A negative culture among staff at a Dublin children’s hospital has “the potential to put patients at risk”, a summary of a 2022 internal review states.
On Monday, Children’s Health Ireland (CHI), which operates paediatric healthcare, published a summary of a review that was conducted in 2021. Finalised in 2022, it highlighted serious cultural issues as well as potential mismanagement of waiting lists.
The organisation has said it cannot publish the report in full due to legal advice.
The review, which has been leaked extensively in the media, is the latest in a series of controversies facing the body, following a review into the use of unauthorised springs in three children with scoliosis, as well as an audit on the threshold for hip surgery.
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According to the summary, a total of 45 individuals at the unnamed children’s hospital were interviewed, with most describing a culture within their department where change was slow, lacked governance and robust processes, and was influenced by strong and challenging personalities.
“These interpersonal difficulties among team members led to poor working relationships and a challenging working environment,” the summary said, adding that there was a high attrition rate among support staff due to “bullying issues”.
A “significant risk” was identified where only one employee managed the needs of a complex tertiary speciality.
“This level of dependency on one individual for a critical service is not in line with best practice and created a vulnerability in this speciality,” the summary said.
Half of medical trainees described the learning environment at the hospital as not conducive to learning. Consequently, the training body indicated there would be no intake of any new trainees or Specialist Registrars (SpRs) into the programme in 2022, under a particular speciality, due to concerns about the trainee experience which was “reputationally damaging” for CHI.
The report also stated that a negative culture can impact service delivery, department dynamics and staff experience and has the potential to put patients at risk, it added.
On the topic of leadership and governance, the report said there was a “substantial and persistent message of concern” regarding the lack of strong site leadership and good governance, along with poor operational oversight and accountability.
“There was consistent feedback that the challenging behaviours of some staff were not adequately addressed by the site leadership team. This led to a number of unresolved personal issues between employees,” it added.
The report also said the management of a particular cohort of patients was inequitable across CHI Hospitals.
According to the summary, issues were also identified with regard to National Treatment Purchase Fund (NTPF) funded waiting list initiatives, in which some patients could have been seen by other departmental colleagues within the existing day to day service and “potentially managed in a more proactive way”.
In the summary, CHI outlined the actions it has taken in response to the review, including hiring an external facilitator to improve culture and teamwork in the department and implementing a “robust process” for NTPF funded waiting list initiatives, requiring multiple approvals.
In a statement, CHI said it wants “to be open and transparent” with families.
“CHI takes accountability to the public and the families it serves extremely seriously. While the legal situation around releasing the full report is complex, we want you to know that the concerns raised in that report have been and continue to be addressed,” the statement said.
“Important actions have been taken, and we have published details of those actions to assure you that improvements have been made.”
It added: “While the culture at CHI has come under criticism, and we know there is more work to do, we also see many powerful examples of kindness, teamwork, and clinical excellence across our hospitals, every day.”
