RADICAL changes to the way Jersey’s Hospital is run will tackle a ‘highly problematic culture, which is exposing patients to unquantified risk and staff to poor behaviour… and bullying’, the Health Minister has promised.
Deputy Karen Wilson announced a ‘root and branch’ plan to improve patient experiences, shorten waiting lists and create a more accountable and transparent service ‘striving for the best international standards of healthcare’.
The minister unveiled her action plan yesterday in response to a highly critical report published in August into the clinical governance of the Health and Community Services Department.
The report was written by independent consultant Professor Hugo Mascie-Taylor, who made 61 recommendations, all of which have been accepted by the minister.
After conducting 77 anonymous interviews with 53 people during seven visits to Jersey, Professor Mascie-Taylor concluded that the health department lacked openness, transparency, internal and external accountability and the systematic approaches necessary to ensure the safety and quality seen in other modern healthcare systems across the world.
He blamed ‘ingrained attitudes and behaviours of many years’ and warned that ‘change would be vigorously resisted’ by some who preferred the ‘current non-accountable and individualistic culture’.
He added that some groups of staff would reject any changes ‘noisily and angrily’ because they believed effective governance amounted to an ‘unnecessary, interfering and bureaucratic’ approach ‘not required in Jersey’, and said that the culture was ‘highly problematic and exposing patients to unquantified risk and staff to poor behaviour’.
He also said that several interviewees had described clinical situations in which ‘bullying, dismissive behaviours had occurred’.
Deputy Wilson has committed to creating a new independent health board, clearer workplace systems and the rigorous use of data to inform decision-making and policy as part of a plan to raise standards of care to ‘a service excellence standard’.
‘We can’t be assured the quality and standards of care are where we want them to be at the Hospital, due to a lack of standardisation,’ she said. ‘I want to be able to give an open and transparent account of what is going on at the moment and bring it up to the standards of care in most other European countries.’
She added that there would be ‘zero tolerance of bullying’ and that a new post – ‘Freedom to Speak Up Guardian’ – would be created to act as a ‘safe space’ for staff and patients to report any concerns to someone who would listen and then take action.
In response to a JEP question about bullying identified in the Hospital by Professor Mascie-Taylor, Deputy Wilson said: ‘Most people come to work to do a really good job, not to experience bullying behaviour leading to fear about speaking up. In a culture of bullying and harassment they’ll be afraid of raising concerns and this has the potential to impact on patients’ safety, when patient safety is paramount.’
She added that ‘separating oversight and delivery of services’ was essential because ‘we know current arrangements don’t work’.
‘All of us now have to step up and make it happen. Robust systems and building up teamwork and trust will improve working practices in the hospital and make it a great place to work, harnessing all the skills and talents of all the workforce.’
She said that patient feedback would be gathered both onsite and after treatment to ensure there was a complete picture of the service received.
Some of the key recommendations from Professor Mascie-Taylor included:
– Clinical outcomes must be measured, recorded and made public
– Staff should be accountable for the advice they give and for their own behaviour
– Staff should recognise that reporting incidents is their professional duty
– People who report incidents must be protected from any form of intimidation
– All relevant national and professional guidelines should be followed, managing both private and public patients using identical policies, pathways and procedures
– Poor and unprofessional behaviour must not be tolerated; it should be challenged and reported as a duty of care to all employees
– An open and transparent culture must be promoted by comparing clinical outcomes with external organisations to create a benchmark to measure performance.