"The only way is up" for Whanganui Hospital after trainee doctors rated it their least preferred place to start work as a qualified doctor.
Final year medical students are asked to rank their top three preferences for the hospital they wish to start work in, with the results published in the New Zealand Resident Doctors' Association's (NZRDA) annual Hospital Review. Whanganui Hospital was in last place for the 2019 training year with only one applicant choosing it as their first preference.
The only way is up for us
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The report points to the Whanganui District Health Board's management, staff wellbeing and welfare and problems confirming safer rosters as the key issues for junior doctors. It notes that the arrival of a new chief executive may bring "some much-needed change".
Whanganui District Health Board (DHB) chief executive Russell Simpson, who has been in the job for eight months, said being ranked last was disappointing but there were plans in place to improve perceptions of the hospital and Whanganui.
"The only way is up for us," Simpson said.
"It's disappointing to be sitting at 20 out of 20. A lot of it is out of our control in terms of perceptions of Whanganui. I've met with a number of non-government and government agencies and the Chamber of Commerce to look at positive strategies to attract people to Whanganui, not just for health but for manufacturing and other opportunities.
"I would like to see us substantially lift in the ratings next year. There is a commitment by both parties [the DHB and NZRDA] to lift the ratings but we need others to help as well."
NZRDA national secretary Dr Deborah Powell had agreed to come to Whanganui to work with the DHB and junior doctors on "positive engagement strategies", Simpson said.
From November, trainee doctors from the University of Otago's Wellington school will be placed at Whanganui Hospital. For the first year of the contract, there will be three or four trainees per quarter and from November 2019 the trainees will spend the whole year at Whanganui Hospital.
Chief medical officer Dr Frank Rawlinson said the trainee intern year was seen as a feeder in terms of where new doctors wanted to work when they graduated.
"We are establishing an education centre as part of the agreement with the University of Otago," Rawlinson said.
"There will be simulators, baby and adult, for training exercises. We will have a room set up as a ward, another as a doctor's office, so they can do real examinations. There will also be a lecture theatre. The education centre will be used by a variety of disciplines, not just the trainee interns."
The environment will become increasingly supportive with these other components
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Rawlinson said in the past trainee doctors at Whanganui Hospital had to go to other hospitals to complete the "live training".
"The environment will become increasingly supportive with these other components," Rawlinson said.
"At most other hospitals they don't get to deal with senior doctors; they deal with the registrar or senior registrar."
Rawlinson acknowledged that Whanganui Hospital usually was not the first choice for new doctors but said the majority who came to the hospital renewed their contracts. Three current post-graduate trainees would soon take three months off at the end of their contracts to travel overseas and then return to Whanganui Hospital.
Rawlinson said people had long memories about Whanganui's chequered health services and the hospital suffered from national perceptions about historic events, despite the DHB's attempts to improve its reputation.
Simpson, who has worked in the health sector for 20 years, said in the past Whanganui was regarded "as a place you don't go in health".
"In the last 10 years I saw Whanganui start to lift itself. Key was the investment in culture and staff culture, cultural values."
Simpson says engagement with staff was a priority.
"I spend a lot of my time out on the floor, face to face with staff. I'm very proactive in communications and update the staff every week on what's happening with the DHB. I like to model walking beside people rather than a hierarchical structure."
Rawlinson said Whanganui Hospital had three rosters. Two were in place and the third had agreement in principle but documentation around fatigue management needed to be signed off. He said it was planned to implement the roster at the start of the next quarter in November.
Staff and patient safety were paramount and the hospital had a culture where staff were "not at all concerned" about raising issues, Simpson said.
RMO wellbeing and welfare doesn't appear to be on Whanganui DHB's agenda. They have really struggled with reaching compliance with Schedule 10 safer rosters... Coupled with this is an attitude that Management is always right
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"Don't go there...
"RMO wellbeing and welfare doesn't appear to be on Whanganui DHB's agenda. They have really struggled with reaching compliance with Schedule 10 safer rosters... Coupled with this is an attitude that 'Management is always right'...
"They do, however, have a new CEO coming onboard in the near future, and we hope they will bring some much-needed change in this DHB."
However, the report goes on to say that training is likely to be approved, the workload is manageable on the wards, there is one-to-one contact with consultants which allows for better learning and procedural experience and SMOs are generally approachable, supportive and friendly.
"There are a number of different factors which influence a doctor's decision about where to work, including some unrelated to the hospital itself, such as where they want to live," Dr Deborah Powell, national secretary of the New Zealand Residents Doctors Association, said.
"Nonetheless, factors such as employer compliance with employment terms and conditions, safer rostering practices, appropriate training and supervision are hugely significant to our new graduates."
The NZRDA says the ranking "is a reflection of Whanganui Hospital's unsupportive management approach and failure to implement their single safer roster. These ongoing issues placed them near the bottom of the list last year and it seems no effort has been made to change, seeing Whanganui now slipping to the bottom of the list."