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SYNDICATE LIMITED
JOSEPHINE ST., WINGHAM BOX 360
357-2283 BILL STEPHENSON W. M. CHANDLER
PAGE 10. THE CITIZEN, WEDNESDAY, OCTOBER 30, 1985.
Wingham Hospital has heated debate over quality appraised committee
After mulling it over for six
months - and despite the continued
misgivings of some board memb-
ers • the board of governors at the
Wingham and District Hospital
has approved setting up a commit-
tee to monitor the performance of
the various departments at the
hospital.
The board voted nearly unani-
mously recently to establish a
quality appraisal committe, as
recommended last spring by the
board's joint conference commit-
tee. However the decision did not
come easily as several board
members continued to express
doubts about whether the struc-
ture of the new committee, which
will consist of hospital staff and one
doctor, will enable it to be an
adequate watchdog.
It also was opposed strongly by a
member of the medical staff, who
suggested the whole thing would
be little more than an expensive
exercise in paperwork, duplicating
the duties of the executive director.
"I don't see this adding any-
thing new except cost," Dr. J. K.
McGregor objected.
Earlier he had described the
proposal as "a monstrous exercise
in paperwork" and "a very large
step toward bureaucratizing the
(hospital)."
On the other side, Executive
Director Norman Hayes argued
that the hospital has no choice but
to create the committee if it wants
to maintain its standing in the
health field.
"We're between a rock and a
hard place on this," he told the
board. "Unless the (quality ap-
praisal) procedure is in place and
working we won't get accredited."
The proposal for a quality
appraisal committee first came to
the board back in April together
with a "mission statement" sett-
ing out goals and objectives for the
hospital. The board was told the
committee would monitor how well
the hospital is meeting is objec-
tives.
It also was emphasized the
committee would only make inter-
nal recommendations and would
have no "teeth".
However some board members
expressed concern that since the
committee would have no means of
reporting directly to the board, it's
concerns and recommendations
could be sidetracked without the
board ever hearing about them.
After a lengthy discussion at the
May meeting again failed to satisfy
the doubts, the matter was sent
back to the joint conference
committee for re-evaluation.
It resurfaced last week, with
Jenny Cummings, director of
physiotherapy and head of the
steering committee on quality
appraisal, appearing before the
board to urge speedy approval of
the appraisal committee. It must
be in place and functioning before
the hospital again comes up for
accreditation in March of 1987, she
emphasized.
Mrs. Cummings gave the board
a pep talk on quality appraisal and
described the working of the
proposed committee. Department
heads are already looking at
indicators of quality, she said;
these would be documented to
make people accountable.
The committee would also pro-
vide reinforcement for staff who
are doing a good job, make
recommendations and provide fol-
low-up to make sure the recom-
mendations are carried out. Quali-
ty care is the ultimate objective,
she said, and this can be measured.
"What I'd like you guys to do
tonight is approve the quality
appraisal program in principle,"
she told the board, noting there is a
lot of work involved in getting the
program into full operation before
the next accreditation survey.
Asked by Mr. Hayes about the
committee structure and the pro-
posal to place a board member on
it, Mrs. Cummings said the
consensus at a meeting she had
attended was that there is no need
to have a board member on the
committee since it is basically a
management committee and
would report to the board through
the joint conference committee.
This was supported by Dr. Brian
Hanlon, hospital chief of staff, who
said the board's function is to make
policy and ensure it is carried out
properly. It should not be interest-
ed in the day-to-day management
or operation of the hospital.
However several board memb-
ers disagreed. Patricia Bailey
argued that the more knowledge-
able trustees become about the
operations of the hospital the
better able they will be to carry the
message to the public, while Nancy
MacDonald-Exel suggested that a
board member could provide
valuable input onquality assur-
ance from an outsider's point of
view.
"I can't see it would hurt to have
a board member on it, at least for
the firstyear," she said, observing
it will be "a very expensive
committee" with so many depart-
ment heads on it.
"Your point is well taken," Dr.
McGregor agreed, suggesting that
the time spent on quality appraisal
away from regular duties would
probably have to be made up by
hiring additonal staff.
"The administrator should have
some figures on the cost. I would
think thousands," he added.
However the board never did hear
what the new program is expected
to cost.
In a spirited attack on the
proposal, Dr. McGregor said this
sort of thing "tends to tie up and
hamper the operation of an
institution by volumninous paper-
work."
When hospital accreditation
first came into existence it was
probably needed, he said, but
now it has become a self-serving
entity, "some kind of sacred cow",
and it is questionable whether it
actually improves patient care.
The same thing is happening in
the medical profession through
peer review, he added. It was a
wonderful idea at the start but has
degenerated into paperwork.
"That which is not documented is
presumed not to be done."
"I would be deathly afraid of this
until I knew exactly what was to be
done," he concluded.
Dr. Hanlon also pointed out that,
while it is being demanded by the
body responsible for hospital
accreditation, quality appraisal is
not a directive from the Health
Ministry and has nothing todo with
the Health Act, which governs
hospitals.
In an attempt to wrap up the
discussion, which by this time had
gone on for nearly an hour, Vice
Chairman Mary Lou Thompson
asked if there would be any
problem having a board member
sit in on meetings of the committee
during its first year.
Mrs. Cummings said she had no
objections, but Dr. Hanlon object-
ed that such a move would set a
dangerous precedent. Having a
board member gobelow the level of
the executive director suggests a
lack of confidence in the director,
he said, and Mr. Hayes agreed.
"If you want to manage the
hospital go ahead and manage it,"
the executive director declared.
"You don't need me."
Board member Ross Davies also
spoke against the proposal, saying
he saw no need for a board member
to be part of a hospital function.
"I don't understand why the
executive director can't do this
(quality appraisal)," Dr. McGre-
gor remarked. "He's the obvious
person to report on the functioning
of the institution, with the chief of
staff."
Mr. Hayes responded that there
is noway the executive director can
know everything which goes on in
an institution.
"It's easier to get cooperation
from people on the ground level to
correct a problem than me sitting in
my office and sending down bolts
of lightning on their heads," he
added.
Following some more discussion
about possible alternatives, Dr.
Hanlon suggested it was a fore-
gone conclusion that the quality
Continued on Pg. 11