An independent review found that systemic issues in women’s health services “impact service delivery, employee morale and well-being, and ultimately patient outcomes.” photo / 123rf
A review ordered by an Auckland hospital following the deaths of mothers and their babies has revealed systemic issues, including staff overwork and feelings of lack of support in environments described as toxic, could reveal an investigation of the Herald.
In March and April last year, four women died during or shortly after giving birth at the country’s largest hospital, which is under COVID-19 lockdown restrictions. In three of these cases, children also died.
The Herald discovered a very unusual cluster of deaths in May of last year and has now obtained the findings of an independent review into the tragedies.
Auckland DHB reports that most of the review’s recommendations are or are in the process of being implemented.
An expert panel reviewed its investigation of DHB in four maternal deaths and concluded in all cases “the quality of care provided by DHB was of an appropriate standard”.
However, speaking with staff, patients, and reviewing internal documents, the investigation revealed widespread problems. they understand:
• Staff reported bullying and racism, a lack of leadership and a lack of confidence, and described the work environment as toxic and “sink or swim”. Some employees lacked cultural competence and “real concerns were raised about institutional racism”. Continuity of care could be better, especially for Maori and Pacific women.
• The shortage of midwives had a “significant impact on service delivery,” said many respondents. The review found that “staff are experiencing increasing levels of stress and distress. There is also a lack of time to provide quality midwifery care (such as breastfeeding support). Nurses sent to the maternity ward “feel abandoned, have negative attitudes towards them and are reluctant to come back later”.
• Large numbers of women who live outside DHB limits still give birth in hospital, creating additional “lasting” demand, the study warns, and restrictions should be considered. The capacity of the theater is insufficient, and “several interviewees noted that it had been on the organization’s risk register for more than 10 years”.
• There are concerns about a “two tier system” that allows women to seek treatment more quickly from private obstetricians, including when invited to do so. He “appears to inadvertently harm non-Pakeha women.”
• The discharge and transfer process was complicated, and “women could walk through the gap”.
The report concludes, “While some of these widespread systemic issues may not be a direct contributing factor to the seven deaths, the panel cannot ignore potential links. “
“[These are] impact on service delivery, employee morale and well-being and ultimately patient outcomes.
Individual investigations into “adverse events” in maternal deaths have been carried out by the DHB. He declined to release the full investigation report, citing confidentiality, but listed 18 related recommendations, covering issues such as staff workload and measures to identify and “downgrade” women with sepsis. Better guidance for treatment was given for those who had little antenatal care.
In March, the Herald revealed that the DHB had concluded that “lack of access or lack of coordination of care” was a notable finding in three cases.
The deaths include Emerald Tai, who died of the infection on March 16 last year at their home after being born with his 3-day-old son Tanatui.
The husband of another woman who died during the lockdown previously told the Herald he was not allowed to enter hospital after losing her baby at 21 weeks pregnant, waiting at home for his wife during the ‘operation and thereafter. had been – and then called hours later to find out. He was close to death in intensive care.
A family spokesperson said the grieving husband was upset that his late wife’s care was deemed “appropriate”. He ponders his answer.
Maternal deaths are rare – only one has been recorded by the Auckland DHB in the past three years.
The full review was conducted by Margareth Broodkorn, Executive Director of Hokianga Health; Sue Brie, director of midwives for Northland DHB; and John Tait, Chief Medical Officer of Capital & Coast DHB and Chair of the Perinatal and Maternal Death Review Committee.
The staff were “extremely dedicated,” he said, but the hospital was seen as a difficult place to work. Midwives said their salaries were not enough to offset the high costs, including parking, accommodation and transportation.
Another problem was the disconnect and lack of trust between management and employees, who were frustrated that their suggestions for improving things had not been acted upon. Some employees told the panel that they were concerned that the recommendations made after the individual investigation into the maternal deaths had not been properly implemented.
“Most of the employees interviewed had no knowledge of the recommendations (unless they were directly involved),” the review found. “There is a risk of insufficient staff to implement the recommendations. “
The Auckland DHB says most of the recommendations, both individual reports and a full review, are or are being implemented. The changes include more staff and senior positions in departments, a new maternity computer system and efforts to improve culture and support.
After Dr Rob Sherwin resigned in June to return to the UK, DHB is recruiting a new director of women’s health.
In an interview with the Herald, Dr Mike Shepherd, Auckland DHB Provider Services Director, said the public can be reassured that women’s health services “are delivering great results for patients.” However, “we also strive to do better” including “really hard working and amazing” employees.
“When employee morale and well-being is not as good as it could be, the international literature shows that this will have an impact on the quality of care we provide. That’s why go ahead with these recommendations and try to improve our services.
The review found that the lockdown did not affect care for dying women and infants, but added trauma to some families and staff.
The pressure on services and the shortage of midwives are not limited to Auckland DHB. Health Minister Ayesha Veral recently acknowledged the “acute” problems in the region and funded “security guards” for each DHB.
Auckland DHB chairman Pat Snedden told the Herald that there has probably never been a time “where there is more tension and tension in place.”
“It’s very difficult to have midwives because we don’t have a chance to bring people into the country, and we go through the COVID process from top to bottom.”