WA News News & Reports Waste under scrutiny
Waste under scrutiny
Written by Jan Hallam
Wednesday, 07 June 2017

 

After Dr Belinda McManus contacted us, we sought some clarification from the Department of Health as to the status of the Sustainable Health Review mentioned in the published response by the Director of the Environmental Health Directorate.

It was announced as we were going to press and will be followed up when it begins in earnest in August.

Digging around, we found a report into Consumable Stock Management in Hospitals prepared by the Auditor General in February 2016. Its preliminary audit found no evidence that the procurement, storage, delivery or quantities of hospital consumable stock were mismanaged.

The auditors visited Royal Perth Hospital, Bunbury Regional Hospital and the State Distribution Centre (SDC) and analysed relevant data.

It found the electronic imprest system worked efficiently in stock control. The imprest system measured the desired amount of each consumable item, in each imprest storeroom, in each ward, in each hospital. When stock reached a lower than desired amount, an order was automatically generated.

Stock is managed in all metropolitan hospitals by the Health Corporate Network (HCN). As an illustration of the scale – RPH has 116 imprest stores. The HCN also runs the SDC where around $6.5m worth of consumables are held on any given day. This equates to about four weeks of stock supply for all metro hospitals.

Product selection

This is where it gets a bit unwieldy but the AG’s team was satisfied with the process. “A robust assessment of the quality, value, safety and function” of a product is undertaken before an item is added to the imprest stores. The assessment is done by a committee of senior nurses and clinicians. Products considered faulty or substandard once in use go through an evaluation process.

However, the report did identify a significant shortcoming: hospitals don’t monitor actual use.

Once an item leaves the imprest store, no hospital is able to determine if it was used, discarded or still remains within the confines of the hospital.  “Therefore actual use and consequently waste of consumables is not known,” the report said.

“The volume of consumables used in each hospital is substantial and methods for directly tracking use may not be cost effective. Senior staff in Health expressed a desire to measure actual use and waste, but as yet, no appropriate direct methods have been identified.”

“Senior staff also believe improvements may be made by indirectly monitoring waste as Health moves to an activity based funding model…It requires extensive knowledge of the exact costs of providing care to a patient, including the cost of consumables.”

It recommends the Department investigate such an accounting method.

By Jan Hallam

 

While communication is one thing, investigation of notifications is another. We believe good doctors want the bad ones weeded out but they don’t want to be part of a witch hunt or get buried in lawyers, politics or paperwork.

The national Medical Board can respond to a complaint or act on the advice of the WA Medical Board to establish an assessment panel to either examine the health or performance and professional standards of a doctor. Health consumers are represented on panels along with medical practitioners.

The Medical Board and AHPRA have undisclosed lists of doctors who are approved by them as panellists and probably as expert witnesses. Many of these people, we believe, were ‘grandfathered’ across when National Law first came in (2010). Their impartiality is as unknown as they are. Then we have expected biases of the legal assessors, chosen by AHPRA, possibly thrown into the mix.

Is there a problem, Houston?

It is important this is sorted to everyone’s satisfaction as 42% of doctors in our survey thought panellists could lack impartiality to a serious extent.

In fact, only one quarter of doctors we surveyed (n=195) were happy with the impartiality shown by AHPRA or the Medical Board in processing a complaint (with 36% unhappy and 39% undecided). Nearly all of those who were unhappy said they were concerned that unfairness will be seriously damaging to someone. Investigation is a very confronting experience.

If someone is being investigated by a panel, either the panel or the person being investigated can opt for a more out-in-the-open State Administrative Tribunal (SAT) judicial hearing – the panel usually refers because it feels the evidence before it constitutes more serious professional misconduct.

What Fair Doctors Want

Talking to doctors, they appear to want an apolitical system of investigation that is fair and timely. They want to be treated reasonably. Unlike the legal profession, their work is mostly built around trust and honesty. They do not want a return to the ‘good old days’ where those with a political bent in the medical profession could influence what the Medical Board did.

While this is a very difficult area for us to investigate, with arguments and counter-arguments at every step, we cannot understand why the Medical Board would turn to arguably the most political organisation, the AMA, for its counsel (the national Board Chair met earlier this year with “senior leaders from AHPRA and representatives of the AMA” to workshop doctor complaints).

Why? Our e-Poll responses raise a question mark over the AMA’s involvement (and we don’t think AMA members have been polled on this issue.)

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