One cancer patient is advised to increase fluids, another sent an electronic script, and a third consoled. All have been saved from an emergency presentation by the timely intervention of a nurse \u2013 in just the first hour of the day.<\/p>\n
So, imagine my dismay when she warns me that her clinic will close for several weeks when she takes overdue leave. Thinking selfishly of my neediest patients, I ask why there\u2019s no cover.<\/p>\n
\u201cBecause there is no money.\u201d<\/p>\n
Considering the eye-watering price tag of many cancer therapies of limited, if not futile value, it seems incredible that there is no money to fund a cancer nurse who saves the healthcare system multiples of what she costs.<\/p>\n
I sympathise that manoeuvring healthcare budgets must be like managing a refractory migraine but still, who looks at this business case and says \u201cit\u2019s not worth it\u201d? In the absence of said nurse, when patients are routed straight to emergency, who says, \u201cthat sounds like a good idea\u201d?<\/p>\n
The catchphrase for every gap in healthcare delivery is that \u201cthere is no money\u201d and clinicians are conditioned to believe it.<\/p>\n
But as a scathing report<\/a> into the failings of one healthcare organisation shows, mismanagement may loom larger than money.<\/p>\n First, some context.<\/p>\n Melbourne\u2019s Cohealth<\/a> is one of Australia\u2019s largest community health organisations. Funded to the tune of nearly $120m annually, it serves highly disadvantaged patients including those facing mental illness, homelessness, substance abuse, domestic violence and incarceration.<\/p>\n Last year, the board announced that it had lost the good fight and was closing three GP clinics<\/a>, citing \u2013 you guessed it \u2013 a lack of funding. This decision took clinicians, and more importantly, more than 12,000 patients, by surprise.<\/p>\n The intense backlash triggered an inquiry. At its heart was the question: was inadequate Medicare funding to blame for the closure of the clinics?<\/p>\n The expert report tells a sad story about how healthcare delivery is failing those most in need.<\/p>\n The experts confirmed that the GP clinics were losing money. But only a small part of this was attributable to low productivity: the reason doctors were not working at the top of their scope was because they were undertaking work done more effectively (and cheaply) by others.<\/p>\n Doctors deconstructing energy bills for patients and walking them to pathology (lest they abscond) were prevented from doing the things they were most qualified to do.<\/p>\n The greatest cause of sustained financial loss, however, was poor practice oversight and high corporate costs. For this, the authors excoriate the management.<\/p>\n Cohealth\u2019s systemic problems were ignored for a decade and kept from the board. The GP service was budgeted as a deficit and ran as a deficit, allowing management to treat this as business as usual. Surplus Covid funding covered over deficits, but the method was opaque.<\/p>\n Management periodically reassured the board that it knew what it was doing but this couldn\u2019t be true when management distrusted the very doctors who could have helped improve clinic viability. Management held annual (!) meetings with GPs, then ignored their ideas before creating vague revenue targets that \u201cchanged depending on \u2018who was talking\u2019,\u201d the report said.<\/p>\n Imagine clinicians focusing on complex patient care when management were described by one GP and another clinic staff member as \u201cpeople in positions of authority without appropriate skills, qualifications and knowledge to do their work\u201d.<\/p>\n But management is accountable to the board, so when the GP clinics were failing for a decade, what was the board doing? According to the report, precious little.<\/p>\n Even when bluntly advised, the report notes, the board did not heed the financial alarm bells and failed to be curious or diligent. It also found it had no comprehensive strategy to protect vulnerable patients from the impact of closure. Its confidence that they would find new doctors was unfounded and inconsistent with its rhetoric of serving patients that other GPs can\u2019t or won\u2019t. For such a consequential decision, it defies belief that the board first met the doctors after the closure announcement.<\/p>\n Predictably, the result of this and the previous board\u2019s \u201cconsiderable organisational, power and cultural distance\u201d from the staff meant patients were the losers. Finding a new GP is generally onerous; given the complexity of its patients, Cohealth\u2019s assumption was naive at best and harmful at worst. When one concerned worker walked around to see if any local GPs were accepting new patients, the answer was no.<\/p>\n The experts made another telling observation that rings true to every clinician.<\/p>\n The leadership was so invested in complaining about funding that it failed to control the things it could, such as monitoring the finances, listening to doctors and changing the model of care.<\/p>\n The closure announcement had a proposed slogan of \u201cwe have fought\u201d but it might well have been \u201cwe didn\u2019t listen\u201d.<\/p>\n The report exonerates the clinicians and even commends them for caring deeply. And it outrightly blames the management and board for failing performance standards.<\/p>\n Cohealth accepted all recommendations in the report and acknowledged there were areas where governance, leadership, communication needed to be strengthened<\/a>.<\/p>\n