Organisational change must address cultural issues, say nurses. By Linda Belardi
Nurses have cautiously welcomed Premier Anna Bligh’s announcement to dismantle Queensland Health, but say there are no quick fixes to the troubled organisation’s entrenched cultural problems.
The break-up of the state’s largest employer will only work if more authority is devolved to frontline staff, said Queensland Nurses Union secretary Beth Mohle.
“The reform process is one that is going to take 20 years to turn around because it is about entrenched power. There are a lot of power imbalances in healthcare and we have a problem with nurses and midwives not having sufficient authority to carry out their responsibilities,” she told Nursing Review.
Mohle said there was not only a problem with corporate administration but with the level of teamwork and co-operation between clinical staff.
Nurse unit managers and nursing directors currently don’t have sufficient control over their own budgets to co-ordinate nursing resources, she said. “Nurses have all of the responsibility but none of the necessary authority to be able to control health services and to co-ordinate them appropriately.”
Bullying was also a significant cultural problem affecting the system. “Doctors and nurses have to work closer together. The 21st century health system is one which should be team-based and it should be focused on the patient.”
Bligh announced on December 12 that Queensland Health would be abolished and split into two new entities.
Under the plan, the large department will be separated into a hospitals and healthcare agency with responsibility for managing the hospital system, and a health services support agency to provide corporate services including finance, HR, and information and communications technology. Bligh said the new agency for corporate support will have somewhere between 3500 and 4000 employees.
The government has appointed Shane Solomon, national leader of KPMG's health practice and a former head of health in Hong Kong and Victoria, to advise the changeover process.
Solomon will report back to state cabinet on January 23 with an implementation plan for the new health system. Bligh has not ruled out the creation of two health ministers to oversee the new entities. She said Queensland Health would cease operating by July 1, 2012.
“The decentralisation has begun with the national healthcare reforms to develop local hospital and health networks. But that’s not enough. We will now embark on a process to dismantle Queensland Health as we know it,” the Premier said at a press conference.
Mohle said she was very concerned that the significant amount of work involved in preparing to implement the federal government’s national health reform could be derailed.
The union had sought confirmation from Solomon that the national and state reform agendas would be complementary.
“We have put a lot of work into national health reform as a union so we didn’t want to see Queensland Health go down another rabbit hole.
“Effectively what we want to ensure is that any structural change facilitates that devolution of power to the local level through the 17 local health and hospital networks and it doesn’t just serve to add another layer of bureaucracy or control.”
She said members were fed up with a string of disasters that have plagued Queensland Health including the 22-month payroll debacle.
The break-up of the department will represent the largest decentralisation of a public sector agency in Queensland’s history. Bligh said that with 80,000 staff Queensland Health is larger than the five biggest companies in Australia.
The alleged theft of millions from the department triggered the announcement. A public servant is alleged to have siphoned off $16 million over three years.Do you have an idea for a story?
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