Professor Graham Reynolds says staff concerns were ignored, led to issues with clinical care

Professor Graham Reynolds has argued the ability of staff to respond to clinical issues has been impaired and described rostering issues as "systematic administrative bullying".

Professor Reynolds, in an opinion piece for The Canberra Times, has argued administrators do not listen to issues raised by staff and this caused cultural problems.

This was particularly evident around staffing issues, he said.

"Over recent years a number of senior paediatricians have retired or reduced their working commitments but getting them replaced is a struggle that has defeated clinical leaders," Professor Reynolds wrote.

"It is well known that senior and junior staff have holiday and study leave and sickness needs like any other professionals.

"Rosters at the Centennial Hospital are structured without relief strategies and those that are left on the rosters have to step in doing extra hours, carrying over holidays or coming to work with coughs and colds because there is no one else to do the work.

"This is what drives poor culture."

Professor Reynolds stepped down as the director of paediatrics and neonatology in 2018. He returned briefly in 2020 during the COVID pandemic.

Professor Reynolds opinion piece was in response to an opinion piece by Dr Nick Taylor, the director of resuscitation at Canberra Health Services, which was published in The Canberra Times last month.

Dr Taylor was writing in defence of the paediatric early warning system which has come under intense scrutiny over recent months. The system is used by clinicians in deciding whether to escalate care for unwell children.

Dr Taylor defended the early warning system, saying it was constantly being reviewed and updated. He said these updates had meant the system had improved to become a more "evidence-based" model, where best practice decisions were made on a review of the best available science.

"The most recent large international reviews of early warning systems suggest that our system is at least equivalent, but likely safer than, alternative models," Dr Taylor wrote.

Professor Reynolds said while the system itself was good it had to be used properly and all of those involved in collecting information had to be aware of how and why it works.

"The clinical checks and balances that keep patients safe are good. The ability of staff to respond to early warning scores is impaired by the work environment," he said.

Speaking to The Canberra Times, Professor Reynolds said clinicians on the ground have been aware of the gaps in the health care system for a long period but it was "incredibly difficult" to convince the administration of this.

"The frustration in paediatrics and in the general hospital is that people on the ground who actually do the work can see trends and needs in clinical care but the administration cannot see it," he said.

"And if they see it they will try and argue themselves out of it and say that we are hysterical physicians or hysterical surgeons or hysterical nurses and the data doesn't support anything that we're saying.

"What I was looking for within the system was a culture which said 'yes, we hear you' and we understand what your needs are."

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In response to Professor Reynolds comments, Canberra Health Services chief operating officer Cathie O'Neill said there had been a number of changes over recent years. The example given was the accreditation handed down to Canberra Health Services.

"This recent accreditation provides external validation that the quality and safety of our care meets or exceeds all national standards, including those that relate to paediatric services," she said.

Ms O'Neill said the organisation took its role of caring for children and young people seriously.

She also said there had recently been a successful recruitment process recently and additional paediatricians were expected to start in early 2023.

Canberra Health Services was also asked to respond to comments around the early warning system's ability being impaired by staffing issues.

In response, Ms O'Neill said the system was well embedded and the system would be implemented in the new digital health record.

"Early recognition of a deteriorating patient and the provision of a prompt and appropriate clinical response are well embedded at Canberra Health Services," she said.

An external review into paediatrics, conducted in 2021, found there was an acknowledgement across staff at Canberra Health Services the current system was "sub-optimal" and created "unnecessary risks for unwell children in the ACT and surrounding catchment".

The review, which was only partially released publicly earlier this month, said there was a demand for a level one paediatric intensive care unit at Canberra Hospital as there was no suitable facility to provide temporary organ support to children to allow them to be stabilised before being transported to Sydney.

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