Over 10 months, Commissioner Peter Garling SC and his team visited 61 public hospitals, reviewed over 1200 submissions, held 39 public hearings, and analysed over 30 000 documents.
The final report of the Special Commission of Inquiry into Acute Care Services in NSW Public Hospitals was published on 27 November 2008 – “the Garling Report” and makes 139 recommendations in 1200 pages and recommends that change should be driven by clinicians “from the bottom up”.
The current issue of MJA has an editorial on Garling report here.
The editorial by Martin B Van Der Weyden opens with the potential viewpoint of a Martian landing in NSW and assessing the health care situatiion:
“Public hospitals are severely stressed and sick. They are afflicted by bureaucratic inertia, and riven with mistrust, poor communication and bullying. To add to their woes, they are chronically under-resourced and understaffed. To the outsider, they appear to be a collection of islands, with health professionals on one island, and administrators, health boards and bureaucrats on others; all are surrounded by seas of silence. Their political masters are at a loss over what to do or where to turn and, in desperation, they resort to conducting inquiries when media reports of adverse hospital incidents become political millstones. In short, there is a pervasive sense of loss — loss of control, loss of direction, and loss of ownership by the hospitals’ serving health professionals, politicians, and the community they are meant to serve.”
Clare Skinner et al of the Hospital Reform Group published their comment and provide more details on the Garling Report in the MJA here.
“Significantly, oversight of the reform process will be independent of the NSW Department of Health.”
“Bullying is covered in some detail in the report, but with little recognition that it is rampant at higher levels. Intimidation and intolerance of dissent threaten morale wherever they occur.”
“The power of the hierarchical bureaucracy has generated widespread “gaming” of system performance measurement.”
“Major recommendations:
- Up-to-date information technology statewide by 2013
- A Bureau of Health Information to identify, develop and publish patient care measurements regarding access to treatment, clinical performance, safety and quality, cost, patient experience, staff experience, and sustainability
- A NSW Institute for Clinical Education and Training to oversee multidisciplinary postgraduate clinical education, to provide training in leadership and teaching, to evaluate performance of staff in training, and to build a hospitalist workforce
- A Clinical Innovation and Enhancement Agency to build on Greater Metropolitan Clinical Taskforce clinician networks to prepare evidence-based care guidelines, to recommend and implement changes to clinical practice “from the bottom up”, and to liaise with NSW Health and private sector change managers
- Appointment of an Executive Clinical Director in each area health service to advise area chief executives
- A single statewide health service called NSW Kids to organise health services for children and adolescents”
“Proposed changes to models of care
- Supervision of junior doctors linked to performance agreements
- Electronic medical records by 2010
- Pharmacist review of every patient
- Enforcement of infection-control protocols
- Multidisciplinary ward rounds and handover protocols
- Improved discharge practices
- Clinical support officers to free up clinicians, especially nurse unit managers, for patient care
- Redesign of rostering to ensure presence of senior clinicians, including allied health professionals, 16 hours per day, 7 days per week
- Centralised workforce planning
- “Just Culture” policy to overcome bullying and intimidation
- Patient-centred key performance indicators (KPIs)
- Redirection of non-urgent presentations from emergency departments
- I discussed this point in an earlier blog in which I point out that so-called non-urgent patients to ED are generally NOT suitable for redirection to GP clinics, and co-located GP clinics have their own issues
- Separation of emergency and planned surgical lists
- Digital diagnostic imaging with statewide centralised reporting
- Closure of selected hospitals and services to allow “critical mass” (ie, sufficient patients for clinicians to maintain and develop their skills)
- Collaborative partnerships between clinicians and administrators”
Also in the MJA is a paper by Graeme J Stewart and John M Dwyer entitled “Implementation of the Garling recommendations can offer real hope for rescuing the New South Wales public hospital system” which can be viewed here
Another related report:
Council of Australian Governments’ meeting (COAG), 29 November 2008
