In recent weeks the Victorian hospital system has been rocked by allegations of data manipulation and error. Is it really happening? Why? Who's responsible? Have your say here.
26
comments:
Anonymous
said...
Elective surgery waiting lists are manipulated by falsely recording patients as 'not ready for care' until a theatre time becomes available. This hides the true waiting time.
Why is this coming as such a surprise? Its not just waiting lists. What about time sheets - when big slabs of overtime are crossed off and instead told to take time in lieu without cover? Statistically looks good for the hospital - Makes it look like their junior doctors are working safe hours yet all the work gets done for free. Its shit. It may sound harsh but I hope they get audited up to they're eyeballs. Its time there was some sort of change in the way hospitals are run - not only for patients, but the poor sods who work in them.
I don't know about data manipulation, but I do know about doctor/patient manipulation to avoid the financial penalties. One of my colleagues was recently forced by administrators to send a suicidal patient home against the judgement of both treating doctors because there was no bed available and the patient was going to exceed the maximum staying time in the emergency department of 24 hours, which would have cost the hospital (I believe) $100,000. This was not an isolated event. This rule, designed to "make" hospitals move the patients through the ED more quickly actually spectacularly backfires when there is nowhere to move them to. The patient would have been safer under observation in the ED in the absence of other options but now the hospital is penalised for keeping them there. The stress of emergency departments is amplified tenfold as a result because everyone is working under this intense pressure to get the patients out in time. If you have other duties in the hospital, once moderately polite staff now stridently demand your immediate attendance in the ED, day or night. Who would work in the ED?? Not me.
I have been a hospital surgical registrar for 6 years at a variety of Melbourne and regional public hospitals. During this time due to a variety of issues waiting lists were regularly manipulated. These were mostly category one patients including those with cancer. They were deferred primarily as there were not enough lists due to the large number of patients coming through the public system, but the reasons are manifold including not enough ICU beds, not enough surgeons, and so on. The waiting list officers were, and I'm sure are still, directed to mark them not ready for care either due to patient directive or due to some fictitious medical reason.
What a shocking surprise that hospitals are manipulating their data! I mean seriously - does anyone who actually works in a hospital not know this? Every emergency department I have worked in has had systems in place which ensured the data was manipulated to meet KPI's - it wasnt a choice for junior staff - it was the only thing that you could do! The reaction of the government and hospital executive (let's look for someone else to blame) is downright poor. Perhaps spending less energy "being furious" and more energy investigating the issues we work with daily might be a more appropriate use of time.
This problem is entirely a product of poor financial management of the public hospital system by the Victorian Government. In a system known to be flailing to service an exploding population, the government was financially penalising departments who didn't see enough patients or where waiting times were to long. This essentially was taking resources away from those services that didn't have enough resources!!!?!?!?!? The only way to ensure enough money was available to treat patients professionally was to avoid these fines at any cost.
The minister for health should be sacked as the health system is a bloody mess. Victorians should write letters to Mr Andrews every time they are forced to wait in an ED or to see their GP and everytime their elective surgery gets deferred because it is only now that the mismanagement of the health system starting to reflect badly on the state government and the Minister for Health.
Please Kevin Rudd, follow up on your pre-election promise to nationalise the public health system. Take over and clean up this mess!!!!
Have worked as surgical HMO/Registrar in Victoria for 11 years. Every unit I have ever worked on (except 1) has routinely manipulated the waiting list so as to not incur fines. The usual way is to mark patients as not ready for care until they are seen at pre-admission clinic. This way the cat 1 patients have a month to be operated on without the hospital incurring financial penalties. Nevermind that the patients are cat 1 (lung cancer of CABG) and have otherwise waited for surgery, prior to being seen in pre-admission clinic, for 3-6 months.
A simple audit of each surgical unit looking at the time between the wait-list form being filled in by the surgeon (ie. entry onto the waiting list) for each individual patient and the date of surgery would reveal volumes.
I agree with the previous comment with reference to data manipulation "I mean seriously - does anyone who actually works in a hospital not know this?!!!!".
Let us change the culture of the hospitals and realise that "it is all about the patients" and not "bean counting".
Sir Bruce Keogh and Ara Darzi's reform of the NHS is leading the way. There are many lessons to be learnt from the UK experience which is ongoing.
At our work its routine for surgical registrars to take care of the surgical waiting lists. Well, sort of. They get a bit of a helping hand from admin - who advise that the group of patients that need surgery probably "not ready for care" at this stage. The more accurate description would be "not ready to care". When is someone going to do something about fixing our health system?!
Create a hospital built around incentives, not a hospital that is penalised when targets are not met.
How can Government expect to set targets for waiting times, inpatient stay when the resources we work with remain a constant, whilst patient attendances are on the increase.
Senior medical staff are leaving the public system into the private sector. Working for themselves they have combined job satisfaction and NO Bureaucracy.
Its time hospital administration and Government realise you cant limit what you spend on health. You need to spend to provide the best.
Let Doctors and Nurses take control of the hospital once more. The current CEOs and boards need to look to and seek guidance from those most important in the system; their staff.
I can not name one CEO that has every come down to the ED or wards and introduced themselves to their employees and seen first hand what it is acutally like to work in our Public Hospitals.
I have however seen CEOs defend their actions on radio, print media and television, blaming the system and not themselves. I have seen the same CEO destroy staff morale by taking away simple pleasures such as nice coffee and milo in staff meal areas.
To all the Hospital CEOs out there, get out of your large expansive office, let your PA take all the calls for a week, put your hospital paid mobile phone on the charger, peel your-self off your leather office chair and....... dare I say it...... Put on some scrubs and tackle the issue head on. See what your workers are doing, find out that the ED doc hasnt had a wee for the last 5 hours because there just isnt time to, or that nursing staff should be paid a bonus everytime they clean up patients vomit.
The first one of you to do so will be rewarded. But I can guarantee none of you will
Yeah, its a bit disturbing that we learnt about KPI's and WEIS in med school...
My gripe is with these "short stay" units, which are essentially re-labelled sections of Emergency, to avoid the fine for patients staying longer than 24 hours. This means that the government doesn't see the hopeless over crowding, because the hospital has avoided it on paper.
It also means that a hospital has more incentive to send a patient to the ward who has been sitting in ED for 10 hours, than one who has been sitting for 25 hours... the latter has already cost the hospital money, so its more cost-safe to move the 10 hour one to a ward, before they too cost the hospital money.
Daniel Andrews had a bad week - that's for sure. But as this story blows over - as it no doubt will, what's the end result for our broken health system? It seems as though the sinking ship just keeps sailing on doesn't it...? Maybe time to do something? Anyone listening?
It's amusing there has been such a fuss this week over something that is so blatantly transparent to anyone working in the hospital system. Now that people believe this, do they believe (or at least accept the possibility) that time sheets of junior staff are altered to meet similar workload KPI's? Its pretty believable to those who work in the system - what about to all those so "rocked" by this weeks revelations?
I overheard a senior ED nurse the other day openly state to a patient that she admitted all patients to ED if they had been there for eight hours. This was fair enough, she argued, as otherwise the department would lose money. There seemed to be no appreciation for the fact that unless the government knew about where the problems were it couldn't fix them.
Part of the problem is that, in some hospitals, the people who are in charge of making decisions about admitting patients to ED are nurses and therefore have much less personal interest in relaying to the government problems at their hospital. Because the rate limiting step is the doctor shortage, not nursing numbers. If I were in charge of deciding when a patient gets admitted to ED, I would only admit when the patient had been assessed by a doctor and a medical decision had been made to keep the patient in ED eg for monitoring. If the government doesn't find out about the problems, nothing changes and patient care suffers. WE NEED MORE DOCTORS!!!
You know what, I don't care how many times clinical services tell me not to put my actual times on my timesheet (as they don't pay unrostered o/t), I'm going to record the CORRECT start and finish times regardless of whether I get pain. It is a legal record of the hours we have worked and will form a statistic which they can later wave in our face. At the moment hospital management can say they don't need to pay O/T as all the work gets done within the set hours - As all junior staff are bullied into lying about the amount of hours they work. Let's stand up for ourselves for once. They may not pay us, but at least there will be a formal legal record that things are rotten in the state of Victoria.
I can’t disagree with any of the comments above. I’m only a junior doctor, and already I see how perverse incentives compromise the delivery of personalised quality patient care.
The 24 hour ED discharge rule is a good case in point. I’ve had several cases where the best management option (from both patient and staff perspectives) has been for an individual to remain in the ED for 24 hours - for observation, infusion or ongoing treatment. In a majority of cases, the pressure has mounted to arrange transfer to another of the hospital (the short stay unit or otherwise) for the sole purpose of number buffing - even though the move has been contrary to the wishes of the treating team and antithetical to patient’s best interests. No doubt all junior doctors could rattle of numerous examples of this sort of activity.
While I appreciate the issue of access block and the necessity of good patient flow processes, flexibility is essential. The patient should come first in all management decision making. When a transfer (to a ghost ward or otherwise) is likely to be detrimental to the patient’s physical or mental health, the system should be supportive of alternative solutions. One size fits all performance targets don’t work for patients, and they place undue pressure on clinical staff.
KPIs and benchmarks and targets do not take into account individual patient factors. At medical school, we are taught to offer a holistic model of health where the patient is central to all decision making. This ethos is compromised by a system that encourages production-line medicine and penalises personalised care.
I get so disheartened when I overhear nurses, doctors and clerks making decisions based on admission times and money-making capacity rather than the clinical picture. It is infuriating!!!!
I wish the Minister could actually hear some of the discussions on the ground in EDs. I know health dollars are limited and mechanisms to ameliorate access block are important, but they shouldn't play into clinical decision making. Yes, we all have a responsibility to be sensible and rational in our treatment decisions, but not to the extent that has become the status quo.
There must be a better business model (for want of a better term) out there!
You just have to look at the private hospitals are run to see a model of efficiency. All staff in the operating theatre work hard to achieve safe, fast turnover of all cases. They are paid per case, and are usually quite happy to work back an hour or so, as they are remunerated for it.
In the public hospitals, we are paid per session, if we were to start a case that would likely finish after 17:30, we wouldn't start it. All that wasted theatre time.
Here's a new business model: Pay us properly. Give us incentives for staying back to complete the work. Don't force us to stay back and work UNPAID overtime. Don't penilise us for increasing workloads - we're not working inefficiently. We have much more to deal with.
I write this to you as i am next to my registrar waiting for our consultant to do a am ward round - said she would be here at 8am. (now 9:50), and still hasn't turned up.
Yesterday, I was told by my registrar and Consultant that i had to work this weekend - Easter weekend - ie. do a morning ward round Fri, Sat and Mon.
I called my HMO services who told me that i would NOT be paid if i turned up.
So I called my consultant last night who said she didn't care, and wanted me to turn up. I asked her to call HMO services and ask them to pay me. She said that it wasn't up to her and that she "expected" me to be here regardless of pay.
I then told HMO services that I had no choice, and pleaded with them to pay me. They refused and told me not to turn up. I asked them to call my Consultant and stick up for me. They refused and told me to speak to my head of unit. WHICH IS ACTUALLY MY CONSULTANT!
And we just had an EBA and this still goes on. Why wasn't the issue of overtime addressed in the recent EBA? This is still a very big issue, yet the AMA didn't bother to address this.
What a relief that the government no longer penalises hospitals for not meeting their arbitrary benchmarks. Or is it? At my hospital, things have become worse since the recent publicity and change in government policy regarding funding. Now, nurses will send an ED patient to the ward as soon as they are waiting to see me, the medical registrar, to see them, even if the patient was only referred to me half an hour ago, even if the eight hour mark is several hours away! Never mind that it is an intern forced to write the drug chart on the patient I haven't seen yet. Never mind if the bloods aren't back yet. Never mind if I'm not even certain the patient needs admitting (because I haven't seen them yet)! ED have done their bit so the ED nurses turf the patient to the understaffed ward where I can sort the patient out properly. This has been going on for all of one week and already there has been a MET call on a patient on the ward who I haven't had a chance to admit yet.
The degree of disrespect I sense is palpable. The ED nurses even want to send the patient to the ward while I'm in the middle of taking the history from the patient! Mr Brumby, this is NOT a system I want to work in.
Interestingly enough, our hospital, this week, and last week is on low activity, as in our operating theatres have been cut from 10 to 5. This is because if we do 'too much work', we are peanalised by the stupid WEIS system, and next financial year we don't receive the same funding.
How ridiculous is that? The waiting list grow longer. Yet we are forced to cut ervices by an ineffective system.
Amazingly, all operating staff, including surgeons, anaesthetists, nurses and technicians, are still PAID to be there...... Can someone please explain ???
The perverse system of using Key Performance Indicators like exceeding waiting list times to penalise hospitals is what encourages data manipulation.
The whole point of KPIs is to help indicate where the problems are and to fix them - but the penalties to hospitals are so severe and the systemic deficiencies and underfunding is so entrenched that it is impossible to fix the underlying problems... so what choice is there but to sweep them under the carpet?
Making patients "Not Ready For Care" before preadmission is widespread in most Victorian hospitals. Patients are further delayed due to a failure to access essential tests like respiratory function tests, echocardiographs, stress thalliums, etc or because equipment or operating facilities are not available. These are all valid reasons for a hospital to be "not ready to care" for the patient, and the current system fails to recognise that!
There is too much focus trying to prevent any Cat I patient going over their 30 days. Just this week I was asked to recategorise one of my patients from a Cat 1 to an "urgent Cat 2" because they had no hope of being done within 30 days, so don't tell me that it does not happen any more!
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26 comments:
Elective surgery waiting lists are manipulated by falsely recording patients as 'not ready for care' until a theatre time becomes available. This hides the true waiting time.
Why is this coming as such a surprise? Its not just waiting lists. What about time sheets - when big slabs of overtime are crossed off and instead told to take time in lieu without cover? Statistically looks good for the hospital - Makes it look like their junior doctors are working safe hours yet all the work gets done for free. Its shit. It may sound harsh but I hope they get audited up to they're eyeballs. Its time there was some sort of change in the way hospitals are run - not only for patients, but the poor sods who work in them.
I don't know about data manipulation, but I do know about doctor/patient manipulation to avoid the financial penalties. One of my colleagues was recently forced by administrators to send a suicidal patient home against the judgement of both treating doctors because there was no bed available and the patient was going to exceed the maximum staying time in the emergency department of 24 hours, which would have cost the hospital (I believe) $100,000. This was not an isolated event.
This rule, designed to "make" hospitals move the patients through the ED more quickly actually spectacularly backfires when there is nowhere to move them to. The patient would have been safer under observation in the ED in the absence of other options but now the hospital is penalised for keeping them there.
The stress of emergency departments is amplified tenfold as a result because everyone is working under this intense pressure to get the patients out in time. If you have other duties in the hospital, once moderately polite staff now stridently demand your immediate attendance in the ED, day or night. Who would work in the ED?? Not me.
I have been a hospital surgical registrar for 6 years at a variety of Melbourne and regional public hospitals. During this time due to a variety of issues waiting lists were regularly manipulated. These were mostly category one patients including those with cancer. They were deferred primarily as there were not enough lists due to the large number of patients coming through the public system, but the reasons are manifold including not enough ICU beds, not enough surgeons, and so on. The waiting list officers were, and I'm sure are still, directed to mark them not ready for care either due to patient directive or due to some fictitious medical reason.
What a shocking surprise that hospitals are manipulating their data! I mean seriously - does anyone who actually works in a hospital not know this? Every emergency department I have worked in has had systems in place which ensured the data was manipulated to meet KPI's - it wasnt a choice for junior staff - it was the only thing that you could do! The reaction of the government and hospital executive (let's look for someone else to blame) is downright poor. Perhaps spending less energy "being furious" and more energy investigating the issues we work with daily might be a more appropriate use of time.
This problem is entirely a product of poor financial management of the public hospital system by the Victorian Government. In a system known to be flailing to service an exploding population, the government was financially penalising departments who didn't see enough patients or where waiting times were to long. This essentially was taking resources away from those services that didn't have enough resources!!!?!?!?!? The only way to ensure enough money was available to treat patients professionally was to avoid these fines at any cost.
The minister for health should be sacked as the health system is a bloody mess. Victorians should write letters to Mr Andrews every time they are forced to wait in an ED or to see their GP and everytime their elective surgery gets deferred because it is only now that the mismanagement of the health system starting to reflect badly on the state government and the Minister for Health.
Please Kevin Rudd, follow up on your pre-election promise to nationalise the public health system. Take over and clean up this mess!!!!
Have worked as surgical HMO/Registrar in Victoria for 11 years. Every unit I have ever worked on (except 1) has routinely manipulated the waiting list so as to not incur fines. The usual way is to mark patients as not ready for care until they are seen at pre-admission clinic. This way the cat 1 patients have a month to be operated on without the hospital incurring financial penalties. Nevermind that the patients are cat 1 (lung cancer of CABG) and have otherwise waited for surgery, prior to being seen in pre-admission clinic, for 3-6 months.
A simple audit of each surgical unit looking at the time between the wait-list form being filled in by the surgeon (ie. entry onto the waiting list) for each individual patient and the date of surgery would reveal volumes.
I agree with the previous comment with reference to data manipulation "I mean seriously - does anyone who actually works in a hospital not know this?!!!!".
Let us change the culture of the hospitals and realise that "it is all about the patients" and not "bean counting".
Sir Bruce Keogh and Ara Darzi's reform of the NHS is leading the way. There are many lessons to be learnt from the UK experience which is ongoing.
At our work its routine for surgical registrars to take care of the surgical waiting lists. Well, sort of. They get a bit of a helping hand from admin - who advise that the group of patients that need surgery probably "not ready for care" at this stage. The more accurate description would be "not ready to care". When is someone going to do something about fixing our health system?!
"The Carrot vs The Stick"
Create a hospital built around incentives, not a hospital that is penalised when targets are not met.
How can Government expect to set targets for waiting times, inpatient stay when the resources we work with remain a constant, whilst patient attendances are on the increase.
Senior medical staff are leaving the public system into the private sector. Working for themselves they have combined job satisfaction and NO Bureaucracy.
Its time hospital administration and Government realise you cant limit what you spend on health. You need to spend to provide the best.
Let Doctors and Nurses take control of the hospital once more. The current CEOs and boards need to look to and seek guidance from those most important in the system; their staff.
I can not name one CEO that has every come down to the ED or wards and introduced themselves to their employees and seen first hand what it is acutally like to work in our Public Hospitals.
I have however seen CEOs defend their actions on radio, print media and television, blaming the system and not themselves. I have seen the same CEO destroy staff morale by taking away simple pleasures such as nice coffee and milo in staff meal areas.
To all the Hospital CEOs out there, get out of your large expansive office, let your PA take all the calls for a week, put your hospital paid mobile phone on the charger, peel your-self off your leather office chair and....... dare I say it...... Put on some scrubs and tackle the issue head on. See what your workers are doing, find out that the ED doc hasnt had a wee for the last 5 hours because there just isnt time to, or that nursing staff should be paid a bonus everytime they clean up patients vomit.
The first one of you to do so will be rewarded. But I can guarantee none of you will
Hi all,
Stew Morrison here. Tried to compile all recent Media Stories on this topic, for your perusal...
1. Minister Orders Hospital Audits After Dud Figures (TheAge, 2Apr09) http://snipurl.com/f7csw
2. Losing Patients (TheAge, 2Apr09) http://snipurl.com/f7ctj
3. Audit Slams Dud Figures (TheAge, 2Apr09) http://snipurl.com/f7cuh
4. Hospital Lied over Waiting Lists (TheAge, 31Mar09) http://snipurl.com/f7cvp
5. The Audit that has been tabled (Audit.gov) http://snipurl.com/f7d1j
Yeah, its a bit disturbing that we learnt about KPI's and WEIS in med school...
My gripe is with these "short stay" units, which are essentially re-labelled sections of Emergency, to avoid the fine for patients staying longer than 24 hours. This means that the government doesn't see the hopeless over crowding, because the hospital has avoided it on paper.
It also means that a hospital has more incentive to send a patient to the ward who has been sitting in ED for 10 hours, than one who has been sitting for 25 hours... the latter has already cost the hospital money, so its more cost-safe to move the 10 hour one to a ward, before they too cost the hospital money.
Daniel Andrews had a bad week - that's for sure. But as this story blows over - as it no doubt will, what's the end result for our broken health system? It seems as though the sinking ship just keeps sailing on doesn't it...? Maybe time to do something? Anyone listening?
It's amusing there has been such a fuss this week over something that is so blatantly transparent to anyone working in the hospital system. Now that people believe this, do they believe (or at least accept the possibility) that time sheets of junior staff are altered to meet similar workload KPI's? Its pretty believable to those who work in the system - what about to all those so "rocked" by this weeks revelations?
I overheard a senior ED nurse the other day openly state to a patient that she admitted all patients to ED if they had been there for eight hours. This was fair enough, she argued, as otherwise the department would lose money. There seemed to be no appreciation for the fact that unless the government knew about where the problems were it couldn't fix them.
Part of the problem is that, in some hospitals, the people who are in charge of making decisions about admitting patients to ED are nurses and therefore have much less personal interest in relaying to the government problems at their hospital. Because the rate limiting step is the doctor shortage, not nursing numbers. If I were in charge of deciding when a patient gets admitted to ED, I would only admit when the patient had been assessed by a doctor and a medical decision had been made to keep the patient in ED eg for monitoring. If the government doesn't find out about the problems, nothing changes and patient care suffers. WE NEED MORE DOCTORS!!!
You know what, I don't care how many times clinical services tell me not to put my actual times on my timesheet (as they don't pay unrostered o/t), I'm going to record the CORRECT start and finish times regardless of whether I get pain. It is a legal record of the hours we have worked and will form a statistic which they can later wave in our face. At the moment hospital management can say they don't need to pay O/T as all the work gets done within the set hours - As all junior staff are bullied into lying about the amount of hours they work. Let's stand up for ourselves for once. They may not pay us, but at least there will be a formal legal record that things are rotten in the state of Victoria.
I can’t disagree with any of the comments above. I’m only a junior doctor, and already I see how perverse incentives compromise the delivery of personalised quality patient care.
The 24 hour ED discharge rule is a good case in point. I’ve had several cases where the best management option (from both patient and staff perspectives) has been for an individual to remain in the ED for 24 hours - for observation, infusion or ongoing treatment. In a majority of cases, the pressure has mounted to arrange transfer to another of the hospital (the short stay unit or otherwise) for the sole purpose of number buffing - even though the move has been contrary to the wishes of the treating team and antithetical to patient’s best interests. No doubt all junior doctors could rattle of numerous examples of this sort of activity.
While I appreciate the issue of access block and the necessity of good patient flow processes, flexibility is essential. The patient should come first in all management decision making. When a transfer (to a ghost ward or otherwise) is likely to be detrimental to the patient’s physical or mental health, the system should be supportive of alternative solutions. One size fits all performance targets don’t work for patients, and they place undue pressure on clinical staff.
KPIs and benchmarks and targets do not take into account individual patient factors. At medical school, we are taught to offer a holistic model of health where the patient is central to all decision making. This ethos is compromised by a system that encourages production-line medicine and penalises personalised care.
I get so disheartened when I overhear nurses, doctors and clerks making decisions based on admission times and money-making capacity rather than the clinical picture. It is infuriating!!!!
I wish the Minister could actually hear some of the discussions on the ground in EDs. I know health dollars are limited and mechanisms to ameliorate access block are important, but they shouldn't play into clinical decision making. Yes, we all have a responsibility to be sensible and rational in our treatment decisions, but not to the extent that has become the status quo.
There must be a better business model (for want of a better term) out there!
Common guys,
You just have to look at the private hospitals are run to see a model of efficiency. All staff in the operating theatre work hard to achieve safe, fast turnover of all cases. They are paid per case, and are usually quite happy to work back an hour or so, as they are remunerated for it.
In the public hospitals, we are paid per session, if we were to start a case that would likely finish after 17:30, we wouldn't start it. All that wasted theatre time.
Here's a new business model:
Pay us properly.
Give us incentives for staying back to complete the work.
Don't force us to stay back and work UNPAID overtime.
Don't penilise us for increasing workloads - we're not working inefficiently. We have much more to deal with.
I wonder how many health department administrators have spent time on a public hospital waiting list, waiting for their procedures to happen.
****WORKING FOR FREE****
I write this to you as i am next to my registrar waiting for our consultant to do a am ward round - said she would be here at 8am. (now 9:50), and still hasn't turned up.
Yesterday, I was told by my registrar and Consultant that i had to work this weekend - Easter weekend - ie. do a morning ward round Fri, Sat and Mon.
I called my HMO services who told me that i would NOT be paid if i turned up.
So I called my consultant last night who said she didn't care, and wanted me to turn up. I asked her to call HMO services and ask them to pay me. She said that it wasn't up to her and that she "expected" me to be here regardless of pay.
I then told HMO services that I had no choice, and pleaded with them to pay me. They refused and told me not to turn up. I asked them to call my Consultant and stick up for me. They refused and told me to speak to my head of unit. WHICH IS ACTUALLY MY CONSULTANT!
And we just had an EBA and this still goes on. Why wasn't the issue of overtime addressed in the recent EBA? This is still a very big issue, yet the AMA didn't bother to address this.
What a relief that the government no longer penalises hospitals for not meeting their arbitrary benchmarks. Or is it? At my hospital, things have become worse since the recent publicity and change in government policy regarding funding. Now, nurses will send an ED patient to the ward as soon as they are waiting to see me, the medical registrar, to see them, even if the patient was only referred to me half an hour ago, even if the eight hour mark is several hours away! Never mind that it is an intern forced to write the drug chart on the patient I haven't seen yet. Never mind if the bloods aren't back yet. Never mind if I'm not even certain the patient needs admitting (because I haven't seen them yet)! ED have done their bit so the ED nurses turf the patient to the understaffed ward where I can sort the patient out properly. This has been going on for all of one week and already there has been a MET call on a patient on the ward who I haven't had a chance to admit yet.
The degree of disrespect I sense is palpable. The ED nurses even want to send the patient to the ward while I'm in the middle of taking the history from the patient! Mr Brumby, this is NOT a system I want to work in.
Interestingly enough, our hospital, this week, and last week is on low activity, as in our operating theatres have been cut from 10 to 5. This is because if we do 'too much work', we are peanalised by the stupid WEIS system, and next financial year we don't receive the same funding.
How ridiculous is that? The waiting list grow longer. Yet we are forced to cut ervices by an ineffective system.
Amazingly, all operating staff, including surgeons, anaesthetists, nurses and technicians, are still PAID to be there...... Can someone please explain ???
The Age: Let Doctors Do Lists: Surgeon 23/7/2009.
The perverse system of using Key Performance Indicators like exceeding waiting list times to penalise hospitals is what encourages data manipulation.
The whole point of KPIs is to help indicate where the problems are and to fix them - but the penalties to hospitals are so severe and the systemic deficiencies and underfunding is so entrenched that it is impossible to fix the underlying problems... so what choice is there but to sweep them under the carpet?
Making patients "Not Ready For Care" before preadmission is widespread in most Victorian hospitals. Patients are further delayed due to a failure to access essential tests like respiratory function tests, echocardiographs, stress thalliums, etc or because equipment or operating facilities are not available. These are all valid reasons for a hospital to be "not ready to care" for the patient, and the current system fails to recognise that!
There is too much focus trying to prevent any Cat I patient going over their 30 days. Just this week I was asked to recategorise one of my patients from a Cat 1 to an "urgent Cat 2" because they had no hope of being done within 30 days, so don't tell me that it does not happen any more!
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