Organisational Governance and Performance Management Report - Analysis

This report examines the corporate governance failures at Bundaberg Hospital, focusing on the clinical governance failings identified by the commission of inquiry. The report details issues such as the failure to properly vet medical staff, specifically Dr. Jayant Patel, leading to adverse patient outcomes. It also highlights failures in risk management, communication, and the presence of unethical practices like workplace bullying. The report then explores governance mechanisms that could have prevented these failures, including adherence to health policies, thorough background checks for medical professionals, internal audits, and a robust reporting system with an ethics committee. The analysis emphasizes the importance of organizational culture, leadership, and quality improvement in preventing such incidents and ensuring patient safety. The report references the Queensland Public Hospitals Commission of Inquiry and relevant clinical governance standards.

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Organisational Governance and Performance Management
8/29/2019
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Organisational Governance and Performance Management
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Contents
Question 1........................................................................................................................................2
Question 2........................................................................................................................................3
References........................................................................................................................................6

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Question 1
Corporate governance can be understood as a system of good governance. This system
includes ethical values such as integrity, transparency, honesty and so on (Thomson, 2009). An
organization has various stakeholders and in such a situation, the same is required to act accruing
to ethics and moral principles. At many of the incidents, it has been seen that entities forgot
considering the interest of other workgroups and focus on one or two only. Different reasons
exist behind different corporate governance collapse. The focus of this report will be made to the
reasons behind corporate governance failure of Bundaberg hospital. The issue has been reported
in 2005 where a commission of hospital inquiry made the investigation in Bundaberg hospital of
Queensland state of Australia. Different clinical governance failures have identified in this case.
As per one of the principles of clinical governance, hospitals owe a duty of care to patients as
well as other staff members. Bundaberg hospital failed to perform this duty of care to not to harm
others as it failed to check paper credentials of a new medical staff member Dr. Jayant Patel
properly. During a period of 1978 to 2005, Dr, Patel was engaged in several adverse clinical
outcomes, due to negligence and poor clinical practice, not only in Australia but in other
countries also (Casali & Day, 2010). If to consider a particular case, this is to state that in one of
the case happened, in 1984, he failed to examine the patient before surgery and therefore his
surgical practice was restricted. This was not the only case against him but many others were
also there. Despite these cases and negligent record of Dr. Patel, Bundaberg hospital appointed
him as head of surgery in 2003 (Johnstone, 2011). This was the significant failure of clinical
governance as in addition to paper credentials, the hospital also failed to check competency and
eligibility of Dr. Patel before appointing him on the position of senior medical officer in surgery.

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Hospital failed to check his credential and past medical practice record. Dr. Woodruff of the
Review Team considered nearly 221 clinical records. Out of these cases, in many Dr, Patel found
to be guilty of medical negligence. In 8 cases, this negligence contributed to the death of
patients. It was concluded that Dr. Patel lacked many of the many of the qualities of a competent
surgeon.
Only Dr. Patel cannot be held liable but other doctors who received complaints against
him were equally responsible. Dr. Keating or Mr. Leck did not pay enough attention to the
complaints that they have received against Dr. Patel and failed to investigate the issues properly
(Qphci.qld.gov.au, 2019). This negligence of these two doctors further contributed to the failure
of clinical governance.
Further, another failing identified was related to the risk management framework of the
hospital which was also examined under the said inquiry. Clinical Governance committee
structure found complexed and it was also detected that there was no single committee which
was delegated the liability of quality and safety issue. In the case of reporting of concern, there
was a lack of proper communication and flow of information. In addition to this, in the
subjective inquiry, it was also found that the Bundaberg hospital consists of unethical practices
such as workplace bullying and harassment (Casali & Day, 2010). The subjective inquiry
revealed that the lead reason behind the resignation of many of the frontline medical staff
member was bullying and victimization. This is another case where medical governance seems to
be failed at Bundaberg hospital. If to discuss the quality of care and clinical outcomes, the
situation of this hospital did not find satisfactory.

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Question 2
All the clinical failures found in Bundaberg hospital could be prevented in one or more
way. Few of the mechanism that could be there in the place and assisted in avoiding clinical
failings at this hospital are mentioned as follow. Firstly, the issue could be prevented if the
hospital had the practice to ensure the consistency with the state's health policy and awards for
medical staff employment. Secondly, a proper check system was required to be there in order to
tract the records of appointee doctors and other healthcare professionals. The failures may be
avoided if before the appointment of Dr. Patel a proper inquiry would have been conducted.
Most of the issues of the case have been a result of the appointment of Dr. Patel and his
negligence. This was the major incident where the hospital failed to follow clinical governance.
Workplace harassment and bullying were also there and here again, the hospital failed to
maintain its corporate governance. The current clinical standard seems to be a good remedy to
the issues identified a Bundaberg hospital. The standard provides provisions related to
organizational culture, leadership, quality improvement and so on (Safetyandquality.Gov.Au,
2019). If policies as mentioned in clinical standard would have been there at the time of
Bundaberg findings, then the issues could be avoided.
Further, whenever it comes to the discussion of governance mechanism, internal
governance audit plays an important role. Corporate governance, as well as clinical governance
failures, could be prevented through an internal audit mechanism. This system checks the
internal proceedings of the organization and let the business managers know the processes where
improvements are needed. If Bundaberg hospital had such a mechanism then the issue of

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negligent appointment of Dr. Patel could have been identified at an earlier stage and lives of
many of the patients could have been saved.
As mentioned above, Dr. Keating or Mr. Leck failed to take reasonable actions on time;
the situation could be deal with a proper reporting system. If an ethics committee was there in
place, then the solution of complaints would not have been delayed. In this manner, this can be
stated that by having a proper reporting structure, ethics committee, and ethical organizational
culture, issue clinical failings at Bundaberg could be avoided.

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References
Casali, G. L., & Day, G. E. (2010). Treating an unhealthy organisational culture: the implications
of the Bundaberg Hospital Inquiry for managerial ethical decision-making. Australian
Health Review, 34(1), 73-79.
Johnstone, M. J. (2011). Bioethics: A Nursing Perspective. Australia: Elsevier Health Sciences.
Qphci.qld.gov.au. (2019). Queensland Public Hospitals Commission of Inquiry. Retrieved from:
http://www.qphci.qld.gov.au/final_report/Final_Report.pdf
Safetyandquality.Gov.Au. (2019). Clinical Governance Standard. Retrieved from:
https://www.safetyandquality.gov.au/our-work/clinical-governance/clinical-governance-
standard
Thomson, L., M. (2009). What is corporate governance? Retrieved from:
https://economictimes.indiatimes.com/money-you/what-is-corporate-governance/
articleshow/3995278.cms?from=mdr