Clinical Governance, Quality And Safety, Leadership, And Organizational Culture In The Bacchus Marsh Healthcare Service: An Analysis

Clinical Governance

For most governments of developed nations, improving the performance of health care systems is the key priority that defines the agenda of health policies. Majority of the healthcare systems have considered clinical governance as a major component of attaining this health agenda through improvements in patient safety and healthcare quality. Gottwald & Lansdown (2014) define clinical governance as a systematic approach in the maintenance and improvement of care given to patients through a culture that emphasizes patient safety and high-quality care.

According to the Australian Council on Healthcare Standards, clinical governance and a safety organizational culture should be demonstrated through shared responsibilities, transparency, and accountability between clinicians and managers. Besides, collaboration should foster continuous improvements, minimization of risks and an environment of care excellence for patients. This paper discusses the issues in Organizational Culture, Leadership and Management that were associated with the health system failure of Djerriwarrh Health Services, Bacchus Marsh, Victoria, Australia hence high perinatal mortality rates. Clinical governance and a safety organizational culture have been associated with high-quality care, job satisfaction, and improved patient outcomes. 

An individual who possesses and voluntarily reports insider knowledge of unethical and illegal events that happen in an organization to the public or a person in an authority position is a whistleblower. In the healthcare setting, a whistleblower may be employees, patients, contractors or any person who is aware of unethical professional practices (Schein & Dawsonera, 2010). In Australia, whistleblowers are protected under various programs that were created in the constitution. For instance, in the case of Bacchus Marsh, it was necessary to have a whistleblower so that the cycle of under-reporting was broken. This would have helped in the early identification of gaps that existed and contributed to high perinatal mortality rates before instituting appropriate measures.

Organizational culture refers to a common system of shared philosophies, beliefs, assumptions, values, and socialization which govern people’s behavior within an organization. Organizational culture has a strong influence on employees and it determines how they act, dress, interact and execute their roles and responsibilities (Schein & Dawsonera, 2010).  

A culture of fear and intimidation contributed to the lack of social lines of communication and acknowledgment of the authority. Besides, it contributed to a communication breakdown and a bad relationship between staff and the management. The end result was poor attitudes and reduced morale from staff who instituted less effort to provide quality care hence high perinatal mortality rates (Shelton, 2015).

An unsafety culture in Bacchus Marsh’s contributed to medical negligence, lack of accountability and resignations. The management of Bacchus Marsh failed to act on reports that questioned the competency of specific health care providers whose practice did not reflect the professional and legal standards of respective professional bodies that regulate the clinical practice. This sent wrong signals to staff and contributed to resignations that further compromised the availability of skills (Shelton, 2015). As a result, most healthcare staff missed opportunities to learn from mistakes and similar mistakes/issues are repeated over and over which negatively influenced the quality of care.

Quality and Safety

Bacchus Marsh did not have a transparent reporting culture where issues raised were openly addressed and feedback provided to patients or concerned health care providers. Instead, staff was punished, intimidated or warned (Spooner, 2017).  Failure to provide feedback to complains raised by staff contributed to their reluctance to make further reports and this limited the improvement efforts of the organization. Besides, a closed loop communication system limited the information that the management obtained through healthcare staff and contributed to a culture of fear and intimidation (Spooner, 2017). This resulted in a bad relationship between healthcare providers and the management and contributed to victimization and blaming and hence hide the failure.

Bacchus Marsh had a culture that failed to monitor performance and hold healthcare providers accountable for their mistakes. For instance, the reports on bullying and sexual harassment of junior surgeons by superiors are a perfect example that revealed how senior healthcare practitioners were unquestionable and this helps to question on some of the competencies that staff had (Olson, 2015). The failure by the management to take action on harassments and hold staff responsible for their mistakes through monitoring of performance helped to hide the failure of the healthcare system.

An open and transparent leader is approachable. He/she does not cultivate fear and intimidation amongst team members. Instead, he/she encourages team members to be free and openly share about individual and group struggles, challenges and disagreements (Chambers, 2013). He/she helps team members to understand that disappoint fears and inadequacy are normal and help them in overcoming them. He/she collaborates with team members to create an environment of honesty and continuous learning.

An open and transparent leader prioritizes the goals and objectives of the team over individual goals and ambitions. In instances where an issue is raised, he/she listens for the feedback from team members and considers them as experts in specific subjects. He/she uses motivators to inspire the efforts of team members to achieve good results.

Open and transparent leaders are clear about their motivations and intentions. He/she also discloses information and much as possible depending on legal and ethical standards. He/she will practice what he demands or ask from team members and rarely dictate.

The key figures in the Bacchus Marsh inquiry were approachable since they were commissioned by the Department of Health and Human Services to conduct an investigation into the perinatal deaths. They were involved in connecting with patients and healthcare staff to critically identify some of the issues that contributed to infant deaths by encouraging them to share individual experiences and challenges that they witnessed (Pehm, 2015).  The key figures who were led by a senior obstetrician openly acknowledged the mistake that there were deficiencies in clinical care under the seven cases that were reviewed which inspired opportunities for improvement (Spooner, 2017). The recommendations that followed this inquiry demonstrated empowerment in the key figures. They suggested opportunities for training, open disclosure through a just culture, adherence to accreditation standards and risk mitigation measures which were to be purely initiated by the patients, healthcare staff and healthcare administrators.

Empowerment provides healthcare practitioners, patients and health administrators with a learning environment. With this provision, healthcare staffs are able to obtain additional skills from other healthcare providers which increase their skills base and efficiency in how care is provided (Chambers, 2013).  Patients are self-empowered to adequately care for themselves and meet individual health needs probably through primary prevention. Approachability promotes the ability of health care providers to consult and coordinate with one another when providing care to a patient. Co-ordinated efforts help to eliminate the chances of medical errors and provide accurate care which guarantees safety (Carter, 2016).  Besides, patients will remain open to talk about individual health issues and this makes it easy to identify potential barriers to quality hence which guarantees quality healthcare.

Transparency and openness increase the ability and willingness of staff to remain honest with the management of an organization on the adverse events and near-miss events that may be exposing patients to risks. This positively contributes to the improvement efforts of an organization in preventing future adverse events through various risk mitigation measures hence promoting safe patient care (Carter, 2016). It promotes the establishment of good interrelations between patients and healthcare providers. As a result, healthcare staff can comfortably understand the needs, values, goals, and preferences of a patient without judgments. With this information, a health care provider can help a patient to make informed medical decisions that positively impact outcomes and safety.  

References:

Chambers Clark, C. (2013). Creative Nursing Leadership and management. Jones and Bartlett

Publishers: Sudbury

Carter, T. (2016). Leadership and management performance. Journal of Hospital Marketing and

Public Relations. 19:2, 142-7.

Gottwald, M., & Lansdown, G. E. (2014). Clinical governance: Improving the quality of

healthcare for patients and service users.

Olson T., (2015). How can we save lives in hospitals? Start by looking for and investigating

red flags. Available at https://theconversation.com/how-can-we-save-lives-in-hospitals-start-by-looking-for-and-investigating-red-flags-52287 Accessed on 12/9/2018

Pehm K., (2015). Review of the Department of Health and Human Services’ management of a

The critical issue at Djerriwarrh Health Services. Australian Commission on Safety and Quality in Healthcare

Schein, E. H., & Dawsonera. (2010). Organizational culture and leadership. San Francisco:

Jossey-Bass.

Shelton P., (2015). Baby deaths at Bacchus Marsh Hospital stem from entrenched systemic

failings. Available at https://www.smh.com.au/opinion/infant-deaths-at-bacchus-marsh-hospital-stem-from-entrenched-systemic-failings-20151019-gkcdpa.html. Accessed on12/9/2018

Spooner R., (2017). Forty workers investigated over Bacchus Marsh Hospital baby deaths.

Available at https://www.smh.com.au/national/health/forty-workers-investigated-over-bacchus-marsh-hospital-baby-deaths-20170309-guv0rc.html. Accessed on 12/9/2018.