Workplace culture contributing to Royal Hobart Hospital’s problems, former medical chief says

The Royal Hobart Hospital’s problems can be attributed to one thing, a former head of medicine at the facility believes.

Ambulances ramped outside the Royal Hobart Hospital emergency department. Picture: NIKKI DAVIS-JONES

THE Royal Hobart Hospital is being held back efficiently treating the most complex of patients by a culture marked by resistance to change, its former chief of acute medicine claims.

Dr Haydn Walters spent five years in the role from 2002 and believed many of the troubled hospital’s issues were more about process than capacity.

“It’s always about preserving the status quo for those that are comfortable within the current setting, although it’s obvious it’s very dysfunctional, and has been for years,” he said.

“In a nutshell, the problem that the Royal has is that it’s not prioritising its resources and personnel to focus on that core duty to treat the acutely ill effectively, efficiently, appropriately and discharge them as soon as possible.”

Dr Walters, also Tasmania’s former head of the Australian Medical Association, said treatment of acute patients coming through emergency had not been properly prioritised and that the workload needed to be better shared across departments. He said resources need to be allocated better to assist with the flow of patients and alleviate the problem of access block.

Professor Haydn Walters says the current struggles at the Royal Hobart Hospital are caused by the workplace culture. Picture: NIKKI DAVIS-JONES

Some of the hospital’s worst failings were laid bare this week during a coroner’s inquest into the July 2016 death of Mornington man Joseph Lattimer, who died following an attempt to take his own life while he was waiting for admission to the hospital for psychiatric treatment.

SHOCKING NUMBER OF PATIENTS STUCK IN EMERGENCY

RAMPING WOES LAID BARE AT INQUEST

The hospital’s emergency medicine director Emma Huckerby told the inquest more than 1800 patients admitted to the hospital last financial year spent more than 24 hours in the emergency department.

This was compared with just two patients at four large Melbourne hospitals combined.

Dr Huckerby acknowledged the cultural challenges, saying it was not as simple as telling people to change their culture, but that it needed a team of people dedicated to addressing it.

“It actually takes a lot of work to change a culture,” she said.

RHH emergency medicine director Dr Emma Huckerby. Picture: ZAK SIMMONDS

Dr Huckerby said one of the “classic” examples of cultural issues at the hospital was when a patient arrived and it was obvious they needed to be admitted, but their needs were complex, and people working in various teams within the hospital did not agree that their team was the right one to accept the patient because they felt uncomfortable taking responsibility for a patient who might need care for a number of conditions.

“We need to get to a culture whereby we all feel supported by each other and that other teams will come and help us,” she said.

“The patient usually ends up delayed in the emergency department. They still get the care that they need ... but moving them from the emergency department in to the next step is delayed.”

HEALTH SYSTEM OVERBURDENED WITH MENTAL HEALTH CASES

Dr Walters said numerous external reviews into the hospital had been commissioned, but said the problems were not solved.

“There was a lot of burying of heads in the sand and nothing happening to make the situation better,” he said.

AMA Tasmania president John Burgess said the Government needed to stop cutting the health budget and put more resources into a system failing to meet demand.

It was also revealed this week the state’s health system blew its budget by more than $100 million last year and missed every target it set for elective surgery.

Premier Will Hodgman told Parliament the state’s health system was not performing adequately and the Government accepted responsibility.

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