Auckland Hospital says most of the incidents were minor “or were identified early and mitigated”. Photo / 123rf.com
Short staffing has likely fuelled an unusually high number of incidents recorded by workers in Auckland Hospital’s women’s health services.
Hospital managers say most of the incidents were minor “or were identified early and mitigated”, and “staffing pressures may have contributed to many”. An example of a common incident includes a delay to care, or poor communication.
Some of the increase happened in a period when nearly half the hospital’s midwifery positions were vacant.
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The situation is revealed in an internal briefing from January, obtained by the Weekend Herald under the Official Information Act.
“Service resilience (ie the reliability of the safety and quality) is negatively impacted by the level of staff vacancy, as is evidenced by patient complaints and adverse events due to recruitment and retention challenges in midwifery and the medical subspecialties,” the document says.
“We’re not meeting our targets for waiting times except in abortion services; disruptions in planned care related to Covid, holiday service reduction, staffing shortages and inefficiencies continue to drive waitlist growth.”
In response to Weekend Herald questions, Te Toka Tumai Auckland (formerly Auckland DHB) confirmed there were 133 incidents recorded into its Incident Management System for the women’s health service between January and April 30.
“This number is more than we would typically expect over a four-month period,” said Dr Mark Edwards, interim lead for hospital and specialist services.
“Most of these were minor incidents that did not result in patient harm or were identified early and mitigated. We know from analysing these incidents that staffing pressures may have contributed to many of them.”
Of the 133, five were categorised as category 1 or 2 “adverse events”, meaning an unexpected outcome could have affected the patient. Examples in these cases included an unexpected need for specialist neonatal treatment for a baby and unexpected blood loss requiring a patient to return to theatre.
“There is always a risk of complications with pregnancy,” Edwards said. “Initial findings suggest staffing levels were not a factor in [these] adverse events. However, we will continue with our process to review all of the cases.”
Overall vacancy rates in the January briefing included 65 per cent in midwifery. Edwards said that “took into account broader midwifery roles in the service such as leadership or midwife educator positions”.
“The actual midwifery vacancy rate for our maternity wards was 45 per cent in January, and this has since reduced to 32 per cent, as at May 1, 2023.
“However, to continue to provide safe care, we also have registered nurses and healthcare assistants working on our maternity wards, which help midwives prioritise care only they can provide.
“The vacancy rate for the overall midwifery and nursing team is currently 17 per cent.”
About 1720 people are on the waitlist for a first specialist appointment, 726 of whom have waited longer than four months (42 per cent), which is the maximum time a person waits before being considered overdue.
There are 391 people waiting for treatment provided by the women’s health department, of whom 117 are overdue (30 per cent).
“Similar to other hospital services across the country, we are still seeing the effects from Covid-19, when we had to reduce planned care volumes to prioritise maintaining essential hospital services,” Edwards said.
“We’re also impacted by staffing pressures and the global shortage of healthcare workers, and our hospitals continue to be busy with people who are very unwell and require longer stays.”
Separate from recording incidents, hospital employees can file formal reports warning of unsafe staffing levels. Reports by staff in Auckland Hospital’s maternity service leapt from 14 to 355 in three years.
Nationwide hospital backlogs are near record lengths, with more than 66,000 people overdue for treatment or a specialist appointment. Dramatic reductions in nationwide wait list times aren’t expected until at least 2025.
The pressure on women’s health services at Auckland Hospital is a major factor in continuing tension between hospital leaders and private obstetricians.
Strict rules have been put on new private obstetricians, after concerns from management about higher caesarean rates, and the fact that many women using private obstetricians live outside the hospital’s central Auckland catchment.
The Auckland Association of Private Obstetricians says there are valid reasons why women under the care of private specialists are more likely to have a caesarean. Most private obstetricians also work in public roles, the association says, and their private work reduces the load on the public system.
An ambitious plan to eliminate decades-old inequities in maternity services at the country’s largest hospital has been scrapped.
In January 2021 the Auckland DHB board signed off an “engagement plan” to overhaul services “and achieve equity in women’s health maternity services”.
Data “suggests that Māori and Pacific women, along with some Asian and Indian women and their babies, experience inequitable outcomes and poor experiences at varying stages of their maternity journey”, the DHB concluded at the time.
Work on the plan was paused during the Covid pandemic, and then abandoned during the further disruption from the health reforms that disestablished DHBs.
Reducing inequities remained a strong focus during the Covid response and recovery, Edwards told the Weekend Herald, and “became part of day-to-day discussions and activities … right across our hospital and specialist services”.
This had continued after the health reforms, he said, with services working closely together across the northern region (greater Auckland and Northland).
Initiatives include growing the community Māori midwifery team, appointing a new Māori lead for women’s health, increasing Māori representation in the workforce, improving triage and how patients move through services, and planning a primary birthing unit.
The women’s health briefing from January makes clear there’s still plenty to do. In answer to the question, “Where are we now?”, it lists observations including “inequities in access and outcomes for Māori, Pasifika and Indian hapū māmā”.
Other problems include a “Eurocentric approach to how we operate across the service”, “vacancies in staffing inhibit the provision of as much whānau-centred care as we would like”, and “more episodic care and less continuity of care than we would like”.
Maternity services came under scrutiny after four women – none of whom were Pākehā – died during or soon after giving birth at Auckland Hospital in March and April 2020. In three of those cases, babies also died.
An independent review concluded that in all cases “the quality of care provided by ADHB was of an appropriate standard”, but warned of wider problems, including concerns about institutional racism and midwife shortages meaning there was insufficient time to deliver quality midwifery care, such as support for breastfeeding.
There have been no maternal deaths involving women cared for by Auckland Hospital’s maternity service since 2020.
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