The DHB today released the independent audit of clinical practices and organizational health at Cranford. Here’s the basic conclusion (download full report):

“…the status quo at Cranford Hospice is not a viable option. While the standard of care to patients has not been detrimentally impacted by the dysfunction resulting from the change management process to date, there is significant potential for this to occur.

“Communication issues between teams, a dissatisfied workforce and the inability of the management team to manage the situation in the past 12 months, must be addressed, as a matter of the highest priority. The existing personnel have verified that the trust and teamwork essential to this working environment has been lost between the teams … This has the potential to impact on patient care and safety in the following ways:

  • failure to raise clinical concerns with the interdisciplinary team
  • disagreement with methodologies used, resulting in failure to follow other teams’ instructions or appropriate clinical pathways
  • inability to hold constructive discussions on clinical management and issues
  • loss of workforce due to workplace stress.”

Commented DHB Chief Executive Dr Kevin Snee in a media statement (full copy here): “The DHB will be working with Presbyterian Support East Coast (PSEC); however radical action needs to be taken to address the underlying problems that are obviously endemic and require far-reaching action. Cranford needs to be delivering an excellent service – clearly it currently does not.”

Now what?

Hopefully the DHB itself will follow through with what Dr Snee describes as a very “hands-on” approach to sorting things out at Cranford. He accepts that DHB was not sufficiently involved in the past, noting: “DHB had other things on its mind over the last two years.”

He commented further to BayBuzz: “We intend to be very active, down to approving any re-structure proposal.” In his view, all parties need to raise their game. “Nobody got a ‘get out of jail’ card here,” he observed. “Nobody has been given a clean bill of health.”

His attitude echoes the report itself, which stated:

“The audit team recognise that the existing staff cannot function together, and as this situation has not been resolved over the past two years, it is unlikely that the same staff can resolve their differences in 2010 and continue to be employed by Cranford Hospice. Therefore, PSEC Board will have to make difficult decisions about future staffing of Cranford Hospice at all levels.” [Emphasis added]

Presbyterian Support (PSEC) and Cranford managers also held a media conference on the report. Unfortunately, there, a different attitude seemed to prevail (Cranford Hospice statement here). Managers essentially characterized the situation, as they always have, as a problem of farsighted executives being frustrated by stuck-in-the-past malcontents.

When John Newland, the “organizational change” consultant brought in by PSEC and DHB to help improve the situation was asked whether his role was to be a adjunct of the present management team or a neutral facilitator of improving the organizational culture, he replied: “My role is to support these two individuals (referring to PSEC’s Shaun Robinson and Cranford’s Barry Keane) in bringing about needed change.”

Given the clarity with which the audit criticized Cranford’s staff tensions and organizational dysfunction, it’s difficult to comprehend how all the problems can be sourced to the corporals on the front line, while the generals are exonerated. As the audit report stated: “…the audit team cannot offer the DHB any assurance on the organisational performance of this contracted provider.”

Fortunately, as Dr Snee emphasized to BayBuzz, Mr Newland reports to both PSEC and Dr Snee, and hopefully Dr Snee will stand by his “no one has got a ‘get of jail free’ card” statement.

All members of the Cranford workforce must now demonstrate they are committed to embracing best clinical practices, and executives must establish they are competent to manage in an environment that is innately and uncommonly sensitive. As Dr Snee put it: “Those who can, stay; those who can’t, leave.”

Tom Belford

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10 Comments

  1. What a way to go , This is meant to be a place of comfort , a relation of mine past away not long ago and have notthing but praises for the team at cranford from the cooks to cleaners to nurses, hastings hospital is no place to spend your final moments.

    Ive had a few relations over the years go to cranford and the funny thing is from then to now you still see the friendly faces of staff.. AND MOST ARE THE SAME FACES STILL THEIR NOW…..

    If i was to pass away there is no way this will be at the hastings hospital , keep the staff , restructure the team , keep the smiling faces of the team PUT THEM ALL ON TRIAL STAFF MORRELL IS IMPORTANT

    STRESS LEAVE WE ALL USE IT NO MATTER WHAT THE JOB IS , ITS NOT ONLY THIS PLACE

    GO THE TEAM .. IM ON YOUR SIDE

  2. Lawrence Yule reveals an unfortunate aspect of his ‘leadership’ style when he says, “The pressure that Baybuzz has put on Cranford may have contributed to this outcome.”

    How pathetic. And what an insult to the independent auditors who came to many of the same conclusions expressed in the Baybuzz investigation.

    Shooting the messenger is clearly a tactic of bullies and I suggest Yule reflect on the fact that as early as mid 2008 he was fully informed about the disfunction at Cranford and did nothing to assist. While he sat back Cranford went from bad to worse. At any time he could have used his influence to broker reconciliation. He did nothing. So it’s ripe of him to now blame those who ‘lanced the boil’ so the healing process could begin.

  3. Well, Damon, were you at the staff meeting earlier in the day yesterday? It was there that the staff were told that the “clinical staff were clear” and “the nursing staff do not have the skills required”. It was there they were told “phase 1” is to take place with nursing and household redundancies. “Phase 2” will start by the end of June.
    There was no mention of management at all being responsible for anything.
    Yesterday in the staff meeting, staff were told by Barry Keane (in answer to a question and with a smile on his face) that no management will be loosing their jobs.
    Interesting…the audit states “PSEC Board will have to make difficut decisions about future staffing of Cranford Hospice at all levels”.
    If Barry Keane brought in the change of Cranford Hospice to “Specialist Palliative Care Service”, whoses responsibility is it to upskill the staff? Barry Keanes? Sandra Sandersons (Nursing Director)?
    Have nurses been turned down for post graduate palliative care courses in the past 12 months…..yes.
    Nursing staff have done other courses, and have years of work in palliative care. I imagine experience is worth more than a piece of paper.
    IV Certification by nurses has not been required at Cranford Hospice. Despite this Hospice Registered Nurses were to attend IV Training on 12 May 2010…..but the Nurse Director said….no.
    So, transferring patients to HBDHB is better for the patients. How. They will be staffed by both a Cranford nurse and a HBDHB nurse. Cranford nurses were told yesterday that they will train the HBDHB nurses….buty they were told they didn’t have the skills? So, how is this better care for the patients? If a Cranford nurse is sick who is to replace them…..a HBDHB casual nurse. So, that would mean that the HBDHB nurses all have post graduate palliative care education? No. Do they have palliative care experience? No? So, how is this in the best interests and care of the patients. And apparantly, patients are moving from Cranford to the Hospital on 17 May 2010, even if they are actively dying. I have never been aware of a patient being transferred while they are actively dying. I imagine it is completely inappropriate.
    Nurse’s stay in unsavoury positions because they love their work, and their patients. Nurse’s are the patients advocate. They fight for them, and they will disagree if they think there is an alternative route. Does this make them bad people…no…it makes them compassionate and committed.
    Please support the nurses. They are still at work. They have had devastating news. They go into patients rooms and the relatives are reading the news about them. That is hard work, and they are doing it with a smile.

  4. A damning inditement of Cranford management and PSEC. Perhaps Keane, Robinson etc should all be "..dis-established..".

    Remember management always have had the choice to act in a compassionate and balanced manner but instead chose to act like a sleazy corporation and employed a private investigator/repossessor/debt collector/evictor (aka Doug Abraham) to investigate (or intimidate) staff.

    QUESTIONS

    1) Did Doug Abraham or management at Cranford inform staff of their right not to be interviewed in the investigation?

    2) How much did Abraham's investigation cost PSEC?

    3) Will Abraham's conclusions (!! – this implies rationale thought processes and some knowledge of the field he is working in) ever reach the light of day?

    4) Did PSEC discuss ACL's (Abraham's) engagement at board level or was this a unilateral decision by Robinson?

    5) What is the relationship between Shaun Robinson and Doug Abraham? Do they know each other from some other past life?

    6) How much is John Newland costing PSEC?

    7) What are John Newland's credentials in the health field?

    You can e-mail PSEC at funding@supportec.org.nz for answers to these questions. I would not expect any straight answers but lots of obfuscation and prevarication such as, "..this matter is subject to an ongoing internal process as thus cannot be commented on..".

    Still no harm in keeping these people on their toes!

    E-mail me directly on SDrFox@hotmail.com if you have information that you would like placed in the public forum.

    Veritas Omnia Vincit

  5. I have never commented on this site before( even though I am the subject of much of its content), however I noted with significant concern the investigation by BayBuzz of this issue.

    The pressure that Baybuzz has put on Cranford may have contributed to this outcome.

    The pressure should not be put on Cranford, rather on those that allowed things to get to this point.

    I am completely behind Cranford. I want you to join me. Please see discussion on my facebook page.

    http://www.facebook.com/topic.php?uid=16405156801

  6. Tom, I don’t think you are giving a true reflection of what happened at the PSEC/Cranford Press conference.

    I was there in the 'paidcapacity' as the communications adviser for Cranford and I would like to assure your readers that those that representing PSEC and Cranford such as Shaun Robinson and Barry Keane clearly accepted the report’s findings that they had not effectively managed the change process.

    They took responsibility for not addressing the issues as well as they could and they did on several occasions during the press conference apologize for their failings – highlighted in report.

    You said there was a different “attitude” – and although I am consulting for Cranford, I have to say in my opinion your take on attitude is misguiding.

    You also say there was a feeling that ”all the problems can be sourced to the corporals on the front line, while the generals are exonerated”. Again this was not a fair comment that could be taken from the press conference.

    I would also like to note in full the seven areas that will be a focus as outlined in the report.

    The risks identified for Cranford Hospice are significant and need to be addressed as a matter of urgency.

    While the audit team cannot provide absolute guidance on how to address these issues, the PSEC Board should consider the following:

    1. The current executive management team have not effectively managed the change process and resistance encountered at Cranford Hospice. While the team have relevant qualifications to lead the staff group, the effectiveness of the group to manage the change process has been limited. The team is suited to management of a workforce where existing systems are implemented and accepted. Therefore, in the short term, PSEC Board should consider leadership that has proven expertise in change management.

    2. A large proportion of the Cranford Hospice staff are part time. This does not promote continuity of care for patients. The PSEC Board should consider having core staff in each team who can work full time roles to provide continuity for team members who only work minimal hours.

    3. There are a number of staff who are resistant to change, or who have become disillusioned with Cranford Hospice. The organisation requires all staff to be engaged in new developments. The PSEC Board should ensure that moving forward, only staff who are willing to embrace new frameworks, systems and methodologies should be part of the Cranford Hospice team. The PSEC Board may find that changes within Cranford Hospice staff may resolve issues with resistance in some areas.

    4. The nursing workforce, while experienced, has limited postgraduate qualifications in palliative care. For Cranford Hospice to become an effective specialist palliative care service, the nursing workforce should have a high skill level. The PSEC Board should consider how the organisation can obtain a nursing workforce with the relevant qualifications, through both training and recruitment.

    5. The medical team is working within nationally accepted guidelines for prescribing and treatment in palliative care. However, the organisation is using Mercy Hospice Auckland clinical guidelines and has not fully developed their own guidelines for Cranford Hospice care pathways. This was intended as an interim measure in 2008, but has continued due to a lack of time and resource to complete the guidelines. These should be developed in 2010.

    6. The nursing team does not use the care plans, forms and tools developed to adequately document nursing care. Nurses should be using standardised documentation to communicate and plan care for patients of Cranford Hospice.

    7. The Quality Manager role is 0.2 FTE, which is under-resourced for an organisation of this size. Quality programmes are not yet fully developed, and quality systems have not been effectively implemented. The PSEC Board should consider increasing the resourcing for quality management, and utilising an experienced Quality Manager to drive the clinical and nursing guideline implementation programme.

  7. My wife is one of the nurses who has had to put up with this nonsense for the last two years. She began work at the hospice after the restructuring in 2008 and therefore had no pre-conceived ideas about past and present management practices. Unfortunately though, as a result of being treated extremely poorly by the present management team her views have hardened somewhat.

    I know for a fact that my wife is a good nurse who is dedicated to her job and throughout these last few months the care that she has provided to her patients hasn't altered, despite the fact that she has been working in an environment rife with bullying and intimidation. I am confident the same can be said for the entire nursing staff at Cranford and I suspect that if the people of HB who have been connected to Cranford in some way were polled on the matter, the nurses would receive overwhelming support.

    The inescapable fact that the PSEC and the DHB seem to have overlooked is that the hospice has been operating smoothly since its creation in 1982, yet Mr Keane was appointed just over two years ago and now the hospice is in complete disarray and is on the verge of closing. As the manager appointed to oversee the restructuring in 2008 he should be the one held accountable for the current mess. Clearly he has failed to manage his staff staff properly, with the result being a situation where the nursing staff do not respect the non-clinical management team.

    It's true, that as a general rule, people don't like change; but there have been many instances in the past where work place reform has been successfully undertaken without a complete breakdown in relations now seen at Cranford. The key to achieving that, Mr Keane, is to treat people with respect. If you treat people with the respect and make a genuine effort to explain to them why changes are necessary and then, most importantly, listen to their concerns, more often than not you will achieve your aims in time. The problems at Cranford could have been easily averted had these basic managerial principles been implemented.

    The shame in all of this is that the only people who will suffer will be the dedicated nurses and support staff who will now lose their jobs and the people of HB who may lose the benefit of that unique quality that Cranford has to offer during a particular time of need.

    My wife is due to work a night shift tonight. Despite being extremely upset about recent events, I am confident that she will be up to the task. The same can't be said for PSEC, who were told months ago by nurses and other interested parties that the situation at Cranford was deteriorating, yet did nothing about it.

    Adrian Barclay

  8. I have been following the media and other sources of news about Cranford since the half page advertisement posted by PSEC late last year (that gained attention because of how it denigrated their nursing team). Now I've read the press releases put out yesterday by HBDHB and PSEC and have read the review report.

    If, as I expect, the PSEC media release was compiled by an experienced communicator they should have anticipated and predicted the headlines that the newspapers have picked up on from those media releases.

    It is astonishing that the same day that nurses are told they've lost their jobs that their employer deliberately provokes this public denigration. This will not make it easier for them to get new employment will it?

    So while I admire Lawrence Yule for showing some leadership, I have to ask him, if the same management remain in post with a new team of nurses, what will change? and how could a blog section cause this destruction of Cranford? Cranford has done that itself by the behaviour of its leadership and governors.

    And Damon Harvey, if as you suggest, the previous correspondent got it wrong, and there was responsibility taken by management at the meeting, how come that is not reflected in the media release sent out by PSEC?

    It is a fascinating subject for a change management study to have a situation whereby a professional staff group is stripped of its pride and employment by a management team that sticks by a story that it has been hampered by a resistant staff group.

    Has there ever been a similar situation involving a staff group that is admired and loved by its community for its professional conduct then hung out to dry by media spurred on by the employer and the funder.

    I agree with Lawrence Yule's call for the community to get behind Cranford. Surely the Cranford nurses deserve better from our community and certainly deserve better from PSEC and HBDHB.

  9. Tears,fears and anger.
    Job losses forecast,but still staff turn up to work albeit in a state shock.And still these staff carry on proffessionally feeling judged at every move by their clients and their families, peers and management.

    Palliative nursing has a uniqueness in that all client based relationships end in death.

    I would think that most Cranford nurses would take some responsibility for where they now find themselves today.I believe they have attempted in the recent past to change,update,upskill,introduce acceptable documentation and found resistance from MANAGEMENT.
    A request by some staff for e-mail password DENIED.
    A request for funding to upskill DENIED.
    A request for information via Hospice NZ IGNORED.
    An attempt to improve above issues and inform of other issues last year by communicating via letter commenced an extremely traumatic era in Cranford history.AND still management unable to change tact on moving Cranford forward .
    For Damon to say management agree to have not effectively managed change at a press meeting,sounds like crocodile tears at the right place to me.
    Why was this not said to staff 28.4.10?
    The TAS report as I read it is damning of management yet nurses denigrated(Dominionpost 29/4/10).Historically this is nothing new.
    PSEC and Keane keep their roles?
    Implimenting change without robust groundwork has impacted unfairly on HB and its people,and with huge impact financially and emotionally
    Why is PSEC still in this loop?Do they now pay DHB for bedspace,medical cover of Cranford patients?

  10. Damon – as you have taken on the role of spokesperson for PSEC can you please answer the following questions:

    What happens to funds when they are donated to Cranford? Are they used exclusively for Cranford’s benefit or are some or all of the funds diverted to PSEC?

    Is it true that the four “Head Start” beds (serious head injury) at the ATR ward at the Hospital (where the Cranford inpatients will move to) will now have to be moved out of HB?

    Can PSEC now release the report compiled by Abraham Consultants regarding the “leak” at Cranford and what did the report cost?

    Is it true that as Messrs Robinson, Keane and Newlands left the staff meeting on Wednesday for their pre arranged press conference, Berry Keane instructed staff that they were not to approach the media to discuss any issues relating to Cranford?

    I look forward to receiving your response.

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