Orthopedic surgeons resign over hospital 'interference' in clinical decisions

Health Minister Rachel Stephen-Smith has offered an olive branch to surgeons upset at the new operations centre at Canberra Hospital but insists the centralised oversight of care will continue.

The Minister was speaking after three of the hospital’s 14 orthopedic surgeons, including head of department Professor Paul Smith, decided to resign over the role of the operations centre, which is designed to prioritise surgery according to patient need and the efficient allocation of resources.

Professor Smith, one of Australia’s most experienced orthopedic surgeons, accused the operations centre of “administrative interference in clinician decision-making”, and lack of consultation and collaboration with surgeons.

“Every gain we’ve made in terms of achieving quality of service has come at a significant cost in terms of battling with administration to try and get the resources to achieve quality,” he told the ABC.

Professor Smith resigned last week after 25 years at the Canberra Hospital.

Orthopaedic surgeon Dr Sindy Vrancic has also resigned, claiming bureaucrats were making decisions for doctors using an algorithm, which Ms Stephen-Smith said was false.

The Minister said the operations centre was run by experienced doctors and senior nurses.

Dr Vrancic said that in the past six months, frontline doctors’ clinical autonomy had been disrupted.

“While it’s really important that we don’t impact patient care, that’s our primary focus … interference with my capacity to offer that care by an external operation centre has now reached the point where I can’t put my hand on my heart and offer the care that I believe our community deserves because of budgetary constraints,” she said.

Dr Vrancic said the new system was compromising patient safety by overriding clinical decisions of frontline doctors.

“There’s been more than one occasion where the operations centre has overridden our clinical decision and I find that unacceptable,” she said.

“I personally believe I’ve seen evidence of it impacting on direct patient care, which I cannot watch without saying something.”

Dr Vrancic said the loss of Professor Smith, whom she called a national treasure, would be huge, given not just his surgical skills but his research and teaching value.

“It is very sad when such a senior, kind surgeon decides to turn his back on a health service that he has essentially built,” she said.

“It was because of him that we have such a bespoke and specialised orthopedic team here in Canberra, and now that has been dismantled by a change of focus from the executive.”

Ms Rachel Stephen-Smith offered doctors an ‘escalation process’ to challenge operations centre decisions.

“Canberra Health Services will be consulting about that escalation process in the next couple of weeks, but it’s a real demonstration that we’ve been listening to what the clinicians have to say,” she said.

But the Minister said the hospital could not have individual clinicians make decisions without reference to the operation of the hospital as a whole, resulting in efficiencies and queue jumping.

“What we need to do and what I’ve talked to the orthopedic surgeons about is bringing together the understanding that the specialists have of the list that they are seeing, with the understanding of what is going on in the rest of the hospital and health system, including orthopedic lists that they don’t necessarily have visibility of on a day-to-day basis,” she said.

“It’s about improving transparency so that better decisions can be made in the interests of patients and with their care at the centre.”

Ms Stephen-Smith said the new approach in the hospital had already borne fruit with improvements in the emergency department and elective surgery.

“We’re not going to move away from our focus on patient centered care and ensuring that our patients are seen fairly and equitably and as quickly as possible across our hospital system, but we of course want to work with clinicians to understand how we ensure the system is also working for them and how they can be part of this journey,” she said.

Ms Stephen-Smith said the hospital had to run more efficiently because funding was not limitless.

“We cannot see it continue to grow significantly above the rate of revenue increase, or we’re going to have to cut back significantly on other services. We hear from Canberrans that this is not what they want.”

Ms Stephen-Smith said arrangements were in place to provide locums to cover an impact on orthopedic services. In any case, at least two of the three had very limited clinical hours in the public area.

The Budget Review allocated an extra $227 million to Canberra Health Services due to surging patient demand.