PHCA2002 Foundations Of Safety And Quality In Health

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PHCA2002 Foundations Of Safety And Quality In Health

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PHCA2002 Foundations Of Safety And Quality In Health

1 Download7 Pages / 1,711 Words

Course Code: PHCA2002
University: Curtin University

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Country: Australia


Choose a public inquiry from the list below or you can choose one of your own and write a report on it.
List of some famous inquiries include:

Shipman Inquiry
Bristol Royal Infirmary
King Edward Memorial Hospital
The Allitt Inquiry
Bundaberg Inquiry
Royal Liverpool Children’s
NHS Trust Inquiry, Mid Staffordshire.


The following report is based on public enquiry undertaken over the Bundaberg Base Hospital and is conducted by Hon Geoffrey Davies AO under Queensland Public Hospitals Commissions of Inquiry Report. The report mainly initiates with the summary of the key information starting from the case or the issue that happened, how it happened, the people who were found guilty in the case, reason behind why the report got undetected. At the end, the report will highlight the gaps which are highlighted in the report which lead to the occurrence of the public health threats followed by the recommendations and implications of recommendation.
What happened?
The Queensland Public Hospitals Commissions of Inquiry (2005) for Bundaberg Base Hospital mainly centres on the misdeed of Dr. Jayant Patel against the comments raised during the tenure of 2004 and early 2005. Dr. Jayant Patel lacked the required skills in the surgery section however, lack of assessment about his clinical skills lead to his appointment in the hospital. This faulty appointment leads to a series of mishaps in the surgical ward of the hospital which took a toll on the life of the patients. During his 24 months of service tenure at Bundaberg Base Hospital, patients and staffs lodged 20 complaints against Dr Patel. These complaints started registering immediately after he commenced his duty at the hospital and continued until he ceased his work. The four main area of misconduct as highlighted by Dr De Lacy include lack of inappropriate patient assessment, defective surgery techniques, poor post-operative management and inadequate follow-up
How it happened?
According to Queensland Public Hospitals Commissions of Inquiry (2005), Dr Patel was appointed as the Director of Surgery by Dr Nydam who was the then acting director of medical services at Bundaberg Base Hospital. He was registered by the Medical Board of Queensland under the domain of need scheme1 as a senior medical officer in surgery. However, about a fortnight after Dr Patel started his duty, Dr Keating was replaced by Dr Nydam as the Director of Medical Services. Both Dr Keating and Dr Nydam failed to access the competency skills of Dr Patel and this lead to tragic outcome. Though Dr Patel was recruited one year of contract, his service tenure was renewed and extended till 2 years (2003 to 2005) and this highlighted lack checking of the competency skills of the doctors in the Bundaberg Base Hospital.
Who was involved?
Queensland Public Hospitals Commissions of Inquiry (2005) report stated that the main culprit was the administrators and medical board members of the Bundaberg Base Hospital. It is their negligence which leads to gap in checking the credentials of Dr Patel at the time of appointment. During the later period of time, it was negligence of Dr Nydam and during the later part it was negligence of Dr Keating who failed to do proper assessment of Dr Patel’s skills which gave rise of unprecedented outcome in the surgical results. Dr Patel’s certificate of Licensure from Oregon, United States of America has restriction imposed on Dr Patel as multidisciplinary measure towards performing specific types of surgery in Oregon. Dr Patel also did not surrender his license of practice in New York which contained disciplinary proceedings against him and he was suspended from the service for one year.
Queensland Public Hospitals Commissions of Inquiry (2005) report highlighted that Dr Patel was appointed was Senior Medical Officer who position would ordinarily be supervised but later was appointed as Director of Surgery, a position which is supposed to be occupied by registered specialist. Thus the policy guidelines for recruitment was not followed by the administrators of Bundaberg Base Hospital
Why did it got undetected for the period of time?
Queensland Public Hospitals Commissions of Inquiry (2005) reported that the overall controversy got delayed due to lack for surveillances and scrutiny of the clinical competency skills and the experience reports of Dr Patel. Dr Patel was appointed was Senior Medical Officer who position would ordinarily be supervised but later was appointed as Director of Surgery, a position which is supposed to be occupied by registered specialist. Thus the policy guidelines for recruitment were not followed by the administrators of Bundaberg Base Hospital and there was negligence in the field of scrutiny.
Group of professionals involved
As per the reports of Queensland Public Hospitals Commissions of Inquiry (2005), three main people were involved in highlighting the scandal of Dr Patel include Ms Toni Hoffman. It was her courage and her prolong efforts which helped to highlight the face of inaction of scandalous Dr Patel. The second person involved in unearthing the case of Dr Patel includes Mr Rob Messenger MP. He helped to surface the complain of Ms Hoffman. The third person was Mr Hedley Thomas of The Courier-Mail. His persistence authority, investigative skills as a respected journalist ensured proper government action and attraction of public notice towards taking noteworthy steps against Dr Patel.
Gaps identified
The main gaps identified in the case study of Bundaberg Base Hospital by Queensland Public Hospitals Commissions of Inquiry (2005) report involving Dr Patel are lack of proper budget in recruiting eligible professionals, failure to perform proper scrutiny about the background of Dr Patel, failure to have Dr Patel credentialed and privilege and failure of adequate complain in the system.
Recommendations and its implications
The main recommendation that can be done in order to avoid this kind of situations in future include proper financial set-up of the healthcare organisation. According to Australian Government Department of Health (2012), the Director of Surgery should be a registered specialist surgeon under Australian specialist qualifications and thus the required to offer a salary and other job facilities which are more generous than Queensland Health would have allowed the hospital authority to offer. Moreover, overseas trained specialist is required to meet the criteria of Royal Australasian College of surgeons with his proper experience and certificates. Proper funding will help in the promotion of the international recruitment strategy and this help to increase qualified overseas professionals under the hospital healthcare system and thereby helping to increase the overall competency of care both under the cultural aspects and on the aspect of quality. Hayward and Charrette (2012) are of the opinion that proper recruitment of the overseas trained healthcare professionals helps in increasing the overall quality of care along with the decrease in the health-inequality.
It is required that the appointed medical board is required to conduct proper scrutiny of the credentials, experience and the certificates before the recruitment of the healthcare professionals under any domain. According to the Medical Board of Australia (2018), international medical students who are seeking registration to practice in Australia must be thoroughly scrutinised in the domain of eligibility, proper experience certificates and competency skills. This scrutiny can be done through competent authority pathway, standard pathway or specialist pathway. In case of Dr Patel, the pathway which will be applicable include specialist pathway were an overseas trained international medical graduate is applying for an area of need specialist level position in Australia. The study conducted by Ross et al. (2013) highlighted that trained and qualified healthcare professionals are less likely to take faulty decision towards procuring care for the patients. Moreover, Ashcroft et al. (2015) argued that a specialist trained doctors with proper qualification and competency skills is expected to work more diligently during his or her service tenure and thereby helping to reduce the healthcare care, unwanted stay in the hospital and improved patient outcome. 
Proper maintenance of the complaint system must be made and regularly scrutinised. According to the study conducted by Reader, Gillespie and Roberts (2014), proper documentation of the patient complain under the healthcare system is regarded as a valuable resource towards monitoring of the patient safety. The systematic review conducted by Reader, Gillespie and Roberts (2014) stated that rigorous analysis of patient complain helps in the identification of the problems in the domain of patient safety. However, in order to achieve this, necessary standards for the documentation of the patient concerns or problems must be made.
The analysis of the report highlighted that Mr Jayant Patel, an overseas trained surgeon was recruited to the Bundaberg Base Hospital without proper scrutiny of his qualifications, degrees and competency skills. This lack of proper scrutiny by the hospital administrators, which was mainly headed by Dr Nydam and Dr Keating endangered numerous life of the patient. Dr Patel was initially admitted as senior surgeon but later was recruited as the Director of the surgery department. However, active intervention of three healthcare professionals after 2 years of service tenure of Dr Patel surfaced the case to public and leading to subsequent termination of the job role of Dr Patel in Bundaberg Base Hospital. The main gaps which were identified in the case study include lack of proper funding of the hospital, lack of proper scrutiny of the experience records of the doctors and lack of proper consideration of the patient’s record. Proper documentation of the patient’s complain and hospital budget along with diligent role of the hospital administrative authority might have been helpful in side passing this fatal situations.
Ashcroft, D.M., Lewis, P.J., Tully, M.P., Farragher, T.M., Taylor, D., Wass, V., Williams, S.D. and Dornan, T., 2015. Prevalence, nature, severity and risk factors for prescribing errors in hospital inpatients: prospective study in 20 UK hospitals. Drug safety, 38(9), pp.833-843.
Australian Government Department of Health (2012). International Recruitment Strategy. Access date: 23rd October 2012. Retrieved from: https://www.health.gov.au/internet/main/publishing.nsf/content/work-pr-otd-recruit
Davis, H. G. AO. (2005). Queensland Public Hospitals Commission of Inquiry. Access date: 23rd October 2012. Retrieved from:  https://www.parliament.qld.gov.au/documents/tableOffice/TabledPapers/2005/5105T5305.pdf
Hayward, L. M., & Charrette, A. L. (2012). Integrating cultural competence and core values: An international service-learning model. Journal of Physical Therapy Education, 26(1), 78-89.
Medical Board of Australia. (2018). International medical graduates (IMGs). Access date: 23rd October 2012. Retrieved from: https://www.medicalboard.gov.au/registration/international-medical-graduates.aspx
Reader, T. W., Gillespie, A., & Roberts, J. (2014). Patient complaints in healthcare systems: a systematic review and coding taxonomy. BMJ Qual Saf, 23(8), 678-689.
Ross, S., Ryan, C., Duncan, E. M., Francis, J. J., Johnston, M., Ker, J. S., … & McLay, J. (2013). Perceived causes of prescribing errors by junior doctors in hospital inpatients: a study from the PROTECT programme. BMJ Qual Saf, 22(2), 97-102.

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