Health staff unwilling to introduce quality improvement measures might "ship out" if told to grow up, Richard Thomson says.
He was responding to a suggestion from health policy researcher Associate Prof Robin Gauld, who said this week the Otago District Health Board should be driving improvement measures at Dunedin Hospital and staff who insisted on doing things the way they always had should grow up.
Prof Gauld's comments followed concerns expressed by Dunedin Hospital emergency specialist Dr Tim Kerruish that moves to reduce waste, increase efficiency and improve patient flow to save money and provide better care for patients might be thwarted in the existing hospital culture.
Mr Thomson, who chairs the Otago District Health Board hospital advisory committee (HAC), where Dr Kerruish raised these matters, said he largely agreed with Prof Gauld's comments which called for a greater emphasis on quality improvement.
However, it was not quite as simple as the board determining a direction and telling those who did not agree with it to grow up.
"Some of those that you might determine need to grow up may well feel that instead they will just ship out.
When you are dealing with significant staff shortages in areas where staff are hard to find then that is a significant risk to take with the region's health."
The HAC had discussed quality issues at some length during the last couple of years and would agree there was significant quality work needed if the board were to get better results out of its funding.
It had been agreed that staff shortages at the hospital needed to be rectified first.
Some of the vacancy issues had been remedied, but it was also clear that examining how things were done, as had been done in the emergency department "Putting Our Patients First" pilot, required synchronicity between the board, management and clinicians.
Mr Thomson said the board and management attempting to impose something without the support of a majority of clinicians would not work.
Dr Kerruish had also made it clear that if the majority wanted to pursue quality improvement and a few did not, then without management and board support for dealing with that, the initiatives would fail.
The issues needed to be seen from the customer's perspective.
The board should be asking how it could get the greatest value out of the available resources to deliver the greatest amount of "quality outcomes" for the people of Otago.
Board chairman Errol Millar said he felt the board was paying more attention to quality monitoring, although much of that was not seen by the public.
He agreed that the issues raised were complex and that the board had to set the standard in creating the environment so improvements such as those promoted in the "Putting Our Patients First" could be achieved.
