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PHE5PUH Principles Of Public Health
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PHE5PUH Principles Of Public Health
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Course Code: PHE5PUH
University: La Trobe University
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Country: Australia
Question:
Explain the main clinical governance failings identified in the Bundaberg hospital incident in Australia.
Answer:
Introduction
Health care facilities and the hospitals are accountable to deliver the best possible care to the patients and maintain an extensive risk management frame work across all the levels of the health care facilities (Groene et al., 2014). Specific protocols have been issued by the Australian government and each clinical settings also have their respective governance guidelines. Despite of all the stringent laws and norms most of the clinical settings fail to meet up to the standards of the clinical governance.
List of the main clinical governance failings identified in the Bundaberg hospital incident
The failure of the clinical governance is evidenced by the malpractice of an Indian based doctor who was being investigated for over 87 deaths in a hospital in Queensland. The mishaps included a considerable number of stillbirths and infant mortality (Casali&Day, 2010). Some of the areas that has been identified are as follows:-
One of the important failure is the lack of congruence among the organizational staffs. The codes of ethics and the guidelines are not sufficient in counteracting the negative influence of the informal codes of practice undermining the community standards and the organizational values. It is important to mention that as per the review report of the Bundaberg incident, the hospital’s codes of ethics was written in a style that reflected the bureaucratic culture of the organization (Casali&Day, 2010).
Not only the doctor, but the health mangers of the clinical settings and there organizational heads also overlooked the repeated complaints of the patients and paved the way for the doctors negligence. The culture of covering up the flaws instead of proper investigation is one of the example of a poor culture in an organization (Waxman et al., 2014).
The common areas of governance failure is that the quality of the care provided wad not up to the standard (Waxman et al., 2014). Although some voices from the organization raised some concerns about the substandard care, but lack of governance and the prevalence of corruption in each of the levels of the health care setting suppressed those voices (Wilkinson et al., 2015).
Another issue that has been identified that a large number of competent medical frontline workers resigned from the hospital due to repeated bullying, intimidation and victimization(Casali& Day, 2010).
Another important factors is the lack of communication between the hospital and the formal controlling agency, who are responsible for ensuring safety standards for the hospitalCasali& Day, 2010). Poor teamwork and collaboration between the team members led to the occurrence of the adverse events (Ezziane et al., 2012).
The formal organizational procedures in relation to the reporting of the sentinel events in Queensland hospital suffered from a downfall.Unhealthy organizational culture is one of the main contributor of these types of incidents (Morton, 2005).. Weak cultures poses barriers to ethical decision making process. Congruence between the individual’s values in everyday practice is necessary to avoid the occurrence of these types of incidents every day.
Poor communication between the hospital organization and the patient’s family also contributed to the occurrence of the sentinel events. According to Groene et al. (2013), patient involvement in designing and assessing the health care service is an important step to provide a patient centered care.
Governance mechanism placed at that time that could have assisted in avoiding such clinical failings in Bundaberg
A healthy organizational culture would have prevented the mishap. Healthy organizational culture involves awareness among the health care staffs to take ethical decisions, proper distributive leadership through all the levels of the organization, keeping the interest of the patient in the priority for a safe and quality care, conduction of the proper risk assessments, keeping of the risk registers, tallying the information with the baseline data (Zingg et al., 2013).
It is not correct to shift the entire blame on the organizational culture. The health care staffs should contain a strong sense of value to take the correct ethical decisions related to patient care. It is the managerial ethical decision making process that helps in the building of a relationship between the individual and the organizational values (Grol et al., 2013).
A healthy clinical governance implies that that there will be a proper reporting of the occurrence of any adverse events (Grol et al., 2013). It is the duty of the organizational staffs to take care of the reporting of the incidents. In the Bundaberg incident, it was unfortunate go find that only one of the nurses refused to be silenced, while the other health care staffs chose to remain quite. Not only this, the report made by the concerned nurse focusing on the flaws of the organization was never carried forward for further investigation.
Some of the expected values in health care staffs of the concerned hospital included, honesty, integrity and dignity, treating everyone with respect and respecting cultural diversities. Such qualities among the health care staffs would have easily avoided the sentinel events (Ezziane et al., 2013).
Paying heed to the grievances of the patient or involving the patients and the families in the decision making process would have helped to avoid any kinds of clinical errors (Anhang Priceetc al., 2014). Obtaining feedback from the consumers is an important aspect for maintaining the safety and quality of health care (Singer &Vogus, 2013). Turnover of the competent staffs could have been avoided by strengthening the regulations of the organization related to bullying and discrimination. This could have facilitated competent staff retention in the organization.
A well-defined managerial leadership was required to ensure patient safety in the organization. An ideal health care leader should make the patient safety the first priority, make patient safety as the responsibility for everybody, making clear assignments for the expectation of the safety oversight and provision of human and financial resources for the analysis of the errors and redesigning of the systems (Barr &Dowding, 2015).
However, it is to be concluded that a lack of a proper organizational culture, code of conduct and personal awareness among the health care staffs are the main reasons for the occurrence of such gross negligence within the healthcare. However, a healthier decision making, proper leadership and shared decision making with the patient and the families have been recognized as the key elements of the quality improvement strategies for a health care setting.
References
Anhang Price, R., Elliott, M. N., Zaslavsky, A. M., Hays, R. D., Lehrman, W. G., Rybowski, L., … & Cleary, P. D. (2014). Examining the role of patient experience surveys in measuring health care quality. Medical Care Research and Review, 71(5), 522-554.
Barr, J., &Dowding, L. (2015). Leadership in health care. Sage.
Casali, G. L., & Day, G. E. (2010). Treating an unhealthy organisational culture: the implications of the Bundaberg Hospital Inquiry for managerial ethical decision making. Australian Health Review, 34(1), 73-79.
Ezziane, Z., Maruthappu, M., Gawn, L., Thompson, E. A., Athanasiou, T., & Warren, O. J. (2012). Building effective clinical teams in healthcare. Journal of health organization and management, 26(4), 428-436.
Groene, O., Sunol, R., Klazinga, N. S., Wang, A., Dersarkissian, M., Thompson, C. A., … Thompson, A. (2014). Involvement of patients or their representatives in quality management functions in EU hospitals: implementation and impact on patient-centred care strategies. International Journal for Quality in Health Care, 26(Suppl 1), 81–91. https://doi.org/10.1093/intqhc/mzu022
Grol, R., Wensing, M., Eccles, M., & Davis, D. (Eds.). (2013). Improving patient care: the implementation of change in health care. John Wiley & Sons.
Morton, A. P. (2005). Reflections on the Bundaberg Hospital failure. Medical journal of Australia, 183(6), 328.
Singer, S. J., &Vogus, T. J. (2013). Reducing hospital errors: interventions that build safety culture. Annual review of public health, 34, 373-396.
Waxman, D. A., Greenberg, M. D., Ridgely, M. S., Kellermann, A. L., & Heaton, P. (2014). The effect of malpractice reform on emergency department care. New England Journal of Medicine, 371(16), 1518-1525.
Wilkinson, A., Townsend, K., Graham, T., & Muurlink, O. (2015). Fatal consequences: an analysis of the failed employee voice system at the B undaberg Hospital. Asia Pacific Journal of Human Resources, 53(3), 265-280.
Zingg, W., Holmes, A., Dettenkofer, M., Goetting, T., Secci, F., Clack, L., …&Pittet, D. (2015). Hospital organisation, management, and structure for prevention of health-care-associated infection: a systematic review and expert consensus. The Lancet Infectious Diseases, 15(2), 212-224.
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