering to patients and poor use of resources.‖ 75―I lay awake at night and worry about other elderly sick folk who suffer thisinhumane, uncaring and unprofessional behaviour. … No one communicates ordoes what they say they will, they just disappear, shifts end, changeover meetingstake place, but still no one knows what is next or who is still waiting for help or ajob to be finished.‖ 76Nursing careA key feature of this inquiry is the degree to which the nursing care for all fivepatients was compromised by workload. This occurred in ECC and on the medicalwards.At the time of these events, nurses were endeavouring to prioritise and deliver care inwhat has been described as a ―chaotic, understaffed environment‖. There was ―a senseof disempowerment‖, with no feedback or mentoring of ward standards of practice,and a lack of ―voice‖ for nurses. 77 Despite the many senior nurses at the DHB in2007, the professional leadership structure was not effective to give nurses authorityover daily practice or enable meaningful partnership with Clinical Directors and72 Rights 1(1), 3, 5 and 4(3) of the Code of Health and Disability Services Consumers‘ Rights.73 Research indicates that approximately 1 in 200 patients who suffer an adverse event in hospital makea complaint: Bismark M et al, Relationship between complaints and quality of care in New Zealand: adescriptive analysis of complainants and non-complainants following adverse events. Quality andSafety in Health Care (2006) 15:17–22.74 Mrs B‘s son.75 Ms A‘s partner.76 Mrs E.77 These concerns are an echo of the situation at Gisborne Hospital in 1999–2000. See GisborneHospital 1999–2000: A Report of the Health and Disability Commissioner (2001). See also Opinion03HDC14692, page 76, for an example of nurses exhibiting ―a mechanistic approach to their role‖ atPalmerston North Hospital in 2002.April 2009 57