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The Quarterly 2012

Review of “Deadly Healthcare” by Dunbar, Reddy and May: Publisher Australian Academic Press.

This is an extensively researched book by a respected medical educator and leader in healthcare safety and quality (Professor Dunbar is Director of the Greater Green Triangle University Department of Rural Health Flinders and Deakin Universities) and two Psychologists one of whom is still practicing and the other who has established his own publishing company.

It is easy to read and covers the areas of personal traits and the professional, and political environments which led to the inevitability of Bundaberg being a "disaster waiting to happen". However, it would appear that the three authors each took different chapters and have adopted different writing styles with some significant repetition.

Generally speaking, the book takes the perspective that a fiscally driven health system which only cares about the bottom line and intimidates hospital administrators into sacrificing basic standards and principals of patient safety and quality of care on the altar of budget integrity can result in significant patient morbidity and mortality. The following exchange between the Director of Medicine and the hospital administration reported in the book demonstrates the tone of the situation described:

Comment to the Director of Medicine: "Peter you have to understand that this is a business" "Well that's where the problem is, you see. I think it’s a hospital"

The authors’ go into some detail in accounting how, in the appointments process, even the most basic requirements of good clinical governance such as carefully checking references and employment history of a doctor including any restrictions previously put on the practice of that doctor were not carried out, and how legitimately made complaints and concerns raised by staff about a doctor’s behaviour and clinical skills were ignored because, according to the authors, the case load being undertaken by the doctor was so high that it brought much needed income into the hospital.

The authors have gone to some lengths to make their point that there are real dangers in having a healthcare system that is tightly controlled centrally with little if any local accountability and is predominantly fiscally driven, and the harm that this can cause to everyone involved including patients, their families and hospital staff. There are however some fairly sweeping statements in the opening chapters about the ineptitude of the management in Bundaberg, which do not appear to be either fair or balanced. At times the writing falls into the trap of emotive sensationalisation of the issues and some fairly gross oversimplifications. There is very little by way of analysis of the situation from the perspective of the two College Fellows caught in the centre of this, nor is there a decent attempt (in our view) to bring the various elements into line to understand better how the situation evolved.

The reviewers obviously cannot vouch for the completeness of the research, the opinions expressed or the conclusions reached by the authors, but never the less believe that this book should be read not only by all Medical Administrators, but by Hospital Administrators and Bureaucrats in Health Departments generally, as there are clearly lessons to be learned from this series of events. It is apparent from what is written that accountability and responsibility for what occurred in Bundaberg extends well beyond the hospital.

In summary, the reviewers believe that this book is a sobering read and thought provoking, but should not be relied upon for commentary on the roles of those who were central in these events.

Dr Michael Jones and Dr Andrew Johnson