Merepeka Raukawa-Tait: DHBs have a tough job

Rotorua Hospital. Photo / File

A recent short stay in hospital convinced me we are lucky to have the health system we have in New Zealand.

Yet in the past 12 months a number of DHBs have come under fire for the quality of services they provided. Below expectations in some instances.

From my observations while in hospital, as an elected member of a DHB, I believe DHBs are doing the best they can to provide hospital services that will produce better long-term health outcomes for patients.

Doctors in our hospitals perform thousands of surgical procedures and operations each year.

When I went into hospital I never feared anything would go wrong. But I was told all operations present an element of risk.

And at times things can and do go wrong. Horribly wrong in some cases. The best systems, and doctors, in the world can't prevent mistakes and mishaps from happening.

How would I feel if the system didn't perform as it should for a member of my family? Devastated I'm sure.

During my short stay I watched and observed dedicated clinicians, nurses and other medical team members doing their work.

They showed total dedication to the job. It must be heartbreaking for them if something goes wrong and they, or their systems, are found to be at fault.

I don't believe any doctor deliberately sets out to harm a patient. But when systems don't perform as they should, are not regularly updated if need be, or accurately followed mistakes can happen.

When I read reports about a preventable incidence it is more often a systems failure at fault. Recommendations will include the need for a systems review to prevent further unfortunate mistakes.

But systems change is difficult to accomplish as systems are interlinked. Change one part then other parts will be affected.

I worked for an organisation once that embarked on a whole systems review. It was felt that changes would benefit the business.

They would have too but after two years the project was canned. It threw up so many problems it became too time-consuming and costly. We seemed to be going round and round in circles.

The majority of people who need hospital services will be well looked after. But perhaps it's time to look more at prevention, trying to help people avoid ending up in hospital in the first place. Look at wellbeing and how that affects a person's life.

As the biggest part of our health dollar is spent after the event on hospitalisation, trying to fix and heal, by making wellbeing a priority we become proactive rather than reactive in managing the determinants that impact how well we live.

I was reminded recently that DHBs are health boards not hospital boards. Therefore hospitals can only be part of the solution to quality health services.

When things go wrong investing in systems change may be necessary. But investing early in what makes people happy and their basic needs such as food, shelter, income, positive social relationships and access to modern conveniences can all interact in influencing wellbeing.

Vulnerable communities, those struggling to deal with their most vulnerable in terms of health, wellbeing and socio-economic parity have a constant and uphill battle. Better engagement with those who have proved hard to reach or that have slipped through the cracks can have a notably positive effect.

DHBs have a big role to play in this area. So too do GPs and other health service providers if they start to move from just avoiding or minimising illness to also focus on resilience, self-management and wellbeing. Outcomes can be life-changing.