A confidential internal investigation into a children’s hospital in Dublin revealed instances of “bullying,” “significant risk,” and “serious issues of concern,” reports RTE.
The review of Children’s Health Ireland (CHI) determined that the culture at the unnamed hospital carried “the potential to put patients at risk.”
The report was initiated in 2021 and completed in 2022, reports RTE.
In recent weeks, the report has been widely leaked.
A summary was released today, with CHI stating that legal restrictions prevent the full document from being published.
“The findings primarily focused on issues related to interpersonal relationships, training programmes, patient management, professional conduct and adherence to standards,” the summary stated, reports RTE.
The summary explained that the report “was never intended to be made public,” but is being partially released “to ensure that a wider audience” can understand its contents while still “balancing the needs of a confidential process.”
“The report 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, reports RTE.
The hospital’s culture reportedly “lacked governance and robust processes, and was influenced by strong and challenging personalities,” leading to 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”, the summary reveals, noting that this “created a vulnerability in this specialty,” it said, reports RTE.
The review also pointed to “a number of issues in relation to a National Treatment Purchase Fund (NTPF) outpatient waiting list initiative”.
“Certain NTPF-funded clinics did not adhere to NTPF standards of chronological scheduling (i.e. seeing the longest waiting patients first),” it said, reports RTE.
According to the summary, some patients “could have been seen…within the existing day-to-day service” if things had been managed “in a more proactive way”, reports RTE.
It raised concerns over “the possibility that this could have led to any negative outcomes for patients”, reports RTE.
The report noted that hospital management had been the subject of frequent and ongoing complaints.
Certain patients were treated in an “inequitable” manner, the review found.
It stated: “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, reports RTE.
“There was consistent feedback that the challenging behaviours of some staff were not adequately addressed by the site leadership team.”
“The management of a particular cohort of patients was inequitable across CHI hospitals,” reports RTE.
To complete the report, interviews were held with “45 staff members from across CHI”, and a range of documents were reviewed.
“Inconsistencies in managing staff contracts” were discovered, with “[half] of medical trainees” saying the work environment was “not conducive to learning”, reports RTE.
This led to the “training body” deciding “that there would be no intake of any new trainees or Specialist Registrars (SpRs) into the programme in 2022”, which was considered “reputationally damaging for CHI”.
After taking corrective actions, “[teamwork] has significantly improved”, and the “most recent training body assessment” was “positive”, reports RTE.
The report also noted: “No direct payments were received by CHI staff from the NTPF,” reports RTE.
The summary states that “CHI now has a robust process for NTPF funded waiting list initiatives which requires multiple internal stakeholder approvals both clinical and financial”.
“Capacity issues were addressed through the hiring of more personnel in certain areas and reconfiguration of access to facilities across CHI,” reports RTE.
It adds that “an identified cohort of patients” now receives care from appropriate specialists, along with new transition pathways from paediatric to adult services.
In a statement released today, CHI said it aims to “be open and transparent” and “takes accountability to the public and the families it serves extremely seriously”, reports RTE.
The organisation explained that “the legal situation around releasing the full report is complex”, but stressed that “the concerns raised in that report have been and continue to be addressed”, and stated that “improvements have been made”.
CHI acknowledged that “the culture at CHI has come under criticism, and we know there is more work to do”, adding: “our immediate focus is on addressing the operational issues”, reports RTE.
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