Health Management and Clinical Malpractice

Hospital Management’s Response to Clinical Mal-Practices

Clinical risk management strategies have been adopted over the recent years by healthcare institutions as a basic framework for dealing with clinical mal-practices (Scott, 2009). These strategies entail a wide range of activities that include coordinating clinical training, accreditation of health workers, provision of optimal quality patient care, database maintenance and provision of an efficient complaint system. Scott (2007) argues that health professionals must be cognizant of the health-related legal requirements that affect their practices as well as their clients’ civil rights. A case study of Bundaberg Hospital presented below discuss the hospital management’s responses to incidents of clinical mal-practices, reasons for the occurrence of the incidences and the possible strategies that may prevent these incidences. 

Bundaberg Hospital lacked a comprehensive formal system through which the workers and patients would file complaints or report incidents of clinical malpractices. The Australian health laws through the Health Care Complaints Commission (HCCC) have stipulated policies for identifying critical incidents in the public health system such as coronial inquest. The policy requires hospital management to thoroughly investigate all complaints raised by any party. However, Bundaberg Hospital management according to Davis (2005) and Dunbar et al., (2011), have little tolerance to complaints unless the incidents have their interest. The unavailability of consumer feedback mechanism in the hospital limits its ability to improve their services. This is because the hospital is not in a position to keep track on the number and nature of the complaints raised by patients and workers. In this case, the management fails in its role of protecting the interests of all the parties involved (DDHHS, 2014; Hagan & Persaus, 2009). 

Davis (2005) noted that Bundaberg Hospital management’s response to health safety-related issues had always been labeled a personality interest conflict. In this case, the management had been able to oversee many complaints raised on the bases of insufficient evidence or claims that they had not received evidence. A complaint raised by Ms. Hoffman regarding Dr. Patel’s performance according to Davis (2005) and Dunbar et al., (2011), had apparently been dismissed by the hospital’s management under the argument that it was a personal conflict rather than actual performance case. Instead of appointing another health professional to look into the complaint raised, the hospital management through Dr. Keating stated that Dr. Patel was a good performer and the complaints were as a result of other workers not getting along with him. The hospital management neglects its role of investigating any complaints raised and thus promotes breach of standards which can only be identified through complaints raised by people who have been directly affected by the breach (HCCC) (Hagan & Persaud, 2009). 

In 2004, the Australian Council for Safety and Quality in Health Care commissioned a comprehensive standard description structure to ensure clinicians’ credentials are verified, and appropriate scope of clinical practice is defined and implemented (Kerridge, Lowe & Stewart, 2013). Bundaberg Hospital management, however, had failed to get Dr. Patel credentials and privileged. Under this circumstance, Dr. Patel’s competence, conduct, and performance were questionable (Davis, 2005; Dunbar et al., 2011). The hospital management’s response to this issue confirmed the final report of the taskforce on quality in Australian Health Care of 1996, which reported a gap in credentialing and scope of clinical practice process in Australia. According to Davis (2005) and Dunbar et al. (2011), the hospital management indicated that the Medical Council had not provided the personnel to enquire staff credentials. 

An important mechanism through which health institutions can manage clinical risks and provide improved health services is through maintenance of an effective and efficient database. According to Kerridge et al. (2013), a clinical audit is an important element of clinical governance which is made possible through the provision of a comprehensive record system (database). This will make it possible for the hospital management to track performance and identify mal-practices in the health care provision process. In Bundaberg Hospital surgical department, the Otego database was not in use, and no efforts had been made to replace it with a more suitable one. Davis (2005) revealed that Dr. Patel, whose performance is in question, was the director of surgery. As part of the hospital management, Dr. Patel had failed or ignored the relevance and importance of the presence of a functional database and had thus encouraged mal-practices in the hospital.  

Davis (2005) and Dunbar et al. (2011) record a situation where Bundaberg Hospital management gave a positive response following the second death from an oesphagostomy. In this case, the hospital management took some responsibility although Davis (2005) argues that the move was too late since the patient had already passed away. The hospital management could have adopted this move earlier by investigating all the complaints raised about Dr. Patel by his co-workers.   

Failings that Enabled Events of Mal-Practices to Occur

Personal Level

Bundaberg Hospital management had always pointed personality conflict among workers as the main issue surrounding provision of safe health care (Davis, 2005). In fact, MS. Hoffman had admitted that they experienced personality crash with Dr. Patel. However, her effort to solve this were futile since it was problematic to talk to Dr. Patel. Aggressive character of Dr. Patel towards his colleagues, patients, and relatives can be attributed to the occurrence of these events.

Failure to raise critical issues affecting the surgical department by Dr. Patel to the management was yet another reason for the incidents that occurred in the hospital. As the Director of Surgery, Dr. Patel was charged with the role of advising the management on the procedural measures that could prevent the occurrence of mal-practices, a role he neglected (Davis, 2005; Dunbar et al., 2011). 

Low morale of workers provided the hospital’s working environment hindered provision of quality services. According to Davis (2005); Dunbar et al. (2011) and Habiba (2014), hospital workers had the feeling that their concerns were not being given attention by the management. Their attempts to consult the nurses’ union had also not been welcomed by the hospital management. 

Organizational Level

Bundaberg Hospital management had failed to provide a mechanism for identifying incidents of mal-practices. The hospital lacked an incident reporting and complaint system, a functional database system, and means of acquiring staff credentials as well as a forum for regular supervision of its workers (Davis, 2005; Dunbar et al., 2011). The management ignored the requirements of the Australian Health Care Policy regarding clinical accountability that required the hospital to appoint another health specialist to look into complaints raised by any department. The management regularly dismissed complaints citing personal conflicts as an excuse. Davis (2005) and Dunbar et al. (2011) identified another failure in the supervisory role that enables the events of malpractices to occur. They argue that the management relied heavily on individual feedback about performance but never carried regular checks to determine the suitability of the equipment and staff in the hospital.

The management had also failed to separate roles which would result in a conflict of interest. For example, Dr. Patel headed the surgical department which he was a player, thus making it difficult to monitor and participate at the same time. According to Davis (2005), Ms. Hoffman was concerned about the hospital’s ICU capacity to handle complex cases and the extended stays. These concerns attracted no attention since Dr. Patel was in charge and surgeries continued demonstrating a conflict of interest.

Bundaberg Hospital management was not pro-active and could only take action after a long probe by the interested parties. According to Dunbar et al. (2011), the hospital management only took responsibility for two patients who had undergone surgery passed away. Another circumstance that supports this claim is when the hospital take action after Ms. Hoffman, the patient’s advocate, made an inquiry using the documentation she had made from the complaints raised at the hospital.

Systemic Level

The Australian health care system experienced shortcomings that surrounded quality improvement system and accreditation process that are essential components in improving quality services. According to the Final Report of the Taskforce on Quality in Australian Health Care of 1996 (Queensland Government, 2005), a gap existed in the credentialing health workers and determining the scope of clinical processes in health facilities. This scenario is evident in Bundaberg Hospital when the management responds to an inquiry stating that the Medical Council had not provided the relevant personnel to carry out the task.

The performance Australian health practitioner regulation agencies, such as the Queensland Nurses Union can also be pointed out as a systemic failure in the prevention of clinical mal-practices. Davis (2005) and Dunbar et al. (2011) reveals that nurses in Bundaberg Hospital had initiated consultations with their union, but reports no action initiated by the union to address these concerns. The hospital management had in fact discouraged this, to the level of labeling Ms. Hoffman the ‘whistleblower’ since she had initiated discussions about the quality of the health services offered in the hospital with a member of the parliament.

Recommendations to Minimize the Risk of these or Similar Incidents Re-Occurring

Development of a comprehensive clinical governance framework that cut across structure organization to service provision is necessary for addressing the clinical risks affecting the health sector in Australia.  Bundaberg Hospital, for instance, should develop an elaborate complaint handling system that would enable the hospital trace mal-practices and take the necessary actions to prevent re-occurrence of the same. The hospital should set aside a team of staff to specialize in receiving, investigating complaints and taking actions against practitioners involved in the malpractices.

The Bundaberg Hospital management can also minimize the risk of these or similar incidents re-occurring by complying with the recommendation developed by the Queensland Government (2005). For instance, the hospital should maintain an electronic personnel files with the Human Resource Department, a move that will enable the management to monitor and document performance of the clinical staff. A clinical governance framework should also be established in the hospital to efficiently monitor the liability for clinical conduct and accountable monitoring for compliance. 

Checking of the relevant accreditations for the health practitioners should be made a compulsory role that all health facilities should adopt before allowing any practitioner to provide services to patients. The regulatory body charged with this responsibility, in this case, the Medical Council, should develop an elaborate mechanism to identify practitioners who attempt to perform without accreditation. The Queensland Health System Staff Management System should be reviewed to define extreme penalties to practitioners who operate without accreditations as a way of ensuring quality services to the public.

A responsive and efficient organizational structure in the supervisory role that eliminates the conflict of interest should be established in Bundaberg Hospital. Departmental heads, in this case, should not be the day-to-day active members of their respective department to avoid irrational decisions that favor their behavior. For instance, Dr. Patel is a key surgeon should not have been the director of the department, given that the decisions he ought to have been making would directly affect him (Davis, 2005; Dunbar et al., 2011).

The practitioner regulation agency in the country should be strengthened to make it possible to adequately perform its tasks. The agency should be in a position to provide registers of accredited health practitioners with the relevant information regarding qualification, registration, and scope of work to the public (Kerridge et al., 2013). The agency should also run regional and sub-regional offices throughout the country through which the public can file health-related complaints. A body of health professionals not directly involved in the operations of the hospital to which a compliant has been raised should be appointed to handle the issue. This would be important in eliminating bias while carrying out investigations on the complaints made. The agency should spell out the course of actions to be taken against the health worker involved in malpractice.

A patient-centered care system should be established through collaborating with the health professionals, patients and the community in the process of making clinical decisions (Queensland Parliament, 2005). This would lead to the development of a clinical services capability framework that provides clear outline of the support services needed such as staffing and safety requirements for all health settings. The implications of these would be prior intervention to mal-practices by the health practitioners defined by the hospitals’ scope of practice.  

Conclusion

Due to the absence of a system for checking the relevant accreditations and insufficient management of complaints by Bundaberg Hospital management, Dr. Patel’s negligence had prevailed in the hospital, and two incidents of deaths were attributed to this. A vibrant, well established clinical governance framework is thus needed to provide direction and avoid some of the events that occurred in the hospital (Davis, 2005; Dunbar et al, 2011). A thorough review of the health systems, workers, management and the regulatory agency roles have been carried out to improve the quality of the health services provided, improve patient safety as well as the organizational culture of the health facilities in the country. 

References

Davies, J. (2005), The Abominable Dr. Patel, The bulletin published on the 

08/06/2005 

Dunbar, J., Reddy, P., and May, S. (2011). Deadly Healthcare. Australian Academic Press, Bowen Hills 

Hagan, J. and Persaud, D. (2009). Creating a Culture of Accountability in Health Care. The Health Care Manager, 2(28), 124-133

Kerridge, I., Lowe, M. and Stewart, C. (2013).  Professionalism. Ethics and Law for the Health Professions, 4(7), 112-130

Scott, R. (2009). Liability Risk Management Strategies for Clinical Instructors and Affiliated Sites. Legal and Ethical Issues in Education, 3(4), 181-196

Scott, R. (2007). Legal Considerations in Health Care. Geriatric Rehabilitation Manual,2(1), 12-22

Queensland Government, 2005: Public Sector Ethics Act 1994 retrieved from  http://www.legislation.qld.gov.au/LEGISLTN/CURRENT/P/PublicSecEthA94.pdf 

Queensland Parliament. (2005). Weekly Hansard In Legislative Assembly (Ed.). Brisbane: Queensland Parliament.