The review initiated by the Health and Disability Commissioner is a positive step … but a limited one as presently described.
What kind of inquiry into the situation at Cranford Hospice will best dig into the issues, yield meaningful findings and recommendations, and produce outcomes that restore public confidence in the institution?
These factors need to be addressed …
The composition of the inquiry team, its genuine independence from currently involved parties, and its ability to generate confidence in the HB community are crucial issues in this process.
All clinicians, all from outside Hawke’s Bay, is not the answer.
While impartial palliative care experts should certainly be on the inquiry team, the issues raised at Cranford extend to more than whether a particular care-giving “regime” is being faithfully administered. Given the complaints raised, management practices and overall organizational functioning must be addressed. Judgments must be made about the workability of Cranford’s current culture, implying the need for “organizational health” and human resource management skills to be at the table.
The situation requires that all levels of management and oversight be reviewed – at Cranford, at Presbyterian Support, and at the DHB itself. Self-assessment by current players will not get the job done. And because some critics challenge the existing working and reporting relationships, the manifest defensiveness of certain parties, and the PSEC governance responsibility itself, participation by DHB Board members is also essential.
The actual scope of inquiry must be expanded beyond what has been publicly signaled. Although DHB staff assert they are responding to a single formal complaint (whose scope has not been revealed), the reality is that broad and credible concerns have been raised and the full brief of any inquiry must be commensurate with those concerns.
While the Health and Disability Commissioner might pursue a narrow brief driven by the specific complaint received, the DHB Board arguably has more far-reaching issues to address to satisfy its stewardship responsibilities.
As suggested above, a broad range of issues have been raised that ultimately affect the quality of care given by Cranford. Certainly, the day-to-day care-giving regime must be examined and compared against quality of care given in the past. But also bearing upon “clinical” practices are organizational cultural issues, management style and attitudes, and fundamental responsibility and accountability for the governance of Cranford.
A more comprehensive brief would suggest a broader range of individuals to be interviewed and types of information to be gathered.
The manner in which the inquiry is conducted must ensure that current Cranford staff are guaranteed confidentiality. The high level of distrust and fear of retribution that exists among Cranford staff make it imperative that they have the opportunity to speak out freely and candidly during any investigation. Without such guarantee of individual confidentiality, this process, without question, will fail to surface and resolve critical issues.
Whatever the Commissioner does, the DHB effectively has one shot to put this matter to rest in a manner that will win public support within our community.
Apart from who conducts the inquiry, what its brief is, and how the investigation is undertaken, the extent of public disclosure of findings and recommendations will be the final important element in restoring public confidence in Cranford.
Although individuals’ rights of privacy surely must be safeguarded, the situation calls for maximum disclosure of findings, not minimum or summary. Further, appropriate DHB leadership (i.e., the Board’s elected members) must be prepared to discuss publicly with their community the findings and any remedial actions to be taken.
The elected DHB Board members must “own” the outcome.