Parents whose children were centre of concern in CHI internal review not informed, summary reveals
It said the review found that patients seen in the outpatient clinic who required ongoing treatment were placed on an already long inpatient waiting list without consideration of redistribution of patients to colleagues with a shorter waiting list.
'The examination raised the issue as to the possibility that this could have led to any negative outcomes for patients,' it said.
However, the summary, which also includes follow-up actions, said an examination of the relevant inpatient waiting list later took place and patients were re-distributed across the department to ensure equitable access to treatment.
'This action was closed out in September 2022.'
It said 'open disclosure' – informing parents about the concerns raised in the report – was not carried out 'as there is no significant scientific evidence that delaying treatment will equate to patient harm in this patient cohort'.
CHI, which has declined to publish the full report for legal reasons, said it was an internal examination commissioned by the CHI Executive. The hospital involved has been previously identified as Crumlin Hospital by CHI chief Lucy Nugent.
During meetings (2020/2021) between employees in this clinical department and members of the CHI Executive, it became evident that multiple legacy and deep-rooted issues existed that regular meetings could not address, it added.
It became clear that a more robust process was required to identify the issues that needed to be addressed
'In early 2021, an operational lead was assigned to look into these issues. However, it became clear that a more robust process was required to identify the issues that needed to be addressed.'
It led to the examination taking four months.
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It said that a number of issues were raised in relation to an NTPF outpatient waiting list initiative.
The NTPF funds hospitals to carry out extra clinics and procedures.
The examination suggested that based on the documentation review, certain NTPF-funded clinics did not adhere to NTPF standards of chronological scheduling – seeing the longest-waiting patients first.
Data suggested that some of these patients could have been seen by other departmental colleagues within the existing day-to-day service and potentially managed in a more proactive way.
'Patients seen in the outpatient clinic who required ongoing treatment were placed on an already long inpatient waiting list without consideration of redistribution of patients to colleagues with a shorter waiting list. The examination raised the issue as to the possibility that this could have led to any negative outcomes for patients,' it said.
'The above raised concerns relating to the prudent and beneficial management of NTPF funding and lack of oversight of access initiatives.'
It found that interpersonal difficulties among team members led to poor working relationships and a challenging working environment.
There was a high attrition rate among support staff due to bullying issues.
A significant risk was identified where only one employee managed the needs of a complex tertiary speciality. This level of dependency on one individual for a critical service is not in line with best practice and created a vulnerability in this specialty.
The report also sets out a series of actions that were taken on foot of the report.
'A cross-city CHI Central Referral's Office was established. This system manages referrals centrally to ensure equitable distribution. Efficiencies have been gained, and this process is being rolled out across all CHI specialties,' it said.
CHI now has a robust process for NTPF-funded waiting-list initiatives
'CHI now has a robust process for NTPF-funded waiting-list initiatives which requires multiple internal stakeholder approvals both clinical and financial. CHI is regularly audited by the NTPF.'
It added: 'A review of all CHI Hospital sites leadership roles and responsibilities was commenced to provide clarity around delineation of accountability at site and executive level – this work has continued as the transformation programme has evolved in preparation for the move to the new children's hospital.'
The original report stated that a negative culture can impact service delivery, department dynamics and staff experience and has the potential to put patients at risk.
It said that CHI is a learning organisation and service improvements through internal reviews and clinical audits, which are an essential tool to support this, will continue to be a priority.
'CHI recognises the importance of transparency and the interests of the broader public in relation to the issues identified in the report,' it said.
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