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Ryall Speech to Emergency Medicine Conference ‘08

Hon Tony Ryall
Health Minister

24 November 2008

Speech to Australasian College for Emergency Medicine Conference ‘08

Thank you for the invitation to open your conference... the first for ACEM here in our nation’s capital.

In my brief remarks today I want to support your drive for greater clinical leadership, to cover our plans to give doctors and nurses more say, and to outline how a new National government intends to hold hospital managers and governors accountable for working with you to improve your service.

It’s a measure of how important your work is that New Zealanders are increasingly concerned about hospital gridlock, excessive delays and poor service as a result of those delays.

No doubt, you feel like the meat in the sandwich: squeezed between the public’s rightful expectations of reasonable service on one side, and the delays and constraints in hospital wards.

Emergency departments have been described as being “barometers” for how well a whole hospital is doing. It’s not just elective surgery and outpatient appointments that are squeezed by shortages of doctors and nurses and facilities... although the growing waiting times do get most attention.

At the same time the overload in hospitals shows up when you cannot get patients into wards, or do not have enough resources to cope with people coming in the door.

Our starting point is New Zealand needs a more responsive health system: one that responds to the priorities of New Zealanders.

It is the public’s priorities that inform the new Government’s priorities. New Zealanders want better, sooner, more convenient healthcare, and they want accountability for results. And that is our goal too.

But we can’t do any of that without you, and other health professionals.

Clinical Leadership

Globally, clinical leadership is recognised as a fundamental driver for better health outcomes. In contrast, the influence of clinicians on patient outcomes here in New Zealand is now less than it has even been before.

This failure to engage the very people with the right expertise – doctors and nurses who know the patients’ needs best – is seriously eroding your ability to provide patients with the care they need.

Recent research by McKinsey and Company based on 126 hospitals across the UK has found a clear link between strong clinical leadership and hospital performance.

The researchers found that best practice approaches in hospitals had a positive impact on productivity, infection rates, readmission rates, and patient satisfaction. And finance.

But the real key to this success was the level of involvement of clinicians in running their hospital services. Stronger and more direct clinician involvement means more service and better quality.

And that is why the new government wants a new partnership with the health professions. We will trust and value our health professionals. We will engage you in decisions about the future of health services. We will not see you as costs, but as a valuable resource.

The National-led government will ensure that doctors, nurses and other health professionals have more say in how health services are developed and improved.

We will do this by requiring DHBs to involve health professionals in decision-making. This is not to say that we want doctors and nurses to stop doing what they were educated to do and become managers. And we do acknowledge that many managers are also clinicians. But we do want to use the wealth of frontline experience you have accumulated to improve quality of care and rebuild confidence in the public health system.

Better clinical engagement will improve quality and job satisfaction. This will help the public health service retain skilled clinicians and attract new staff.

Along with that we will challenge the health professions to become leaders in improving the delivery and quality of patient care across all parts of the health system; to work collaboratively with management; and to deal effectively with any poor standards of practice where you see it.

You have solutions to problems facing our health service. Come to us and we will work on them together.

Emergency Departments and Acute Care

As Professor Michael Ardagh has written: Emergency department overcrowding is widespread and worsening. International evidence is clear that overcrowding and long patient stays in ED are linked to poorer patients outcomes, longer in-patient stays in hospital, and less service. Languishing in a corridor isn’t good for anyone.

And since we are now in these difficult financial times, we must all note that delays in the long run are likely to be more expensive than doing things sooner. Eg: delayed treatment of fractures and other injuries can lead to infections, more pain and DVTs.

ED presentations have grown by an estimated 20% in the past five years. This is well in excess of population growth.

I am told that the Ministry of Health recently requested patient-level length of stay information from one large and two medium-sized EDs over a two-week period in the usually less pressured month of February. While the majority of patients were seen within several hours, a significant minority waited much longer. At one of these three hospitals up to 20% percent of patients spent longer than eight hours in the ED. But if you look at only those patients later admitted to hospital, between 10 and 37 percent of patients spent longer than eight hours in the ED.

I don’t need to tell you about the pressure of hospital gridlock or access block. Patients languish in ED because there are no beds available in the wards.

This is not unique to New Zealand. All around the world hospitals have been working to speed up emergency departments and to get patients into wards sooner.

A few months ago I travelled to Adelaide to visit Flinders Medical Centre.

I won’t go over what’s happened there because you’ll know it better than me. But I came away with the clear understanding that it is motivated and supported doctors and nurses who make this faster, better, more approach happen. Not just managers.

Similar improvements have happened in many hospitals throughout Britain.

As you know, key to the British success in reducing waiting times in EDs was the NHS target that ‘by 2004 no patient should wait more than four hours from arrival to admission, transfer or discharge’. Within a few years, I understand, the number of people waiting in EDs for more than 4 hours fell from 23% to only 3%.

There’s little accountability for governors and managers in New Zealand when it comes to ED waiting times. DHBs that perform poorly were usually excused and praised by the previous Government.

The new National-led government will be introducing a new set of Health Targets to reflect the public’s priority for better, sooner, more convenient health care. We will be holding district health boards and management accountable for meeting these targets. These targets will be included in their performance arrangements.

The government will introduce firm targets for emergency department waiting times. No longer will it be acceptable for DHBs to leave patients waiting endlessly. I will consult with you in setting these targets, and ensure DHBs work with you in making it possible for you to meet them. We are determined the quality of care will not be compromised by the target but improved.

We are awaiting the report of the ED working group before finalising the ED target.

Around the country we have hundreds of superbly qualified and motivated clinicians who can work with management and take responsibility for redesigning and improving their services.

Speeding up emergency departments, and improving acute care is a priority for a National-led government. We will seek your help and support to use your skills to achieve this.

Your conference ahead looks very interesting. I’ve no doubt you’ll be fascinated and challenged. No doubt you’ll be thinking how you can apply what you’re hearing to your hospital.

As I travel around the country listening and talking to doctors, nurses, midwives and other health professionals I often ask: what really frustrates you about working in health care today? Is it the money? Or is it the lack of respect by the centre? Or is it the inability to use the skills you trained for and the experience you’ve gained?

What I have found out is that all of you are very dedicated to doing better for your patients and would like a more responsive system that allows you to guide the improvements to do so.

These answers always make me optimistic for the future of the NZ public health system.

Our hospitals and GP clinics are staffed with dedicated people who want to do the best for their patients and New Zealand. They want to be valued, respected and involved. They want to make a difference. So do we.


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