Staff have been working 'well outside' their training in Dunedin's stressed urology service, a situation worsened by a 'rift' between specialists and management, a review has found.
The review found there was ``significant'' clinical risk for Dunedin patients.
Some staff, including nurses, secretaries and booking staff, were working ``well outside'' what they were trained for.
``It is the review committee's view that the apparent level of clinical risk is concerning and that urgent action is required to fully identify the level of risk and manage it as a high priority to avoid patients being adversely affected,'' the report says.
Patients had waited up to three years for follow up; cancer patients more than six months for surgery, and surveillance cystoscopy cases were up to a year overdue.
There was a major rift between Dunedin doctors and senior management.
``There has been escalating tension between clinicians and senior management, particularly on the Dunedin site, and since the appointment of two new urologists in 2014.
``Clinicians in Dunedin all expressed frustration and anger because they feel they are not listened to and that they have been misled.''
The service had had three service managers in the past 18 months.
``Non-clinical staff [are] in effect making clinical decisions (secretaries/booking clerks) because of the frequently stressful work they are doing in the patient management area.''
In November, the row over departmental staffing levels deepened and specialists demanded an external review. But It did not take place until June this year.
``The clinicians agreed between themselves that they would not consider any additional work (either insourced or outsourced) until a service improvement plan was in place.
``This decision has resulted in a significant decline in waiting times and ability to meet targets over the last six months at the Dunedin site.''
Southland urology is operating more efficiently and in some respects impressed the reviewers.
The sites were operating independelty and often had incorrect perceptions about what was happening at the other site.
There was a sense of the two sites competing for resources, the review said.
The Otago Daily Times is interviewing chief executive Chris Fleming this afternoon, and will have more in tomorrow's ODT.
Urology woes:
- Rift between doctors and senior managers
- Invercargill and Dunedin sites operate independently of each other with little communication.
- Significant clinical risk for long-wait patients in Dunedin.
- Invercargill functioning more efficiently.
- Poor understanding of size and needs of population
- Required unit changes in Dunedin cannot wait for hospital rebuild.
- After-hours model needs to change.
Recommendations:
- Review the service and all roles.
- Some staff working ``well outside their scope''.
- Assess how resources are allocated across Otago/Southland
- Upgrade facility at Dunedin Hospital _ it cannot wait for the hospital rebuild.
- Be transparent about review and progress.
