18 April 2018

Patient safety and governance issues put Canberra Hospital accreditation at risk

| Ian Bushnell
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Canberra Hospital will need to address serious governance and patient safety issues. File photo.

The Canberra Hospital has been given 90 days to turn around dozens of shortcomings, including serious governance and patient safety issues identified in an interim report, so that its accreditation can be renewed.

The Australian Council on Health Care Standards (ACHS) interim accreditation report released by the ACT Government shows that of 208 core criteria, the hospital had met 176 but failed to meet 33, which ACT Health is now acting on.

The report found that the current governance system with its lack of clarity, role confusion and poorly defined accountable structures created a high risk for the organisation, and that there was no strategic plan in place.

“The current system is fragmented, lacks consistency and clear direction across the organisation for the staff and service delivery,” it said.

Patient safety had been put at risk including major delays in rectifying the ligature points in Mental Health after several suicides in the area, the state of the kitchen, and ongoing high counts of Legionella rates.

The report noted serious concern at a number of issues in Mental Health and the number of suicides in the health service – four in the Mental Health Unit and one in the general ward – over the past three years, which have not had a robust review nor strategies implemented to mitigate the risks.

The report recommended an external review of all Mental Health Inpatient Units, Alcohol and Drug, and Justice Health facilities, and the establishment of a Mental Health Review Advisory body to oversee the review and the implementation of subsequent recommendations. Mental Health Minister Shane Rattenbury said this was already being acted on.

It also found issues with reporting of incidents, with compliance fragmented and a number of reports only partially completed. “There is also a need to ensure that all significant incidents are reported to the highest level of governance,” the report said.

Other criteria not met included those related to infection control and cleaning regimes.

Minister for Health and Wellbeing Meegan Fitzharris reassured the community that care at the Canberra Hospital had not been compromised and that ACT Health had accepted all of the report’s recommendations and were acting on them.

“If myself or my kids got sick that is absolutely the first place I would go,” she told ABC radio.

The recently announced splitting of ACT health into two agencies – administrative and clinical – was a response to the poor governance issues and she said the hospital would be able to address all concerns by July when it was due to have its re-accreditation renewed.

She said the findings were disappointing but all jurisdictions were facing similar problems of increasing complexity of health issues and demand for services.

Australian Medical Association ACT president Professor Steve Robson said the findings reflected a system under pressure, with increasing workloads across the hospital.

He said infection and hygiene issues were the result of the ageing building, saying the AMA had been pressing for a rebuild of the main facilities for many years.

He also said there were also systemic issues with ensuring areas were consistently clean.

“It’s usually not the nurses, doctors or allied health, it’s the systems in place to make sure these things happen all the time. They’re are likely to need attention,” he told ABC radio.

Opposition Leader Alistair Coe said the report was a discredit to Ms Fitzharris’ performance and had effectively put her on 90 days’ notice.

“It’s an embarrassment, and demonstrates the Government’s indifference to ensure quality care to patients,” he said.

“Ms Fitzharris and the Chief Minister need to finally demonstrate some leadership and bring order back into our health system.”

Mr Coe was sceptical of Ms Fitzharris’s decision to split the directorate, saying there was already a part of ACT Health that had responsibility for corporate matters.

“I fail to see why just calling it a directorate is going to solve anything,” he said.

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Would rather a billion dollar hospital than a new light rail leg.

The whole thing acts a patch on a patch. The hospital site is a rats maze anyway.

A single DG term was never going to be enough to fix what was broken at Canberra Hospital, as anybody who’s had anything to do with the place already knows.
I think the initial excitement of a necessary and radical business transformation was drained by the realisation that as the previous DG began to understand the scale of the task, traction was lost, compounded by a lack of necessary funding and the cancelling of projects to fit in with the Govt budget.
It’s correct that health is very very expensive, but it’s also correct that there is no point in chucking good money after bad until they can transform and actually produce a business plan that can be implemented. The worst decision the Govt ever made was to attempt a refurbishment on the same site whilst keeping the existing hospital running….it will have cost far more than the price of a brand new hospital, has complicated the running and maintenance to such an extent that control has been lost and critical risks have not been addressed, and the campus is full of infrastructure, services and systems of different types and ages; and no hospital plan exists at all which is startling !!
The answer will be a new hospital and a massive undertaking to transform business management practices strictly aligned to strategic targets, to allow healthcare outcomes and efficiencies to improve.
This also means reigning in politicians and getting professional behaviour from them to support the entire health function as a system, rather than targetting pet projects and tit-for-tat promises to win elections. This has created an imbalance and gaps elsewhere, thus weakens the whole and makes the job too difficult.

Capital Retro10:12 am 19 Apr 18

Even the trams will be giving TCH a miss.

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