1 Consider the corporate governance failure of Bundaberg hospital described in the commission of hospital inquiry and list the main clinical governance failings identified
2 What governance mechanisms, if in place that at that time, may have assisted in avoiding the clinical failings of Bundaberg
1. One of the key expectations for a hospital is that a healthy organisational culture must exist. Such an organisation culture must promote the shared values which consist of both the staff values coupled with espoused organisational values. For a hospital, the espoused organisational values are even more critical considering that human life is at stake and hence compassion and integrity is of utmost importance and has been spelled in the form of Queensland Health Code of Conduct. This unhealthy organisational culture has led to a host of clinical governance failings which have been identified by subsequent investigation into the failure. These are highlighted below.
- The quality of care that the hospital extended to patients did not meet the reasonable standards which have been clearly spelled out in a host of code of conduct released by major health agencies. However, these were not observed at the hospital and only superficial adherence was practiced.
- Only a few employees ever raised concerns about the poor service standards observed at the hospital due to unhealthy work culture and also unethical decision making at the hospital. This is apparent from the instance of Toni Hoffman who decided to act as a whistle-blower but faced a torrid time to raise the concern through the organisational channels. There were constant attempts made to cover up and protect the wrongdoers as a result of which the adverse event report that Toni prepared was never passed on.
- It is imperative that prompt communication shall be maintained between the hospital and controlling agency but this was not the case here. As a result, the interest of the patients was jeopardised and the interest of the few individuals was considered to be more important.
- In hospitals, a key process is the reporting of adverse cases to the higher authorities so that requisite action can be taken but in the case of hospital the organisations procedural in the processes were exceedingly poor as have been seen with the example of Toni Hoffman. Hence, the employees (even the honest ones) are discouraged to report any adverse cases as the final outcome is already known and hence the status quo is cemented. This happened in case of Bundaberg Hospital which is why the failure came to light only after substantial damage had already been done.
- For hospitals, teamwork and collaboration is imperative as there are a host of staff members which are involved in rendering service to a given patient either directly or indirectly. But on account of unhealthy and at some place illegal organisational culture, this was adversely impact. An instance worth mentioning is the promotion of Mr. jayant Patel despite his documented record of poor care being extended to patients. As a result, the morale of the team is adversely impacted and collaboration reduces.
- Also, the communication between the communication between the organization and the patients along with their relatives has been found to be poor which leads to poor outcomes as is visible in the given case.
2. The various governance mechanisms that could have avoided in clinical failings as the hospital are highlighted below.
- A proactive role of the regulator i.e. Queensland Health would have been helpful. This would include surprise visits at the hospital premises to check if the standard operating procedures are being followed or not. Besides, on a periodic basis the officials should have ascertained whether the regulations are being complied with or not. Further, interaction with the staff and customers would have been helpful in this regard. Besides, since the organisation has to safeguard the interests of the customers, hence soliciting feedback from the customers treated at the hospital would have helped at averting the current crisis. Had the regulators been proactive, then they would have acted before and not after two years had elapsed from the appointment of Mr. Patel.
- There need to be proper and adequate organisation procedures for adverse event reporting and strict action need to be taken against anyone who is found to interfere with the requisite procedure.
- Further, more communications channels should have existed between the higher authorities of the hospital coupled with the regulators as the wrongdoing which was being carried out at the hospital was apparent to the staff and some honest staff members did try to put forward the concerns but faced resistance.
- An ethical and strong organisational culture would have been immensely useful to prevent unethical decision making which was rampant in the organisation coupled with lack of teamwork and collaboration. This poor culture had an adverse effect on the morale of the employees and also impacted the teamwork which led to poor patient outcomes. This is evident from the promotion of Mr. Patel as the head of surgery which would adversely impact the whole team as they are aware that the leader is not able and is not ethical.
- Adequate mechanism for whistle-blowers coupled with a protection policy should have been in place. Typically, to report any wrong activities which are being carried out, there are dedicated helplines where the staff can complain especially if the supervisor fails to take the requisite measures. This should have been corroborated with an active participation of the regulator to conduct enquiry.
- Performance of quality audits (both internal and external) should be necessitated so as to ensure that the various performance parameters are correctly reported and accountability needs to be fixed on the requisite person concerned.
- The improvement in the communication between the various internal stakeholders and their communication with the external stakeholders also would have helped to a certain extent as in the given case there seems to lack of accountability caused due to limited communication which ensures that the status quo is maintained and people with unethical decision making are promoted so that all the potential channels from where communication may happen are closed.