Auditor-General slams health system in damning report

UPDATED: Urgent action is needed to fix the state’s emergency departments — which are failing to work efficiently or effectively, the Auditor-General says.

TASMANIA’S public hospitals are failing to deliver effective emergency care because poor leadership and resistance to change is preventing longstanding problems from being fixed, the Auditor General says.

The observations came in a report examining the working of emergency departments in the state’s four major hospitals between 2009 and 2018.

DOCTORS WANT ACTION OVER HEALTH CRISIS

Auditor-General Rod Whitehead said urgent action was needed increased wait times and an increase in adverse events suffered by patients.

Auditor-General Rod Whitehead.

His report was scathing of the failures of health authorities in recent years, finding:

PATIENTS are waiting longer for treatment in emergency departments, with no major hospital meeting targets to treat 80 per cent of patients within four hours.

AMBULANCE ramping is up 149 per cent since 2012-13.

ADVERSE EVENTS increased 60 per cent between 2015 and 2018

THE ROYAL Hobart Hospital was “significantly bed blocked” 93 per cent of the time, “with patient safety severely and routinely compromised, on average, almost once every four days”.

THE RHH is at escalation level four 23 per cent of the time, indicating it was severely compromised in relation to delivery of safe patient care.

THE DEPARTMENT of Health and Tasmanian Health Service have failed to implement recommended and necessary reforms.

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“Department of Health monitoring reports show the Tasmanian Health Service has consistently failed to meet its service delivery targets relating to emergency department access and care over the last three years,” Mr Whitehead wrote in his report.

“The excessive wait time by admitted patients within EDs for an inpatient bed, after the ED phase of care has finished, is limiting timely access to emergency care for other patients and contributing to ED overcrowding.”

A new report has delivered a scathing assessment of the leadership within the state’s health system. Picture: MATHEW FARRELL

The Auditor-General found that, in part, changes to the structure of the health system made by the Liberal Government were to blame for the woes.

“Staff consistently referred to the absence of effective leadership both within hospitals, THS and the wider health system as the major impediments to tackling longstanding cultural barriers to change and the dysfunctional silo mentality,” he wrote

“There was a consensus among those we spoke to that the health system has been busily engaged for several years in implementing a range of related, but often disjointed and overlapping activities that have neither been pursued nor managed as part of a co-ordinated and integrated program of reform.”

He said the problems in the Tasmanian Health system were well-known but had not been addressed.

“Successive reviews by the Tasmanian and Australian governments over the last decade have highlighted dysfunctional silos, behaviours, process barriers and resistance to change from some clinicians and administrators within hospitals as major drivers of inefficiencies,” he said.

“These issues mainly lie outside of the EDs but are within the control of hospital leadership teams and have yet to be addressed.”

The report found that Tasmania’s decline in performance was worse than most other Australian states.

Mr Whitehead recommended urgent action including that: “THS and DoH urgently implement a culture improvement program and initiatives … to eliminate the longstanding dysfunctional silos, attitudes and behaviours within the health system preventing sustained improvements to hospital admission, bed management and discharge practices.”