The Royal North Shore Hospital

Joint Select Committee on the Royal North Shore Hospital The Royal North Shore Hospital Ordered to be printed 20 December 2007 according to Standing order 231 Report - December 2007 PARLIAMENT OF NEW SOUTH WALES The Royal North Shore Hospital New South Wales Parliamentary Library cataloguing-in-publication data: New South Wales. Parliament. Joint Select Committee on the Royal North Shore Hospital. Report on inquiry into the Royal North Shore Hospital / Joint Select Committee on the Royal North Shore Hospital. [Sydney, N.S.W.] : the Committee, 2007. – 250 p. ; 30 cm. (Report ; no. 1). Chair: Rev. the Hon. Fred Nile, MLC. ‘December 2007’. ISBN 9781921286193 1. Royal North Shore Hospital of Sydney. I. Title II. Nile, Fred. III. Series: New South Wales. Parliament. Joint Select Committee on the Royal North shore Hospital ; no. ? 362.11 (DDC22) ii Report - December 2007 JOINT SELECT COMMITTEE ON THE ROYAL NORTH SHORE HOSPITAL How to contact the committee Members of the Joint Select Committee on the Royal North Shore Hospital can be contacted through the Committee Secretariat. Written correspondence and enquiries should be directed to: The Director Joint Select Committee on the Royal North Shore Hospital Legislative Council Parliament House, Macquarie Street Sydney New South Wales 2000 Internet www.parliament.nsw.gov.au/royalnorthshorehospital Email [email protected] Telephone (02) 9230 2412 Facsimile (02) 9230 2981 Report - December 2007 iii PARLIAMENT OF NEW SOUTH WALES The Royal North Shore Hospital Terms of Reference 1. That a joint select committee be appointed to inquire into and report on the quality of care for patients at the Royal North Shore Hospital, and in particular: (a) clinical management systems at the hospital, (b) the clinical staffing and organisation structures at the hospital, (c) the efficiency, effectiveness and appropriateness of resource allocation and utilisation within the hospital, and in particular the operation of the Emergency Department, (d) the effectiveness of complaints handling and incident management at the hospital, and (e) operational management of Royal North Shore Hospital in general but in particular, the interaction between area and hospital management as it relates to hospital efficiency, effectiveness and quality of care. 2. That the committee consider any strategies or measures in place or proposed for improving quality of care for patients at the hospital which may also benefit New South Wales’ public hospitals. 3. That any individual patient complaints identified in the course of the inquiry be referred by the committee to the Health Care Complaints Commission. 4. That notwithstanding anything contained in the standing orders of either House, the committee consist of eight members, as follows: (a) three members of the Legislative Council, of whom: (i) one must be a government member, (ii) one must be an opposition member, and (iii) Revd Mr Nile, (b) five members of the Legislative Assembly, of whom: (i) three must be government members, (ii) one must be an opposition member, and (iii) one must be a cross bench member. 5. That the members be nominated in writing to the Clerk of the Parliaments and the Clerk of the Legislative Assembly by the relevant party leaders and the cross bench members respectively within seven days of this resolution being agreed to by both Houses. 6. That Revd Mr Nile be Chair of the committee, and that the committee elect a Deputy Chair at its first meeting. 7. That, notwithstanding anything in the standing orders of either House, at any meeting of the committee, any four members of the committee will constitute a quorum, provided that the committee meets as a joint committee at all times. 8. A member of either House who is not a member of the committee may take part in the public proceedings of the committee and question witnesses but may not vote, move any motion or be counted for the purpose of any quorum or division. 9. That leave be given to members of either House to appear before and give evidence to the committee. 10. That the Committee report by Thursday 20 December 2007. iv Report - December 2007 JOINT SELECT COMMITTEE ON THE ROYAL NORTH SHORE HOSPITAL Committee Membership Revd Hon Fred Nile MLC Christian Democratic Party Chair Mr Peter Draper MP Independent Deputy Chair Hon Amanda Fazio MLC Australian Labor Party Hon Jenny Gardiner MLC The Nationals Mr Michael Daley MP Australian Labor Party Dr Andrew McDonald MP Australian Labor Party Mrs Jillian Skinner MP Liberal Party Hon Carmel Tebbutt MP Australian Labor Party Report - December 2007 v PARLIAMENT OF NEW SOUTH WALES The Royal North Shore Hospital Table of Contents Chair’s Foreword xi Summary of Recommendations xiii Glossary xviii Abbreviations xix Chapter 1 Introduction 1 Establishment of the Committee and the inquiry 1 Conduct of the inquiry 1 Background to the inquiry 2 Summary of issues 3 Report structure 4 Chapter 2 Background 6 The New South Wales health system 6 The geography of NSCCAHS 6 The Royal North Shore Hospital 9 Chapter 3 Patient experiences 10 Adverse patient experiences at RNSH 10 Ms Jana Horska, former patient 10 Mrs Jenny Langmaid, former patient 11 Ms Wei Deng (Wendy) Gao, former patient 12 Ms Vanessa Anderson, former patient 13 Mrs Therese Mackay, relative of a former patient 14 Mrs Christine Rijks, relative of a former patient 15 Ms Lindy Batterham, relative of a former patient 16 Mr Steve Crosby, relative of a former patient 17 Mrs Sharon Hooper, relative of a former patient 18 Positive patient experiences at RNSH 19 The physical environment 20 Cleanliness 20 Inappropriate accommodation 22 vi Report - December 2007 JOINT SELECT COMMITTEE ON THE ROYAL NORTH SHORE HOSPITAL Chapter 4 Operation of the Emergency Department 25 The Royal North Shore Hospital Emergency Department 25 Structure of the Emergency Department 26 Activity, staffing and performance 27 Attendance and utilisation 27 Staffing in the Royal North Shore Hospital Emergency Department 28 Performance of the Emergency Department 33 Access and exit block 36 How many beds are there in Royal North Shore Hospital? 37 Causes of access block 38 Overcoming access and exit block 41 The Australian Triage System 46 Chapter 5 Developing a positive workplace culture 53 A culture of bullying and harassment at RNSH 53 What is bullying and harassment? 53 The Dalton/Meppem Report 53 Why has a culture of bullying developed at RNSH? 55 Stress caused by inadequate resources and unreachable goals 56 Management structure and practices 57 The management of staff grievances 57 Involvement of the NSW Nurses’ Association 59 Overcoming a culture of bullying at RNSH 60 Recommendations from the Dalton/Meppem Report 61 Response from NSCCAHS and NSW Health 62 Chapter 6 The organisational structure 64 Organisational structure of the Area and the Royal North Shore Hospital 64 The decision to form the amalgamated Area in 2005 66 The merger of Royal North Shore Hospital with Ryde Hospital 67 The senior management structure 69 The size of NSCCAHS 70 The lack of authority of the General Manager 71 The high turnover of senior managers at NSCCAHS and RNSH 71 The role of the Northern Sydney Central Coast Area Health Advisory Committee 73 A hospital board? 73 Report - December 2007 vii PARLIAMENT OF NEW SOUTH WALES The Royal North Shore Hospital Chapter 7 The clinical services plan 76 The need for an Area-wide clinical services plan 76 The need for a clinical services plan for North Shore Ryde Health Service 79 Managing patient flows 79 The difficulty of scheduling surgery at RNSH 80 The report of Professors Hughes and Walters 81 The Clinical Services Redesign Program at RNSH 82 Chapter 8 Management issues 85 The decline in governance standards at RNSH 85 The perceived disconnect between clinical staff and management 87 The new Clinical Reference Group 90 The operation of the Medical Staff Council 91 Planning for the new RNSH 92 The workload of clinical directors 95 The perceived disconnect between nursing staff and management 97 Chapter 9 Workforce issues 100 The New South Wales health workforce 100 The RNSH medical workforce 101 The RNSH nursing workforce 101 Nurse workloads 102 Nurse recruitment 104 The Royal North Shore Hospital Nurse Taskforce 104 Ancillary and administrative staff at RNSH 106 Chapter 10 Financial management and resource allocation 108 Resource allocation – the New South Wales Health budget 108 Distribution of the NSW Health budget to Areas 108 The Resource Distribution Formula 109 Funding of Royal North Shore Hospital under the Resource Distribution Formula 109 NSCCAHS budgeting and financial performance 113 Net Cost of Services 113 The Royal North Shore Hospital budget 115 viii Report - December 2007 JOINT SELECT COMMITTEE ON THE ROYAL NORTH SHORE HOSPITAL Financial management at Royal North Shore Hospital 116 Efficiency of Royal North Shore Hospital 117 Internal reporting and analysis of financial performance 122 Budgetary control and autonomy 124 Capital funding at Royal North Shore Hospital 126 Information Management and Technology services 131 General information technology investment 131 Future investment in Information Technology at Royal North Shore Hospital and across the Area Health Service 133 The use of special purpose and trust funds 136 Chapter 11 Incident and complaint management 139 The quality in healthcare movement 139 Incident management in the NSCCAHS 140 NSW Patient Safety and Clinical Quality Program (2004) 140 Incident Information Management System (IIMS) 141 Training in

Load more