Wednesday, October 13, 2010

They Are Just Not Listening

It’s no wonder our hospitals are struggling so badly to keep up with the demands placed upon them. All the evidence would seem to suggest that hospitals in New South Wales are overcrowded. Occupancy rates at many major hospitals have been reported as consistently exceeding 90%, with Saint Vincent’s registering 99%, the Prince of Wales running at 95%, and the average across the state reaching 87.9% for the 2009-10 financial year. Doctors have been repeatedly calling for a target of 85% occupancy to be set, describing it as an internationally accepted standard necessary for optimum safe and efficient care. Repeated inquiries and studies have determined that the primary cause of overcrowding in emergency rooms is access block, caused by a lack of available beds in the hospital when an emergency patient needs to be admitted to a ward. No beds available, means that patients are stacked up in the emergency department taking up space and soaking up resources so that new arrivals are forced to wait.

However, when confronted with these facts, the New South Wales government, and the Department of Health simply deny that any problem exists. Deputy Premier and Health Minister Carmel Tebbutt claims that “there is no definitive rule that states it is unsafe for hospitals to operate above an 85% bed occupancy,” and insists that achieving such a target would mean that more than 3000 acute care beds would be left “fully staffed but deliberately empty.” Today I spoke with the Deputy Director of New South Wales Health, Dr Tim Smythe, and he went even further. Dr. Smythe said that the 85% figure is a myth and is meaningless in terms of quality of care. He insisted that the claimed occupancy rates, such as the 99% at St Vincent’s for example, are based on “patient-bed-days” and are not an accurate representation of actual occupancy rates. He further claimed that there is no one single “magic figure” to define optimum occupancy rates with different rates being appropriate for different treatments, different procedures, different patients, different locations, and different circumstances.

This is such a typical bureaucrat’s response, and only serves to demonstrate that figures really can be twisted around to mean whatever you want them to mean. The idea that maximum efficiency is achieved by running at maximum capacity is fatally flawed, one that seems to take industrial theory and apply it to healthcare. But patients are not products, and hospitals are not factories, and it is wrong to treat them as if they are. The target of 85% is supposed to reflect an average which will accommodate surges in demand which might at times stretch hospitals to beyond normal circumstances. Failure to structurally incorporate such excess capacity not only means that there is no surge capacity, but also that staff and resources are pushed to the limit all the time, which only increases the prospect of adverse events such as medical mistakes and unnecessary deaths, which ultimately actually cost us all much more than it would to have a reasonable margin for safety built in to the system.

This bloody minded denial of the obvious also makes it painfully clear that the government, and their bureaucrats, are simply not listening to the doctors, not listening to the patients, and most certainly not listening to the taxpayers of New South Wales.

No comments: