Healthy start but not a cure-all

Management changes welcome but major work needed, explains Emily Shepherd

IWELCOME the announcement by Health Minister Michael Ferguson that he intends to improve governance in the Tasmanian Health Service by returning key decision-making to the local level.

Members of the Australian Nursing and Midwifery Federation have long held concerns about the direction of the THS. The minister’s announcement is an acknowledgment of these concerns and we are hopeful it is the first step in addressing numerous systemic issues in the health system.

It comes after calls from the ANMF for the minister to release the findings of the Deloitte review.

With escalating concerns regarding effective decisionmaking within the THS, the Deloitte review that interviewed senior staff in the health service was seen by the ANMF as an opportunity to have these concerns highlighted and addressed in a transparent way.

While not being in receipt of the Deloitte summary, the ANMF was not surprised by the reported findings, which highlighted ineffective leadership. This is having a flow-on effect to all levels of management and, of course, impacting on nursing and midwifery staff.

The ANMF looks forward to reviewing the entire Deloitte summary, but one example of the poor processes and poor decision-making is highlighted by the now abandoned Royal Hobart Hospital Mental Health Observation Unit proposal.

This proposal completely ignored the views of nurses and midwives, who consistently warned the unit would not work for a number of reasons. The refusal to take their voices seriously compounded the lack of confidence of nurses and midwives in the THS executive.

Return of strengthened local leadership which better enables decision-making is a positive step in ensuring that nurses and midwives’ views are listened to and valued.

While the planned governance changes will not take effect until July, the ANMF has welcomed the commitment to consult widely with nursing and midwifery staff to ensure the altered governance structure is a positive change that will offer better support and leadership to the THS. Having local leadership authorised to make decisions based on feedback from health professionals (including nurses and midwives), local management and in response to service demand is a positive improvement. Unfortunately, under the current structure decisions are being made by senior executives, which have not always clearly reflected the needs of staff or patients.

This significant acknowledgment by Mr Ferguson is hopefully the first positive step in addressing a series of poor changemanagement processes since the transition to the THS.

The ANMF is eager to see significant change within the executive structure, which also incorporates feedback from members and patient needs. The ANMF is hopeful this will be developed in conjunction with a strategic plan based on staff feedback, patient needs and, importantly, evidence.

Nurses and midwives in the THS are working in an environment of constant change with an everincreasing demand for inpatient beds and health services. This is also occurring at a time when staffing recruitment of nurses and midwives is challenging and double shifts and overtime are continuing to increase. The lack of clear leadership and effective communication strategies has destroyed the confidence of nurses and midwives.

It is essential the change to the executive structure is not seen as the solution to all the challenges of the THS. While effective executive leadership is fundamental to an effective health service, it is essentially providing the foundation to addressing the systemic concerns.

The minister says the new governance structure will

Extra inpatient beds are desperately needed ... Perhaps the system is so broken the new executives are overwhelmed

generate cost efficiencies and the ANMF is hopeful these funds will begin a process of reinvesting resources into the health system. Capacity for extra inpatient beds is desperately needed across the state and importantly at the RHH, where patients continue to wait for excessive periods in the emergency department due to a loss of inpatient beds during the hospital rebuild.

While the executive restructure is welcomed in conjunction with consultation, it is just the beginning.

However, the ANMF also has concerns that ongoing changes in structure are not helpful.

Perhaps the Tasmanian health system is so broken that the new executives are overwhelmed.

Without appropriate resourcing, another executive team may not fare any better. Kneejerk reactions to care events are not helpful.

Regardless of what happens from here on, the ANMF is hopeful this is the beginning of a new consolidated, locally responsive and responsible structure directed by a strategic plan that supports solutions to urgently increase inpatient capacity as well as enabling nursing and midwifery staff to support quality patient care.