Proposed restructure at Waikato Hospital would disrupt patient care, remove accountability

Patient flow would be disrupted under a proposed restructure at Waikato Hospital, according to an expert, but Waikato DHB is working on another proposal. Photo / Christine Cornege

Leaders of a radical restructure at Waikato Hospital, that would create a "fat corporate structure" and "disjointed patient flow", have gone back to the drawing board after receiving almost 1000 pages of submissions from staff.

The restructure follows a damning review last year that revealed patients cared for by Waikato District Health Board are spending longer than average in hospital, there's a lack of funding to improve Māori health inequalities and tension between clinicians and management.

But a 42-page consultation report proposing the new structure, seen by the Herald, caused an "uproar by clinicians" when submissions were called for in August, according to a source close to the DHB.

"The restructure took power away from clinical directors and gave it to non-clinical people," the source said.

The significant amount of feedback prompted the DHB to rework the restructure proposal, with an updated document and consultation period due early November.

An organisational design expert, who did not want to be named, called the first proposal an "absolute mess". They said it:

• Increased organisational levels by three resulting in higher patient costs and diminished single point accountabilities;

• Turned the hospital into a large corporate structure taking people away from the business at hand;

• Left clinical groupings mismatched to logical patient flows causing disjointed patient movement, meaning the time to treat and cost would likely increase;

• Moved control of doctors to middle management. For example, doctors would work five levels below the chief executive.

The expert said the restructure was supposed to improve accountability yet accountabilities were shared by "leadership teams".

They believed the initial proposal would have resulted in "organisational paralysis".

"It looks like someone is building an empire and trying really hard to move themselves as far away from patients as is humanly possible.

"Give the hospital back to the doctors and get rid of these useless levels of counterproductive bureaucracy."

A health management expert, who also did not want to be named, said there was merit in restructure but leaders needed to be careful not to "over-engineer" the hospital, known as the "provider arm".

He said too many managers often resulted in unnecessary extra co-ordination and communication, and turf wars or boundary issues where there was no clarity of who is responsible for what.

Waikato DHB chief executive Dr Kevin Snee told staff in July the proposed structure was aimed at strengthening clinical and operational partnerships aligning leadership, creating clear accountability for shared clinical, professional and operational decision-making, ultimately improving patient care.

Waikato DHB chief executive Dr Kevin Snee said the updated proposal will take account of the synergies between services and the complexities of each service. Photo / Duncan Brown

In September he told staff there were almost 400 individual submissions totalling close to 1000 pages - which he had personally read.

"The quality and thoughtfulness of your feedback has been heartening, providing insight, helping to correct mistakes or misconceptions, and helping to shift some of the thinking about what a new structure should look like," Snee wrote.

"This is one of the most significant restructurings that has taken place at the DHB, so I will be working with the team and taking on more of a leadership and decision-making role in developing the structure moving forwards."

Snee said some of the feedback indicated some staff had perceived an undue emphasis on having directorates of a similar size.

"We want to assure you that in our updated proposal it will be clear where we have taken account of the synergies between services, the complexities of each service, and we recognise the importance of how our services work with our primary and community care partners."

The author of last year's review and leader of the restructure executive team, Leena Singh, said in a video in August there was significant inequity in the lack of accountability framework within the DHB structure.

"We have, over the last six months, had a look at the recommendations from the resource review and determined that as we progress through the rest of the organisation's levels that inequity and confusion and lack of transparency around our structure existed even further than what we thought it did," Singh said.

The Herald asked to interview Singh and put questions to the DHB about the criticisms of the restructure.

A spokesman said there had not been a provider arm restructure of the scale initially proposed in the past 10 years.

He said the DHB would not provide further information or interviews for media at this time because it was important to communicate with staff directly and allow them opportunities to provide feedback.

"It is not appropriate to do this via media."

He said the DHB was preparing an updated proposal incorporating staff feedback and expected there would be significant changes made to the proposal followed by a full re-consultation.

"We are grateful for how our staff have engaged with this process as a key element is how we use it to build the culture of this organisation, it isn't just about structure."