ANALYSIS:Smaller management team may improve hospital's standards of accountability
ANYONE WHO has followed the controversy surrounding the unreported X-rays and unprocessed GP referral letters at Tallaght hospital in recent days will need no convincing of the need for a good shake-up of management structures at the hospital.
We already know it was not just GP referral letters which were not getting to consultants to determine if patients should be seen urgently or put on a waiting list. Ironically, even a letter dispatched by a local GP to the chairman of the hospital board, Lyndon MacCann, in April 2009 informing him something had to be done about referral letters “getting lost in the Tallaght hospital system” never reached MacCann. The letter, which also mentioned “thousands of unread X-rays” was addressed to MacCann at the hospital. It was stamped “received” by the chief executive’s office but never reached MacCann. He says the first he heard of it was when it came into the public domain last week.
There was also a report presented to the hospital’s clinical governance committee in November 2009 indicating that there were just 700 X-ray cases of concern. The following month, the hospital’s chief executive Prof Kevin Conlon was informed this figure had snowballed to over 57,000. While many of these may have been orthopaedic X-rays which radiologists decided not to report, as happens in other hospitals, the hospital has not given an indication of this to date.
But we do know that among them were at least two chest X-rays that went unreported, something that should not have happened, and as a result two patients had a delayed diagnosis.
The hospital’s chief executive up to late last year was Michael Lyons, who still has not commented publicly on what went wrong and why, though he was out sick for extended periods before deciding to retire early on grounds of ill health.
The controversy was considered at a special meeting of the board on Monday night, which also had before it recommendations to improve governance and accountability at the hospital arising out of a review of the organisation by PricewaterhouseCoopers (PwC) last year.
The recommendations have been accepted by the board and in coming months the hospital will have a 10-member board of management meeting each month to consider issues around the performance of and the running of the hospital. Up to now a 22-member board oversaw the running of the hospital, but its size, as a consequence of three hospitals merging in 1998 to form Tallaght hospital, was considered unwieldy. PwC also found there was an over-representation of clinical skills on the board and a deficit of business skills.
The smaller board, which will now incorporate some of these missing skills, along with a smaller senior management team with fewer people reporting to the chief executive, should make the operation tighter and more efficient. But it may be some time before the results of the reforms become obvious to patients in terms of shorter outpatient waiting times.