I wasn’t actually going to write anything about this.
But after everything I have written about the problems in our emergency department over the years, it just seemed a little…..well….. a bit of a cop out, not to document it here.
Gaming the statistics:
It has been an awful few weeks in our emergency department. For many reasons.
Following the detection of anomalies in waiting time data, a senior executive admitted to ‘gaming’ the statistics to make hospital performance appear better than it is.
The subsequent forensic analysis conducted by PricewaterhouseCoopers (PwC) found that around 11,700 performance records – about six percent of all records had been altered from within the Emergency Department Information System (EDIS).
The report also noted: “The executive’s admission to Audit does not appear to account for all of the changes to EDIS records that have been made to improve timeliness performance.”
Manipulation of data was found to have been relatively easy due to the use of generic logins and inadequate user password security. ( Those of you running EDIS in your own ED, or any other electronic patient management system for that matter, can take heed and read more about our security issues here.)
The audit estimated that in the last 12 months, achievements in meeting targets for just one single group of patients triaged as Category 3 (urgent, should be seen within 30 minutes) had been overstated by at least 19 percent.
Data gaming was thought to have occurred as far back as late 2010.
Now, there may be many others involved, but I can tell you that I know the person who has admitted to gaming the EDIS data.
She worked extraordinarily hard at developing strategies to improve the flow of patients through our department.
As have we all.
So personally, I feel it is a sad and totally demoralising situation that this person felt that:
“The only thing that worked to achieve benchmark targets was to alter the data.”
There is no question that she did wrong. And she betrayed the trust and admiration of many.
But she is a good person. A fact that makes it all the more painful.
Gaming the politics:
So. It is all a bit of a mess right now.
It is an election year and the whole thing has become charged with a political ugliness.
The name of the person involved was ‘accidentally’ leaked to the media.
The fact that the Chief Ministers own sister is a senior nurse working at the hospital was hung on an insinuating hook by the political opposition, despite the fact that the investigation found that she had no part in any data gaming.
That was just nasty, and whomever did it is far worse than all the people combined who might have altered data in my book.
As I said, a real mess.
It might have all been worth something if a politician or member of health directorate executive had said: well hang on here, the environment of access block and emergency department overcrowding is far worse than we have been led to believe. There is some bad shit going down here. This is not an emergency department problem, this is a hospital wide problem. Our first priority must be to apply expert resources to immediately ease this situation. And then re-evaluate what we are doing to ameliorate it.
Because we are well aware of its adverse impact on patient care.
Remember: There is very strong evidence now that increased length of stay in our emergency departments leads to increased morbidity and mortality amongst these patients. At the very least is has a direct impact on quality of patient care. So this is no small matter.
Instead, the distraction placed on executive right now seems to be directed towards data security, password protection re-evaluating the inaccurate data1. Cleaning up the political fallout. Damage control.
Meanwhile, our doctors and nurses (and yes, management) are so busy trying to maintain a quality service from within a critically overcrowded department that they barely have time to jump up an down to try and get someone to pay attention to the real data that is being corrupted:
Blood pressure. Pulse. Respirations. Pain score. Access to care. Bladder circumference.
Overcrowding and access block is a serious problem in emergency departments all over the world. Implementing accurate systems to track key performance indicators is a vital part of improving the state of play. But I have no doubt that some form of data manipulation at one level or another is widespread. Especially when targets are linked to funding. And especially, especially, when meting targets are linked to political performance (which is always).
Not that it is an excuse, but perhaps our own dirty laundry might lead to scrutiny of other hospitals performance data. Data that might be obfuscating the real issues we face.
Do you want to know the biggest stress that clinicians (doctors, nurses, physiotherapists, clerical staff, wardsmen) in any emergency department experience?
- Is it data security?
- Is it meeting the National Emergency Access Targets?
- Is it the workload?
No, it is the day to day, pernicious, internal conflict arising between the external need to comply with their own directorate policy, organisational requirements, confidentiality and professional expectations……and the internal need to address any ethical and moral issues around delivering effective, quality and compassionate care.
Those two needs should not conflict. But, in many emergency departments, they can. They can stretch us apart.
For nurses, this conflict might well be intensified by studying our own national competency standards for the registered nurse:
National Competency Standards for the Registered Nurse:
1.2 Fulfils duty of care.
Clarifies responsibility for aspects of care with other members of the health team
Recognises the responsibility to prevent harm.
1.3 Recognises and responds appropriately to unsafe or unprofessional practice.
Identifies interventions which prevent care being compromised and/or law contravened
Identifies behaviour that is detrimental to achieving optimal care
2.4 Advocates for individuals/groups and their rights for nursing and health care within organisational and management structures
Identifies when resources are insufficient to meet care needs of individuals/groups
Anyone who has read this site for a while will know that my own internal conflict has resulted in many posts on the effects of access block and overcrowding on our patients.
Many might say that I can on occasion be a little naive and foolhardy and unprofessional and step over the line of advocating within organisational and management structures. Yup…point taken.
I have gotten in trouble. And I know that hospital executive watch this site regularly to see if might step over any line some more.
(Hold me back people, hold me back).
So to them I respectfully shout out without putting my hand up: the real issue here is not about data. Or about politics.
Pull your heads out of the spreadsheets and dashboards for a bit. Come down and visit our department on a Monday night at 8 o’clock. Or a Friday night at 7 o’clock.
Spend a few hours, talk to the staff, see what is behind the data. You will learn a whole lot more.
The real issue here is about our patients, their families and our (your) colleagues.
But most importantly for me, the issue here is about being a nurse. How about you?
- incredibly important activities…..granted [↩]