The Otago District Health Board needs to drive quality improvement measures at Dunedin Hospital and staff who insist on doing things the way they always have should "grow up", a health policy researcher says.
Harkness health care policy and practice fellow Associate Prof Robin Gauld, from the University of Otago's department of preventive and social medicine, said from Boston yesterday that transforming the hospital culture was a board and leadership issue.
He was commenting on concerns raised by Dunedin Hospital emergency specialist Dr Tim Kerruish that moves to reduce waste, increase efficiency and improve patient flow, which would both save money and result in better care for patients, could founder in the existing hospital culture.
Prof Gauld said the Otago board, like other district health boards, appeared to be missing the boat when it came to a focus on quality improvement.
It was unfortunate its importance had not been realised given the context of underfunding and ever-increasing pressure for cost savings.
While what Dr Kerruish and his "Putting the Patient First" team was doing was "really, really important", it would not succeed without the board driving the message home to staff, Prof Gauld said.
Dr Kerruish has told the board hospital advisory committee a clear organisational vision for the hospital is lacking.
Prof Gauld said the board's mission could be to become New Zealand's highest quality hospital and the most quality-focused district health board while at the same time cutting costs.
That would be much more positive than "uh-oh, we've got an $8 million deficit" and then looking at possible service reductions.
Battling a deficit did not mean a more long-term view should not be taken.
The "vanguard of health-care quality", the Institute for Health Improvement in Boston, would say a time of deficit was the best time to focus on quality.
He cited the case of a 150-bed Massachusetts hospital he had studied which had an $8 million deficit and had chosen to focus on a quality strategy designed to result in fewer readmissions, fewer mistakes and a much more efficient organisation.
High-performing hospitals often had quality committees which were as powerful as the board and could override board decisions relating to quality - "they take it that seriously".
Prof Gauld said hiring health consultants, which could cost up to $200,000, was not the answer - "I could tell them for $10".
About 30% of funding was spent on medical errors, which could be reduced by introducing processes which were "robot-like", allowing for consistency in the way patients were treated.
Prof Gauld, the first South Island Harkness health care policy and practice fellow, will return to Dunedin in July after almost a year studying quality improvement practices in the United States and Canada.
