Nurses and doctors deliver their new Royal Adelaide Hospital diagnoses

IT’S only six months old but the new Royal Adelaide Hospital has had no shortage of ups and downs. Now the groups representing those at the cutting edge have given us their verdicts so far.

• Interactive: Explore the Royal Adelaide Hospital
• RAH check up: The hoorahs and faux pas

THE Australian Nursing and Midwifery Federation have ongoing concerns with the RAH, ranging from cleaning to safety of staff.

SA branch secretary Adj Associate Professor Elizabeth Dabars said members are continuing to settle in to the new site.

“There are still a number of unresolved issues at the hospital which are largely as a result of the public/private partnership entered into for the new hospital delivering inadequate support services,” she said.

“The support arrangements that have been contracted to private providers continue to present problems in operating the new hospital.

“These range from simple tasks that have become more difficult such as having beds cleaned after discharge of patients through to resolving issues with the physical environment particularly in the mental health unit.

“The emergency department is often overcrowded and has been inadequate to meet demand on a regular basis

“The emergency department is often overcrowded and has been inadequate to meet demand on a regular basis. This is not unique to the nRAH with most metropolitan emergency departments experiencing similar pressures.

“The most significant issues at present are being experience in the mental health unit with the duress system still not fully operational. The area is difficult to properly staff and supervise patients and is presently supported by a large number of security staff. The system issues need resolution and more sustainable answers must be found.

“The high volume of activity, both elective and emergency is placing significant pressure on nursing and other staff with areas opened that were not intended to be operational for several months and reliant on casual/agency or temporary staff for their daily functioning.

“Despite these additional beds being made available there still is almost daily pressure on bed capacity to meet demand. Once again this experience is replicated in most metropolitan hospitals on a regular basis.”

Doctors’ union view of new RAH

SA Salaried Medical Officers Association released a statement saying: “The old saying “You get what you pay for” should mean the Royal Adelaide Hospital is the Rolls Royce of hospitals, but after six months doctors are yet to be convinced that there is “bang for buck”.

“Six months after the opening of the Royal Adelaide Hospital there is notably still substantial work to be done to gain confidence from clinicians this is a good hospital, after all, at the end of the day what clinicians want is a robust hospital to treat the patients in their community quickly and efficiently.

“All the bells and whistles that come with the new hospital are wasted if clinicians are unable to provide good and timely care to their patients. If the doctors can’t achieve this goal the

criticism will continue of the new hospital will continue, if not grow.

“The good in this hospital, as in any hospital, is the good people who work there every day, are the heart; the doctors, nurses, allied health, paramedics and administration provide good care for their patients, but this hasn’t changed from the old hospital.

“What has always made the Royal Adelaide Hospital great are its people. They are smart, loyal and committed to helping the patients who come to the Royal Adelaide Hospital and to ensuring the patients receive the most up to date, timely and safest care they can provide.

All the bells and whistles that come with the new hospital are wasted if clinicians are unable to provide good and timely care to their patients.

“What is new, is the disappointment and anger in the product that promised so much, still hasn’t delivered.

“The greatest worry is that these good people are becoming disappointed and disheartened with the large number of minor and major issues needed to be fixed in the new hospital.

“Lockers don’t work, keys for doors can’t be found that is, if you are lucky enough to have doors.

“There is no room for additional desks, there is no space (hard to believe really when you walk through the grand entrance) for junior doctors to do their paper work, not all the services are yet at the RAH, the Emergency Department is still overflowing, mental health patients are still waiting a long time for a bed, duress systems in some areas are still not working, EPAS requires work rounds and ramping continues.

“There is a big list of problems and where to start, without the backing of the Department and

Government, seem to an onlooker, insurmountable. What the bureaucracy has at the hospital, is the dedication of the clinicians to their patients and a strong willingness to fix the problems. “They should consider tapping into this resource and opening the purse just a little, to finish the job.”

AMA boss on the new RAH

Australian Medical Association state president Associate Professor William Tam said South Australians would like to be excited and proud of the new facility.

“Many aspects of the old RAH were showing their age, so having a shiny new building to look after patients in certainly has its attractions,” he said.

“Many elements have been designed with patient comfort in mind, and that is good news too. Things like single patient rooms, and the use of space and light are intended to make hospital a much more pleasant place to be. That’s good for patients and good for doctors too — no-one enjoys being in a dark rabbit warren. It certainly helps to have big open spaces with lovely courtyards and contemporary artwork.

“What doctors are probably most interested in though are the practical aspects around providing the best possible care to patients. Sadly, the new RAH has some structural and capacity issues in terms of what fits where, as well as various teething issues.

“I think we can all understand that nothing new of any complexity comes out of the gate perfect. But I think that everyone will now be ready to admit that there were some real planning failures in the RAH’s design, many due to a lack of genuine consultation with clinicians, who will now have to work around these deficiencies.

The dream is for everything to really be an improvement on what you had. After all, you’re starting from scratch.

“From the AMA (SA)’s point of view, outpatient services and clinical research space are two of the most notable, and they are two issues we have been raising for quite some time — years, in fact. We have also been concerned about the question of the Chest Clinic, and the overall transition of services from old to new — what would go where.

“A new hospital presents new opportunities. The dream is for everything to really be an improvement on what you had. After all, you’re starting from scratch. But a major project such as a new hospital is a huge undertaking with many complex, interrelated parts.

“Getting it right is a massive challenge and requires a very sound process of looking at what you have, and why it is that way, and what you will need. What works on paper might not work as well in real life. A really rigorous process, with proper listening, is vital. And somewhere in the process that went wrong on a few fronts.

“A hospital is about much more than the physical structure though, no matter how striking. It is about the people and services. And whatever issues there are, the new RAH will be doing its best for the people of South Australia, because the people working there will be doing their best.

“Where there are problems, they will be working on solutions. They will be advocating for their patients. They will be getting the job done. Because at the end of the day, when the alarms don’t work, the IT is clunky, or the lights go out, we don’t stop doing our jobs, we keep going.

“What I would say is that the management and the Government of the day need to do their jobs too, which is to listen to the feedback, understand the issues, and act to resolve those outstanding issues quickly and properly. Let’s have a new hospital set up that allows doctors and nurses to get on with caring for their patients without the distraction of these outstanding issues. Let’s get them fixed.”