Te Whatu Ora chair Rob Campbell is speaking out about his ‘concern for each and every one’ of those suffering bad health care
Health professionals, managers, directors and politicians must all share personal responsibility for improving health services, says the head of New Zealand’s big new health agency.
Rob Campbell is speaking out to Newsroom, in response to mistakes in the country’s hospitals. It comes after the death of a “healthy” 50-year-old woman who had suffered a brain bleed. She died after leaving Middlemore Hospital’s emergency department because staff told her there would be an eight hour wait.
“Lip service apology is nothing alongside empathy for all involved fuelling determination to do better. We all bear responsibility, not some object called a system.”
– Rob Campbell, Te Whatu Ora
Counties Manukau Health says the hospital was under extreme pressure and patient presentations had been abnormally high for this time of year. An independent report this week found Middlemore’s emergency department was “unsafe, dysfunctional and overcrowded”.
Health Minister Andrew Little acknowledged the health system was under “extraordinary pressure”, but told RNZ that Te Whatu Ora would be engaging with the healthcare workforce to do all it could to help increase staff numbers. “We know that there have been major problems with the health system, that’s why we’ve had to add resources.”
It’s not just Counties: this month, it emerged that a heavily pregnant woman in her 20s died in Palmerston North Hospital earlier this year, after her admission to intensive care with sepsis was delayed.
And at Whangārei Hospital’s Emergency Department, an unnamed nurse told the Northern Advocate that staff are so tired from working long hours they are making major errors with medication.
The country’s 20 district health boards were merged into Te Whatu Ora in July. New chair Rob Campbell says: “Lip service apology is nothing alongside empathy for all involved fuelling determination to do better. We all bear responsibility, not some object called a system.”
He says providing medical services to seriously ill people is regarded by many as a rewarding career. “That is just as well, because at some point in our lives a great many of us will seek the help of those who do. We and our whānau rely on their skills and the facilities and technologies they use when we are in need.
“We call those services a health service or system. This makes it seem something separate from us and from the people who make it up. It seems like an object. But it is just people, fallible people like us, doing what they can. With the same stresses and pressures we all have.
“When we objectify like this we can more readily dismiss the system as wrong or useless or careless in a way most of us would never do to people directly.”
“These bad results do happen in all medical services. Fallible people, fallible diagnoses, fallible medications, processes and technologies. That does not mean we should ignore mistakes or pretend they have not happened.”
– Rob Campbell
Campbell says there are two aspects that cause him particular concern. One is the way that much public discussion of bad results from medical services proceeds.
“These bad results do happen in all medical services. Fallible people, fallible diagnoses, fallible medications, processes and technologies. That does not mean we should ignore mistakes or pretend they have not happened.
“What we should not do is bay like a drunken crowd at a Twenty20 cricket match when a fielder drops a catch. You know the chant: ‘You f***ed up’.”
“What we should do is to empathise with the victim and their whānau. And with those involved in the service who are impacted by strong, if different, emotions too. We must all also resolve to do better.
“I have used the term ‘we’ here because we are all part of the service as users, owners, staff or, yes, directors and politicians.”
His second concern is, he says, something of a mirror image.
“One of the things which helps people to do better or worse is the way we organise ourselves. The system may not be responsible in the way we each are but it is a primary cause of how we perform.
“A great organisational structure can help us to perform well. A poor structure is a handicap, an obstacle, to that. We choose our structures to act together then they limit or lift us. It’s just part of being human.
“In health services we have constructed ways of acting which have achieved much. But they can also get in the way. We condone or encourage behaviour which is risky to health. We construct funding, training and financial reward process which drive certain outcomes. For humans, incentives in the broadest sense matter a lot.”
Campbell says there is now an opportunity for Te Whatu Ora to change some of this.
“We do not have the power to transform it. But we can change many parts that do matter. As we do, one important thing is not to kid ourselves or try to kid others that we are doing more than this.
“But even more important is to guide every action by the personal responsibility we all have to feel the pain and do better. The more we all feel this way the better we will do.”