WIDESPREAD staff dissatisfaction, frustration and burn-out is occurring right across the health system due to "huge schisms" between management and clinicians, a senior Hunter physician says.
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Rather than punishing managers who do not stay within budgets, internal business models should be changed to reward activity and outcomes, a senior staff specialist anaesthetist based at John Hunter Hospital said.
Dr Ross Kerridge pulls no punches in his submission to the NSW Special Inquiry in Healthcare Funding.
Dr Kerridge began as an intern in 1980 and has been at the forefront of system-wide innovations including a perioperative system for managing elective surgical patients emulated internationally.
As he approaches the end of his career, he finds himself "confronted every day" by the gulfs between health staff and management, Dr Kerridge says.
"I am hopeful that recent changes at the senior level may encourage change, but there is a lot of repair work to do so," he said.
"Unfortunately, in the Hunter New England LHD, I believe we have had some 15 years of executive leadership that was antagonistic to, and disengaged, from clinicians," the submission says.
While that was not unique to the Hunter, it was "perhaps more noticeable" because the region was once seen as the state's leading health service.
Since then, however, a "pervasive culture of division, antagonism and non-cooperation" has developed.
Key issues contributing to inefficiencies included a "relentless emphasis" on financial outcomes, and staying within budget, rather than improving productivity.
"Managers have lived in an atmosphere of fear and bullying, and respond with dysfunctional parsimony, unwilling to do or change anything that may result in a budget overrun, even if it will clearly improve efficiency and effectiveness of patient care," Dr Kerridge says.
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A common example could be seen in operating theatres where there was a culture of working steadily but slowly, to stay within staffing levels and within budget.
"They receive no extra funding (and thus have no incentive) to increase productivity," his submission says. "Ultimately, this results in semi-urgent patients, admitted to hospital through emergency, having to wait unnecessarily.
"They may wait in hospital for two to three days, rather than having their surgery completed so that they can be discharged from hospital. It is a bizarre paradox:- a unit within the hospital will institute policies to save money on their own budget even though the global increased cost to the hospital greatly outweighs the 'saving' that the unit may have made."
It is a bizarre paradox:- a unit within the hospital will institute policies to save money on their own budget even though the global increased cost to the hospital greatly outweighs the 'saving' that the unit may have made
- Dr Ross Kerridge
A Hunter New England Health spokesperson said the health service was committed to delivering high-quality and accessible patient-centred care "in a way that delivers value for money".
"We're pleased to participate in the Special Commission of Inquiry into Healthcare Funding."
In its own submission, the health service highlighed workforce shortage issues and the related high-cost of hiring agency staff and locum as key concerns.
About 200 submissions have been made to the inquiry which was a key election commitment of the NSW Labor Government, and established by Health Minister Ryan Park on August 24.
Submissions closed on October 31 and were made public online on Monday.
Mr Richard Beasley SC is Commissioner of the Inquiry and will deliver a final report to the Governor by the end of August, 2024. Hearings are scheduled to begin in Sydney on Monday (November 27).
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Gabriel Fowler
Community health & welfare, social justice, investigations, general news. Gabriel.Fowler@newcastleherald.com.au
Community health & welfare, social justice, investigations, general news. Gabriel.Fowler@newcastleherald.com.au
