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.”
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.”