Dysfunctional hospitals: presentation to HRC

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Dysfunctional hospitals presentation to HRC

• NALEDI
• May 2007

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NALEDI

• COSATU research/policy institute
• Research at Chris Hani Baragwanath hospital
• Transformation advisers to labour management
• Research into 8 public hospitals for DPSA
• Transformation consultants at CHB
• Research/knowledge from below

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Research results

• Dysfunctional management structures
• Underfunding understaffing
• Public hospitals are stressed institutions
• Impact on clinical outcomes

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Understaffing

• National public health staff
• 235 000 (1994)
• 213,000 (2004)
• 225,000 (2006)
• Redistribution from hospitals to clinics
• Regional Hospital staff shortages
• 24-31 shortages (three cases)
• 0-6 shortages (three cases)

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Understaffing tertiary hospitals

• Johannesburg General
• 23 understaffed all staff (1100 posts)
• 28 understaffed nurses (500 posts)
• Chris Hani Baragwanath
• 52 understaffed all staff (5200 posts)
• 46 understaffed nurses (1750 posts)
• CHB staff establishment is 7500
• funded posts are 4800 (36 understaffed)
• CHB Surgical Division
• 251 permanent nursing staff
• 158 agency nurses (39)

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Dysfunctional structures

• Head office does not have the necessary
  competence to do their tasks. They do not know
  what is happening on the ground. More powers is
  precisely what is required, especially for HR and
  finance. CEO
• When we meet with management we complain about
  the shortage of staff, the linen, cleaners - they
  tell us to try your best! Its a joke! They come
  with no solutions. Who do we cry to? We never see
  the head of nursing. We never see the CEO. We
  never see the clinical head. (Professional
  Nurses)

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• The budget is meaningless, it bears no relation
  to operational activity. (Clinical Head)
• No-one takes responsibility. CPN
• We have reached the ceiling, there is nowhere
  for us to go. There is no recognition and no
  incentive. - In-charge CPN

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Staff shortages

• Our patients are helpless. Others come and go, I
  remain. I must skip my tea. I have to jump, to
  rush time - I must stop washing and serve tea. If
  there are no ward attendants I must make tea
  myself. Theres no point in washing the patient
  and giving medications, but failing to feed him.
  You cannot leave the patient with an empty
  stomach. Again, how can you leave a sick person
  in a wet bed and go for lunch? - NA

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• We always have to rush we wash, we medicate,
  we move on. You miss some things. You cannot
  listen to the patient. You cannot implement
  things that would improve health care and staff
  morale. We also have to do inventory, push
  patients to other departments, clean floors, take
  a trolley to fetch food and dish up, all because
  there is a shortage of support staff. Nurses
  resign, die, retire, and they cannot be replaced.
  You cannot have tea, you cannot eat. We become
  demotivated and no longer have empathy.
• -- group of CPNs

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• The biggest change since democracy is a shortage
  of staff - Nurse
• People resist working properly through
  frustration at unreasonable workload. Staff
  shortages cause aggression. - Matron
• We sometimes only do the most critical patients.
  Sometimes we just top and tail patients instead
  of giving them a full wash. - In-charge nurse
• Im the worst, Im the Atlas carrying the ward.
  We have to ignore the rules we were taught in our
  training. - NA

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Clinical care

• Everything is done in a rush and staff are left
  exhausted, resulting in avoidable morbidity and
  mortality. CHB clinicians
• We have had cases of wound sepsis because we
  have nothing to wash our hands with. CPN
• Recently shortages caused a patient who needed
  turning to get bedsores. This led to
  complications and then the patients death. CPN

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Recommendations

• Recommendations sent to January 2006 Cabinet
  Lekgotla
• Cabinet accepts recommendations
• Gauteng MEC implements
• Piloting at Chris Hani Baragwanath Hospital