Changing the culture in healthcare - part 2

Too many staff are agreeing that the only way to emotionally survive as an employee in the public health system is to give up caring and learn to live with the mess. This must be of concern to all of us.

Coexisting are the doctors’ and nurses’ world of blood and vomit and dangerous short-cuts and the ministers’ and area executives’ world of reorganising and then reorganising the reorganised. As the problems become more overwhelming, the world of the decision-makers keeps moving towards the stratosphere.

Typical of any organisation staring collapse in the face, there is unethical damage control on the one hand and an escape into fantasising about better days ahead on the other.

This silencing [public discussion, doctors who speak out] has been balanced by numerous high profile consultant-led inquiries into the future of health where day-long seminars of contrived public consultation in expensive hotels achieve predictable outcomes.

The “predictable outcomes” Professor Steven Leeder refers to are feel-good delusions. What is the “contrived public consultation” the professor mentions?

The policy from high which failed on the ground

From about the mid-90s, public sector executives everywhere have been trumpeting their wholehearted acceptance of the citizen’s right to play a role in public policy.

In public health some recommendations were astonishing. In 1996 the Australian Health Ministers’ Advisory Council was even recommending that consumer representatives should participate in quality management. The 2000 Health Council Report commissioned by the New South Wales Government stated that a health service has no real legitimacy without consumers being involved in the planning of services.

Participating in quality management and the planning of services! That’s a big step up from putting ticks in boxes in a consumer survey. We had been promoted from the bilge to the captain’s cabin.

Riding on the surge of a brainwave, any prior research was seen as being unnecessary. A bit of probing would have revealed that two criteria had to be met if the grand idea was to be more than pie-in-the-sky:

• the staff had to accept the idea and not have it thrust upon them; and
• community representatives had to be both capable and fearlessly independent of the public health service.

Neither criteria were met.

The busy health care employees resented the intrusion of political correctness. They resented being required to listen to every ding-a-ling consumer opinion. There was a fear of becoming hostage to articulate minorities and an awareness of a rising culture of complaint. The prospect of close engagement with the community made many in the industry feel very uncomfortable.

The outcome was a service determined to keep consumer power as weak as possible. Consumer committees were required to be established by policy handed down from above. But, by ensuring that they had no clearly defined and attainable goals, the committees inevitably became self-absorbed. This has been a very effective means to render them impotent.

Since their inception around 1994, the area health services’ consumer participation programs have not raised the quality of health care by one iota anywhere in this country. All that happened was that significant money was sucked out of the health budget by this useless arrangement.

Now the reform becomes blatantly dishonest

Dates vary from state to state but from about 2005 began a shift away from the magnanimous open door approach where everybody was welcome to join a consumer committee. Consumer committee seats have now to be applied for.

This would have been the right move if an established community organisation such as Rotary made the selections. But, it was the self-serving health care bureaucracy which made the selections. Applicants looking suspiciously like potential boat-rockers are screened out.

The voice of the people is to be under the complete control of the organisation. The threat of criticism is to be subdued by bringing the people’s “representatives” inside the tent.

And - the system remains determined that there will be no use of the Internet to engage the mass of the people with online workshopping of health service concerns (or even simple blogging).

Where can we go from here?

All existing public health service consumer committees funded by the taxpayer must be scrapped.

Also, community “representatives” sitting on advisory councils and service committees must be removed. They cannot understand the shop-talk and desperately spend their time trying to think of something intelligent to say. They are there because they want to tell their friends that they sit at the same table as doctors.

We must have structures similar to citizen juries which can fearlessly follow through on staff and patient grievances that the system is either incompetently or dishonestly processing.

Hands-on health care is too technical for laypersons to pass judgment upon, but anybody can recognise the improper processing of a grievance.

Every employee grievance (such as intra-service bullying, overwork, unfair rostering) is evidence of a potentially dangerous service.

Every patient grievance (such as feeling abandoned by staff, being discharged while still unwell, having scheduled surgery rescheduled) is evidence of a potentially dangerous service.

Members of the juries must be drawn completely from the outside. Those who are on a government payroll or rely on government funding would be compromised. Organisations such as Rotary would be suitable for choosing the members from the private sector and releasing them from duty as need be.

Conclusion

The system in its present form is incapable of making itself safe for us.

As a reputed 50,000 hospital patients are permanently injured by their health care each year, we must get involved in our own protection by means of community-based structures which the government has nothing to do with - except to fund their operation.

Part 1 to this article is here.