Public hospital boards struggle with patient care and safety, study finds

Some Victorian public hospital boards and executives are struggling to deal with quality of care and patient-safety issues despite the buck stopping with them if things go wrong, according to a study published in an international journal.

A survey of 233 board members from 82 Victorian public hospitals has revealed wide variation in engagement with quality-of-care matters such as monitoring death and injury rates that might be caused by errors or systemic negligence.

Subsequent interviews with 35 board members and executives by Melbourne University researchers also found that some of the interviewees were frustrated that ministerial appointments were undermining the right mix of skills required on boards to govern hospitals.

“We did hear that there was potentially some political influence," said Dr Marie Bismark, a patient-safety expert who led the study.

“When it comes to the skills and expertise of board members, we'd really love to see a shift to boards having the ability to identify what skills they need on the boards and for those appointment processes to be merit and skills based.”

While most interviewees in the study believed they could influence quality and safety through setting priorities, monitoring progress, holding staff to account and shaping culture, many identified barriers such as a lack of time, resources and training, as well as being preoccupied with their fiscal responsibilities.

A report on the study published in the journal BMJ Quality and Safety said although some of the boards were engaged in activities aimed at improving the quality of care, one chair of a Melbourne hospital board said: “Major investigations in the health sector still come about through whistleblowers, not data.”

Another chair of a regional hospital board said: “The finance consumes a lot of time because we run in deficit."

Dr Bismark said many reported difficulty in getting the right information at the right time to monitor their hospitals and said unhelpful regulation such as multiple levels of accreditation often took over.

“Several board members said to me that when there is a big failure in their healthcare system, they will sometimes still find out about it by reading it on the front page of the newspaper. So even though they are getting volumes and volumes of board reports... they still don't feel like they're getting the right information,” she said.

Dr Bismark, who is dually trained as a doctor and lawyer, said although new national performance measures may improve quality and safety governance, more work was needed to ensure boards were on top of their responsibilities. She recommended better training and refined data collection, as well as remuneration of members of sub-regional and rural boards because they currently serve as volunteers.

Dr Bismark said poor board oversight had been identified as a contributing factor to many high-profile failures in care including Britain's Stafford Hospital scandal, where hundreds of people are thought to have died due to neglect. She said the inquiry into the service found that the failure of the hospital trust board to "get a grip" on its governance responsibilities left them blind to many concerns.

“The boards of directors are going to be the ones who are ultimately held accountable if there is a big failure that results in patient harm.”

In Victoria, health service board members are appointed by the Minister of Health for a three-year term with the possibility of re-appointment.

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