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New Zealand Institute of Health Management Reflections on the Bristol Heart Scandal

New Zealand Institute of Health Management Reflections on the Bristol Heart Scandal. December 2004 Stephen Boardman. Introduction. Steve Boardman Director of FMC Sabbatical with CMDHB and CDHB Finnamore Management Consultants 100% health focus Predominantly NHS

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New Zealand Institute of Health Management Reflections on the Bristol Heart Scandal

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  1. New Zealand Institute of Health ManagementReflections on the Bristol Heart Scandal December 2004 Stephen Boardman

  2. Introduction • Steve Boardman • Director of FMC • Sabbatical with CMDHB and CDHB • Finnamore Management Consultants • 100% health focus • Predominantly NHS • Largest independent health consultancy in UK • Purpose and objectives • What are your expectations?

  3. Disclaimer • Personal reflections • What I knew • What I did not know • Senior executive… • …but limited involvement in cardiac services • Pre-dated Hugh Ross

  4. Headlines • 100 + babies (switch operation) • GMC hearings • CEO ( John Roylance) • Medical Director (James Wisheart) • Cardiac surgeon (Mr Dhasmana) • Kennedy Inquiry • 577 witnesses • 900,000 pages of documentation

  5. 1985 – 1995 Dr Roylance CEO of HA and UBHT 1987 – 1994 Steve Boardman Director of Planning of HA and UBHT Regional Director of Business Planning Chronology(1)

  6. Chronology(2) • Mid to late 1980s – ‘killer K….’ • Late 1980s to mid 1990s – anaesthetists’ suspicions and cover up • Private Eye – ‘killing fields’ • Cardiac Surgeon becomes Medical Director • CEO retires • Leaks to newspapers and TV • GMC hearings and then Inquiry

  7. My perspective (1) • Scope of inquiry included culture • ‘Trust you to tell the (whole) truth’ • ‘Espoused culture’ • ‘Culture in place’ • Balancing the evidence • John Roylance • Devoutly religious • Sense of humour • James Wisheart • Helpful • Dedicated

  8. My perspective (2) • Transformational leader • Tolerated managers • Detested administrators • Medical model • ‘a manager must never get in between a Doctor and his (sic) patient’ • NHS Trusts….’an opportunity for Doctors to re-possess the health service • Every health intervention is prescribed by a Doctor • Tried to engineer MD (the cardiac surgeon) as next CEO • Club culture • Academic observation • Handy: ‘gods of management’ • Bristol-centric • Subject never, ever raised at DMT (=EMT)

  9. Consequences • Result of GMC not Inquiry(?) • Clinical governance • NICE • CHAI • New Labour’s good cop/bad cop • Bristol • Best cardiac results in UK • New children’s hospital • Kennedy – CHAI • The Doctors • CEO and MD retired on full pension • Mr Dhasmana ‘a broken man’ • Whistleblower – in Australia • Transplant study kicked into touch?

  10. Conclusion • Kotter and Heskett, studying a larger sample of US firms and their long term economic performance. They identified successful companies as having strong and effective company cultures which: • Were aligned with the company’s business strategy. • Were responsive but maintained core values. • Met the needs of key stakeholders: customers, employees and owners. • They conclude that corporate culture was ‘more powerful than anything else’, including strategy, structure, leadership, financial analysis or systems, in determining corporate success.

  11. Recommendation “The culture of the future must be a culture of safety and quality: a culture of openness and accountability, a culture of public service, a culture in which collaborative teamwork is prized and a culture of flexibility in which innovation can flourish in response to patient needs” Let me finish with a couple of questions

  12. Lunch in the Medici You are having lunch in the Medici and overhear two anaesthetists talking about a vascular surgeon’s high mortality rates. This is not the first time you have heard these rumours: • What would you do? • What should you do?

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