Lessons From Bundaberg
Present-day public hospitals are often lacking in humanity, costing more and doing less, and run by executive staff with minimal clinical knowledge, according to an article published in the current issue of the Medical Journal of Australia.
Dr Anthony Morton, Medical Statistician at the Princess Alexandra Hospital in Brisbane, says the Bundaberg Hospital scandal is a symptom of the problems facing the health system and unless the underlying causes are addressed nothing will change.
"The current obsession with finding and punishing Dr Jayant Patel, instead of dealing with the system that sponsored him, seems likely to ensure that, when the dust has settled, the status quo will remain," Dr Morton says.
Current problems in Australian hospital systems have their roots in the reforms of the 1980s, which focused on the bottom line.
"The managerialist approach produces staff and bed shortages, long waiting lists and excessive bed usage. It concentrates on business plans and targets, and negative short-term financial objectives, producing perverse economic activity," Dr Morton says.
Good systems are designed deliberately to produce high quality work. By eliminating waste, delay and the need to redo substandard work, they achieve long-term cost effectiveness, he says.
Rather than rewarding people for quick fix solutions, Dr Morton says hospital departments need clinically competent, committed leaders.
Dr Morton says people who control the running of our hospitals should behave more like coaches than controllers or judges. Good coaches are able to mould effective teams, they are expert at dealing with poorly performing players, and they themselves are expendable if the team persistently underperforms. Coaches also think of the longer term, he says.
"The best means of command is through service to patient care," he says.
"To create an enduring and worthwhile hospital system, public administration has to move beyond corporate structures and managerialist management approaches," Dr Morton says.
In the same issue of the Journal, Dr Martin Van Der Weyden, MJA Editor, echoes Dr Morton's call for reform in Queensland and beyond in the interests of patient safety.
He says the Bundaberg scandal has undermined the public's trust in hospitals and doctors and, while it revolves around Dr Jayant Patel, it is a symptom of an affliction affecting health care Australia-wide.
He says the tragedies exposed in Bundaberg could have been avoided had the 2003 registration of Patel by the Queensland Medical Board been more rigorous.
Dr Van Der Weyden says the questioning of Patel's performance at Bundaberg Hospital did not emerge from a clinical governance system, but from concerns of individual doctors and nurses about his surgical performance and prowess.
It was a letter from nursing staff that led to the Morris inquiry which, it was hoped, would shed light on Patel's appointment to Bundaberg Hospital; the role of the Queensland Medical Board in assessing, registering and monitoring overseas-trained doctors; the role of federal, state and territory governments and the clinical colleges in these processes; systems to ensure accountability and monitoring of appropriate performance of individuals and clinical services; and systems to receive, process and resolve complaints about clinical performance or services.
The Inquiry was terminated because of perceived bias, but answers to these issues must be pursued because of their implications nationally. Ten years after the Quality in Australian Health Care Study and five years after the establishment of the Australian Council for Safety and Quality in Health Care, there is still no nationally accepted framework for clinical governance to ensure the safety and quality of Australian health services.
The interim report from a second Queensland inquiry, headed by Peter Forster, depicts Queensland Health as a gigantic dysfunctional conglomerate with a corporate centre that is more concerned with performance indicators, revenue generation and cost control, than with people, and is a source of concern, frustration and anger among physicians.
Dr Van Der Weyden says responsibility for the impoverishment of the Queensland health system lies squarely with the Premier and it's time Queensland Health was dragged into the 21st century.
This will require a boost to the health budget and attractive recruitment and retention packages for public hospital staff, Dr Van Der Weyden says.
The Medical Journal of Australia is a publication of the Australian Medical Association.
CONTACT Dr Anthony Morton (07) 3397 4651
Dr Zelle HODGE, AMA Queensland 0417 607 072
Judith TOKLEY, AMA Public Affairs, 0408 824 306 / (02) 6270 5471