DHB lifts shroud on death figures

By Martin Johnston

The Waitemata District Health Board hired a health watchdog to help it to lift its game in responding to complaints and treating patients with compassion. Health reporter Martin Johnston checks on progress.

The Health Roundtable figures indicate that deaths at North Shore Hospital are about 10 per cent below the expected rate. Photo / Dean Purcell
The Health Roundtable figures indicate that deaths at North Shore Hospital are about 10 per cent below the expected rate. Photo / Dean Purcell

An Auckland health chief has flicked the shroud of secrecy off death-rate data produced for his hospitals by a transtasman number-cruncher.

Dale Bramley, chief executive of the Waitemata District Health Board, has opted to publish the in-hospital mortality statistics after receiving a report from former health and disability commissioner Ron Paterson that said: "Public reporting is looming."

District health boards last year refused to give the Herald the mortality reports produced for them by the Sydney-based Health Roundtable. Members risk expulsion if they use the data to bad-mouth others.

The organisation said it restricted release of its reports because it sought to improve care of patients as quickly as possible by using draft information from hospitals, rather than waiting until data rules and accuracy could be guaranteed.

But Dr Bramley has chosen to give Waitemata's Roundtable in-hospital mortality figures to the Herald and will publish them in board papers from next month as part of a renewed drive for transparency, quality of care and compassion for patients.

"We are very proud of our in-hospital mortality data. In the latest Health Roundtable data we are trending down," he said.

The figures indicated North Shore Hospital's rate of death was about 10 per cent below the expected rate, given the age, ethnicity and other characteristics of its patients. At Waitakere Hospital, whose complex cases usually go to North Shore, the rate was about half what was expected.

Dr Bramley estimated that, taken together, his two hospitals were 20-30 per cent below their expected rate.

Mr Paterson, now an ombudsman, said in his health board-commissioned review of quality that Waitemata should start an internal debate on public reporting of data on the quality of each of its services. This would go beyond "the current rudimentary reporting of DHB performance against priority health targets".

He indicated hospital mortality data might be a starting point and in his book, The Good Doctor, he highlighted New York State's requirement to publish risk-adjusted data on mortality after coronary artery bypass surgery "at hospital and individual surgeon level".

Mr Paterson told the DHB it had an opportunity to be a national leader by publishing new kinds - for New Zealand - of quality data. "This would signal to the community both the organisation's commitment to quality and safety, and its confidence in the health services it delivers."

Waitemata, like other DHBs, has started publishing performance data which once had to be extracted under the Official Information Act, such as rates of compliance with hand hygiene guidelines (currently 73 per cent), and how long patients have to wait for colonoscopy and various other investigations and treatments.

And on the more sensitive information, Dr Bramley said the internal discussion had begun on which kinds of data to report from a long list including surgical complications, infections from surgery, obstetric injuries, mortality for various health conditions and patient experience.

Asked if the likes of surgeon-level complication rates would eventually be published, he said, "I think in the long term we would be aiming there. We have to get down to the service level first."

Mr Paterson, who as commissioner in 2009 found major flaws at North Shore Hospital, was appointed as the board's chief quality adviser in 2011 to conduct the quality review.

Dr Bramley said: "We are the first DHB to get a full external review of quality systems from the grassroots all the way through the organisation. I have encouraged other DHBs to do the same. It's a different focus ... seeing how well are you really doing, what's working well and where are the opportunities for improvement."

The Health Quality and Safety Commission chairman, Professor Alan Merry, welcomed Mr Paterson's report.

"The commission will be encouraging other DHBs to consider this as a very good idea," he said. "It is a really good thing to seek an expert, outside view ... mostly these things happen in response to some sort of problem or event that precipitates an inquiry."

Aside from quality of care, other aspects of the Paterson review include serious adverse events and patient-centred care.

The DHB has adopted his recommendation to publish in meeting agendas the findings of investigations into cases where healthcare goes badly wrong - the "serious and sentinel event" brief reports which are at present released annually through Professor Merry's commission.

On patient-centred care, Mr Paterson noted that the majority of complaints to the DHB appeared to be due to patients experiencing "a lack of respect and caring", and that this was also a key theme of his 2009 North Shore findings.

"The fact such issues endure points to some deep-seated cultural issues - which are all too common in hospitals in New Zealand and internationally."

The DHB is following the Paterson prescription, but Dr Bramley said it had already taken huge strides in care and compassion since 2009 and even this year, including training for frontline staff in customer service.

"People [in hospital] are vulnerable, scared and sick. We have reoriented the whole purpose of the organisation."

Next week, the DHB will start a trial of the "Friends & Family Test", an ongoing survey initiated in Britain, to assess staff respect and service and whether patients would recommend the ward to friends and family.

Dr Bramley has also started having videos of patients telling of their experiences - good and bad - shown to board members before every meeting and to staff.

Chief medical officer Dr Andrew Brant said the patients' stories were about connecting with staff at an emotional level.

"It's about why we are actually doing this job and the patient stories help. This is a way of engaging our staff in this quality initiative rather than using slogans and data.

"People go into health because they see it as a vocation. We all turn up to work because we care."

Staff see hospital through patients' eyes

Pam Johnson never made a complaint about the care she received at North Shore Hospital, although she admits she started "getting a bit cross".

The 78-year-old retired teacher, of Glen Eden, with a number of other former patients, features in videos used by the Waitemata District Health Board to try to beef up the level of compassion its staff show for patients.

Mrs Johnson visited Waitakere Hospital's emergency department in February last year for unstable angina. The following month, she was treated at the North Shore ED for pneumonia, which had been causing severe pain and a high fever.

During the pneumonia episode she was transferred to a North Shore ward and spent 11 days in the hospital.

She said the ED staff at both hospitals were "wonderful", but her experience on the North Shore ward, where the staff were extremely busy, was mixed.

She praised the nursing staff and said the young doctors were "lovely", but some of the senior doctors were "aloof at times" and she couldn't get answers to her questions.

"I queried a diet I was put onto, jelly, icecream and fruit juice, for two or three days. Nobody would give me a direct answer as to why."

Then she couldn't get an answer about why she was given an injection in her abdomen.

"This is when I started to get a bit cross. I thought, 'I may be elderly, but I'm not stupid.'

" ... They are talking to their medical [group] half the time; they're not talking to you.

"I still never got what I would call a satisfactory answer why I was getting these injections."

The request for Mrs Johnson to be videoed about her hospital stay came through a community health group where she had heard a talk by anaesthetist and author Dr Robin Youngson, the founder of the Hearts in Healthcare movement which aims to rehumanise healthcare.

"His book [Time to care: how to love your patients and your job] was on compassion. All the things I had worried about were in this book. What he spoke about related to my experiences in hospital."

Rate my health workers

Patients will be asked to rate their ward with tick-box answers on tablet computers in a trial at Waitemata District Health Board hospitals.
*How likely are you to recommend our ward to friends and family if they needed similar care or treatment?
*Did we see you promptly?
*Did we listen and explain?
*Did we show care and respect?
*Did we meet your expectations?

- NZ Herald

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