This is the ‘official’ Layperson’s edition of a paper I authored with my supervisors earlier this year. I say ‘official’ because I not only authored the paper, but also conducted the research contained within the paper*.
For the purpose of ‘impact’ (aka, people using the research I’ve done), I’m recommended to translate my work from Academic-ese to something a bit more readable. So, here it is! A free, accessible version of my paper/research/findings for all to use on ONE condition…please cite me!
APA style Reference: Kendrick M., Bartram T., Cavanagh, J., & Burgess, J. (2017). Role of strategic human resource management in crisis management in Australian greenfield hospital sites: a crisis management theory perspective. Australian Health Review. [ONLINE]. doi: 10.1071/AH17160
What is the paper about?
In essence, I looked at two hospital sites when they were brand, sparkling new and compared how successfully and/or smoothly their opening periods were. I set the opening period time as 12 months, as this is how ‘Greenfield’ sites are usually categorised.
(A Greenfield site is a new building with new staff – such as the case hospitals I studied).
The two hospitals were; Fiona Stanley Hospital in Western Australia, and Lady Cilento Hospital in Queensland. The former is a large, tertiary hospital – the latter is a specialist children’s hospital. Both are public facilities under the Australian health system.
These hospitals, being Public Hospitals in the Australian Health system, are funded primarily by taxpayers. As a result, health care at these facilities are free (or heavily subsidised) and rely on government planning and management for their operation. In each Australian state there is a Department of Health, which specifically oversees the function of hospitals, in addition to the health needs of the Australian community.
Okay, so what’s the problem?
Australia has been listed as one of the best countries in the world when it comes to health care, but we could still improve. One of the ways in which we could improve is the efficiency and effectiveness of taxpayer money towards large-scale investments like a public hospital. A second way we could improve is to make hospitals a better place for doctors to work.
In short, hospitals cost billions of dollars to build, and I don’t want any of that money being wasted. Also, I don’t want hospital staff working in poor conditions when there is a better alternative. Why do we have to force exhausted health professionals into literal life-or-death situations? Answer: We don’t.
Problem is, specifically in the cases of Fiona Stanley and Lady Cilento Hospitals…money WAS wasted, and better alternatives for positive working conditions were ignored. Money wastage directly contributed to the case hospitals becoming poor places for hospital staff to work, and unsafe places for patients to be treated**.
So many things went wrong, in fact, that authors in the field of management and ‘Greenfield’ sites (new organisations), categorically label the situation as a ‘crisis’.
Oh No! How was the money wasted?
Improper contract negotiations with companies offering to build the hospital, poor workforce planning, and dodgy agreements made with third-party organisations to provide privatised services under the guise of being more affordable.
Some of the state health departments responsible for planning and allocating money towards their new hospital decided to circumvent important contract proceedings in order to speed up the hospital building process.
As a result, the ‘cheap’ companies that were contracted used inferior materials, rushed certain stages of building, and did not properly check some facilities. The resulting ‘shortcuts’ directly created issues for the hospital after it opened; such as leaky pipes and flooding in an operating theatre.
Another company, contracted to privatise certain services for ‘affordability’, took advantage of the government’s rushed contract process and legally bound the Department of Health to an inflexible, 10-year contract for services that are now considered to be unfit for purpose. AKA – they don’t perform services to the standard that a hospital requires for safety purposes, and the taxpayer is being charged more than an in-house service would cost.
Each of these money-wasting shortcuts ended up actually costing the taxpayer more in the long run. In addition, these shortcuts ended up impacting the quality of patient care and staff satisfaction with a new workplace.
How did you find this information?
I looked at transcripts of the multiple parliamentary enquiries that followed each hospitals’ first year of operation. In addition, I searched for media articles – one of which contained an anonymous letter from upset staff over poor working conditions.
After reading parliamentary transcripts, media articles and other documents related to the hospitals I was investigating, I looked at academic articles to see if I could find any similar cases from the past…and any advice on what could be done better.
Academic-Ese Methods used?
Manual Hand coding to look for themes in the selected documents. I utilised Archival analysis, which involved looking through documents as opposed to interviewing people myself due to a tight deadline for this project.
Manual hand coding essentially meant that I flicked through pages and pages of text, and physically used a pen and a highlighter to mark relevant information.
Parliamentary Enquiries? Why Did You Look At That?
Well, since both hospitals experienced difficulty during their first 12 months, the government wanted to know why. In cases concerning public infrastructure, like a hospital, there can be an Inquiry into the issue, such as in the case of Fiona Stanley Hospital in 2015. These documents are freely and openly accessible to the public.
Within these transcripts, a panel asked people responsible for the hospital’s opening about why things went wrong. The responses were very useful, as they revealed information that media articles and academic papers don’t usually contain… such as why a high-ranking government official would be negligent in contract negotiation proceedings when the contract in question is worth millions of dollars at the expense of the taxpayer.
I combined information from all of the sources I could find, identified common themes present in all of them, and then analysed what this information could mean. I found research on topics such as How To Open A Brand New Business, How to Make Hospitals Better Places to Work, and How To Avoid A Crisis. It was all very interesting, but I had to keep my focus narrow; so I made sure that everything I used involved all three topics mentioned above, or a combination of two in the same article.
So How Does Crisis Management Theory Come Into This?
Crises, essentially, are Really Bad events that escalate and damage the organisation. A crisis could be a fire that destroys a whole building, or a scandal that impacts people’s willingness to interact with the company (such as Thermomix exploding and injuring its users, resulting in consumers being unwilling to invest in the product).
In the case of a new hospital, everything that could have gone wrong…went wrong. Let me list some of the things that occurred at my case hospitals;
- The hospital was not ready for patients when it opened
- Not enough staff members, leading to denied requests for holiday leave and short-staffed teams
- Staff overwork, exhaustion, and burnout within the first 3-4 months of opening
- Surgical equipment not being properly cleaned
- Operating theatre flooding due to a broken pipe
- Technology not working; phones can’t make calls, computers don’t work, hospital doctors can’t communicate with community doctors about a patient’s health
- The CEO of the hospital quit after a few months leading the hospital
- Specialists and senior doctors walking off the job
- Nurses and other Hospital Staff complaining to the media that the hospital is ‘unsafe’ and hospital management isn’t listening to complaints
- Patients with mental illness aren’t monitored closely enough, leading to one’s death
- Another patient died after a medication error
- Doctors having to leave their duties to assist with the hospital’s set-up due to lack of assistance with moving expensive equipment to the new facility
- Media reports of private companies charging the government to provide services for an empty hospital
- Hospital leadership criticising doctors for complaining, calling them ‘grizzlers’ and implying that they were being unreasonable about the unsafe conditions in the hospital
The list goes on, and on, and all are cited in the references list available via the link provided.
These crises heavily impacted the hospital, both from the inside and from the community. The community grew hostile towards employees of the private company provided over-priced services for the facility, patients lost faith in the hospital’s ability to provide healthcare, staff grew unhappy with their workplace, and the media heavily scrutinised the hospital’s activity.
So…What….Do We Do With This Information?
Essentially, I used this case as a guide of What Not To Do when setting up a new organisation, let alone a hospital. It’s a story of just how much poor planning and management can impact people’s lives, and I for one was privileged to be able to access the information and analyse its application for professional and scholarly use.
To give a comprehensive list of ‘how to open a hospital well’, I would need to undertake a decade or so of extra study. However what I can give you is a concise summary of my findings;
The hospital which opened ‘successfully’, in my academic opinion, was Lady Cilento Hospital. This opinion originates from what I found; that staff were empowered to take action as they saw fit, that leadership in the hospital responded to their needs and complaints, and the hospital quickly moved towards stability with the support of their local Department of Health. The activities of hospital leadership matched textbook definitions of good leadership, Crisis Management, and many other positive theories of Strategic Human Resource Management (a business speciality).
While the hospital could not possibly have prepared for the situation of opening an entire facility from scratch, I believe that they adapted quickly and handled it well without significant impacts on patient safety. Bravo, you guys.
( I go into a little more detail within the paper – thanks to my co-authors it is also far more eloquently written. Please contact me if you require assistance with accessing my work/specific quotes and passages.)
The hospital which did not open successfully was Fiona Stanley Hospital. Most of the ‘crises’ that I listed in bullet points were from Fiona Stanley Hospital, and due to the loss of life and near-misses that occurred within a 12-month period I am confident in saying that the hospital was very poorly managed, both by medical and management leadership. There are many more, ongoing issues that lay beneath the surface of my original topic – which indicates a deeper problem with the hospital’s culture and management than I had first anticipated.
To fully understand these issues I would have to undertake further research, so for now I’m content with stating that Things Were Bad, Are Still Bad, and to state Just How Bad things are I’ll have to get back to you.
Why Is This Paper Important?
It’s among the first in the world to take a Crisis-Management Theory perspective on the opening of new organisations, in addition to being one of the first to investigate the opening of two new hospitals within the same 12-month period as a direct comparison.
My recommendation, in addition to a request for further study on the topic of Crisis Management, Hospital Management and Greenfield Site Management, is that leadership needs to pay closer attention to their staff ‘in the front line’ and learn to better adapt to unstable situations. With proactive and responsive leadership, Fiona Stanley Hospital could have been as successful as Lady Cilento hospital. Instead, leadership overworked, ignored and blamed staff for shortcomings when the organisation should have been adapting to the new environment. The building phase had already caused enough problems; blaming staff for attempting to work around pre-existing challenges is an approach that has never been demonstratively successful.
This is first-year-management-textbook examples of poor leadership, and I called on Australian hospital management to do better. Come on guys – you’re meant to be high-level executives at this point. Set the standard for good management practice.
Ideally, with the use of research like mine, we can work to improve the standard of hospital management – regardless of whether the hospital is brand new, or over 100 years old. This is why, despite the fact that my paper is not open-access, I endeavour to let my findings be heard by those who could best use them.
*DISCLAIMER – I conducted the research as an Honours Student, and largely unassisted. If you take issue with my work, or what I have written, please contact me so that we can discuss what you disliked, and whether I can improve in some capacity.
**This article is an incomplete, and brief overview, of my work. As I am currently working on a similar-but-mildly-unrelated topic for my PhD, I am happy to explain in greater detail anything written above, but do not wish to over-disclose my full findings at this point in time.