Organisational Governance and Performance Management Analysis - Report

This report examines organisational governance and performance management, particularly within a hospital setting. It identifies critical failings in clinical governance, highlighting issues such as unhealthy organisational culture, lack of adherence to codes of conduct, poor adverse event reporting, and inadequate teamwork. The report analyzes the case of Bundaberg Hospital, where these failures led to adverse patient outcomes. It also explores governance mechanisms that could have prevented these failings, including proactive regulatory roles, improved reporting procedures, a strong ethical culture, whistleblower protection, and performance audits. The analysis underscores the importance of effective communication, accountability, and ethical decision-making in healthcare organisations to ensure patient safety and quality of care. The report provides valuable insights into how to mitigate risks and improve overall performance in healthcare settings.

Organisational Governance and Performance Management
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Organisational Governance
Question 1
One of the key expectations for a hospital is that a healthy organisational culture must exist. Such an
organisation culture must promote the shared values which consist of both the staff values coupled
with espoused organisational values. For a hospital, the espoused organisational values are even
more critical considering that human life is at stake and hence compassion and integrity is of utmost
importance and has been spelled in the form of Queensland Health Code of Conduct. This unhealthy
organisational culture has led to a host of clinical governance failings which have been identified by
subsequent investigation into the failure. These are highlighted below.
 The quality of care that the hospital extended to patients did not meet the reasonable
standards which have been clearly spelled out in a host of code of conduct released by major
health agencies. However, these were not observed at the hospital and only superficial
adherence was practiced.
 Only a few employees ever raised concerns about the poor service standards observed at
the hospital due to unhealthy work culture and also unethical decision making at the
hospital. This is apparent from the instance of Toni Hoffman who decided to act as a whistle-
blower but faced a torrid time to raise the concern through the organisational channels.
There were constant attempts made to cover up and protect the wrongdoers as a result of
which the adverse event report that Toni prepared was never passed on.
 It is imperative that prompt communication shall be maintained between the hospital and
controlling agency but this was not the case here. As a result, the interest of the patients
was jeopardised and the interest of the few individuals was considered to be more
important.
 In hospitals, a key process is the reporting of adverse cases to the higher authorities so that
requisite action can be taken but in the case of hospital the organisations procedural in the
processes were exceedingly poor as have been seen with the example of Toni Hoffman.
Hence, the employees (even the honest ones) are discouraged to report any adverse cases
as the final outcome is already known and hence the status quo is cemented. This happened
in case of Bundaberg Hospital which is why the failure came to light only after substantial
damage had already been done.
 For hospitals, teamwork and collaboration is imperative as there are a host of staff members
which are involved in rendering service to a given patient either directly or indirectly. But on
account of unhealthy and at some place illegal organisational culture, this was adversely
impact. An instance worth mentioning is the promotion of Mr. jayant Patel despite his
documented record of poor care being extended to patients. As a result, the morale of the
team is adversely impacted and collaboration reduces.
 Also, the communication between the communication between the organization and the
patients along with their relatives has been found to be poor which leads to poor outcomes
as is visible in the given case.
Question 2
The various governance mechanisms that could have avoided in clinical failings as the hospital are
highlighted below.

Organisational Governance
 A proactive role of the regulator i.e. Queensland Health would have been helpful. This would
include surprise visits at the hospital premises to check if the standard operating procedures
are being followed or not. Besides, on a periodic basis the officials should have ascertained
whether the regulations are being complied with or not. Further, interaction with the staff
and customers would have been helpful in this regard. Besides, since the organisation has to
safeguard the interests of the customers, hence soliciting feedback from the customers
treated at the hospital would have helped at averting the current crisis. Had the regulators
been proactive, then they would have acted before and not after two years had elapsed
from the appointment of Mr. Patel.
 There need to be proper and adequate organisation procedures for adverse event reporting
and strict action need to be taken against anyone who is found to interfere with the
requisite procedure.
 Further, more communications channels should have existed between the higher authorities
of the hospital coupled with the regulators as the wrongdoing which was being carried out
at the hospital was apparent to the staff and some honest staff members did try to put
forward the concerns but faced resistance.
 An ethical and strong organisational culture would have been immensely useful to prevent
unethical decision making which was rampant in the organisation coupled with lack of
teamwork and collaboration. This poor culture had an adverse effect on the morale of the
employees and also impacted the teamwork which led to poor patient outcomes. This is
evident from the promotion of Mr. Patel as the head of surgery which would adversely
impact the whole team as they are aware that the leader is not able and is not ethical.
 Adequate mechanism for whistle-blowers coupled with a protection policy should have been
in place. Typically, to report any wrong activities which are being carried out, there are
dedicated helplines where the staff can complain especially if the supervisor fails to take the
requisite measures. This should have been corroborated with an active participation of the
regulator to conduct enquiry.
 Performance of quality audits (both internal and external) should be necessitated so as to
ensure that the various performance parameters are correctly reported and accountability
needs to be fixed on the requisite person concerned.
 The improvement in the communication between the various internal stakeholders and their
communication with the external stakeholders also would have helped to a certain extent as
in the given case there seems to lack of accountability caused due to limited communication
which ensures that the status quo is maintained and people with unethical decision making
are promoted so that all the potential channels from where communication may happen are
closed.