As the citizens of Bundaberg in Queensland followed the trial and subsequent conviction of “Dr Death”, Jayant Patel they perhaps didn’t worry too much about events thousands of miles away in the UK, or even in Texas.
This may be just as well as there is no telling whether they would find these developments oddly comforting or even more alarming. What they would find is further evidence of the phenomena that blighted not only Bundaberg Hospital, but other hospitals and health organisations across the world. This new ‘MRSA’ seems as endemic in health care systems as any other dangerous hospital acquired infections.
This particular vocational virus, I’ll call it ‘Management Resistance to Staff Alerts’ (MRSA) has been implicated in almost every hospital ‘scandal’ and health system failure inquiry in recent years. In a nutshell, health organisations and their leaders are not only failing to listen to their front line nursing staff, but in the worst cases, they are actively and forcefully trying to silence them. These whistleblowing nurses are the canaries down the mine or the frogs in the health care ecosystem who provide the first alerts and early warning signals that all is not well. If they are metaphorically falling from their perches or deserting the pond, unnoticed and unacknowledged, then the next ‘Hospital Scandal’ will not be too far away.
In the UK, The ‘Francis Report’ into what was widely reported as ‘over 400 unnecessary deaths’ at Mid Staffordshire NHS Trust Hospital revealed a litany of failings at personal and organisational levels across the organisation. Even as the hospital was committing the catalogue of horrors against patients and staff its Executive and Board were seemingly oblivious to its failings. Seduced by their own spin and transfixed by targets and achieving ‘Foundation Trust’ status, they presided over a culture of intimidation and ‘toughness’ that effectively silenced any concerns or objections raised. The Francis Report noted, with stiletto accuracy: “The evidence indicates that the Trust was more willing to rely on favourable external assessments of its performance rather than on internal assessment.” (p.16) and that: “Many staff members did raise concerns, individually and collectively, but none experienced a satisfactory response. This discouraged persistent reporting of concerns.” (p.186).
In situations like this, you silence your canaries at your peril. At Bundaberg, it was the bulldog advocacy and persistence of nurse Toni Hoffman in the face of managerial inactivity and intimidation that eventually stopped Dr Patel. Toni was recognised for her role in the ‘Dr Death’ saga with an Australian Local Hero Award in 2006. In Texas, it was nurses Anne Mitchell and Vickilyn Galle who were railroaded, prosecuted, and faced prison after they raised serious concerns over the practices of one Dr Rolando G Arafiles Jr. They have now been fully vindicated.
If notions of patient safety, quality, advocacy and professional judgement in health care organisations are to mean anything, then we have to be able to do better than this.
So, on my instantly created ‘Canary Scale’ of 1 canary for ‘Stalinist’ to 5 canaries for ‘Rogerian’, how many ‘Canary Friendly’ stars would you award your hospital or service?