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WHEN BEING THE BOSS ISN’T ENOUGH

BY CARLENE BOUCHER, RMIT UNIVERSITY

Central Health Aged Care Service (CHAC) is a large, government-owned organization that employs more than 500 staff including nurses, doctors, allied health staff and many types of health assistants and administrative staff. The organization provides a range of in-patient and out-patient rehabilitation services to older people in the community. It is funded by the government, based on the number of patients that the organization treats, and there is a strict formula that controls how much funding it receives. The day-to-day operations of CHAC are overseen by the chief executive officer (CEO), who reports to a board made up of a range of professionals including medical doctors, accountants and lawyers. The chair of the board is Dr Lewis Clark, who recently retired and was a local general practitioner for many years. He has been chair for only three months.

The CEO of CHAC is Marcia Chan, who has worked in aged care for over 20 years. She became CEO early in 2011. Her background is in finance and human resources management, and she managed a number of smaller facilities very effectively before coming to CHAC. The clinical services at CHAC are overseen by Dr Ryan Gosling, a medical doctor in 2009. He is a very well-known and respected doctor, specializing in the care and treatment of older people. He had applied unsuccessfully for the job of CEO when Ms Chan was appointed.

Recently, there have been a number of instances where Ms Chan and Dr Gosling have disagreed and staff have disobeyed Ms Chan’s directions and complied with Dr Gosling’s requests. The most recent of these incidents was about the transfer the patient because she believed it would be too expensive for CHAC to provide the care that the patient needed. She also had some doubts about whether Dr Gosling had the medical expertise needed to treat the patient. She thought that the patient would be better off in a facility where there was a range of specialists, rather than just geriatricians. However, Dr Gosling believed that the patient should not be transferred because the long ambulance trip might harm her. He also believed that he and the other medical staff were capable of treating the patient. He thought that Ms Chan was more concerned about being sued if something went wrong than about what was best for the patient. The other medical staff supported Dr Gosling, and Ms Chan was not prepared to cause conflict by insisting that the patient be moved. The patient stayed at CHAC and recovered, but the cost of the intensive care provided was considerable and created a significant financial problem for Ms Chan.

Yesterday, Dr Gosling came to Ms Chan and told her that he wanted one of the senior nurses dismissed. He said that the nurse could not manage her staff, was too concerned about how much money was being spent on medical supplies and that she tried to save money at the expense of patient care. He told Ms Chan: ‘That nurse will kill someone one day and you will be responsible’. He also said that the nurse ignored his orders and did not discipline more junior nursing staff when they were rude to him.

Ms Chan considered what she had been told and decided that she would not sack the senior nurse. She told Dr Gosling that the nurse was doing what was best for the healthcare service and for the patients. She said that the she thought it was a personality conflict between himself and the nurse and that he needed to be ‘more understanding of others’ responsibilities’. She said: ‘It won’t do any of the patients any good if we run out of money because we just spend it on whatever we like’.

Today, Dr Gosling emailed the chair of the board tendering his resignation. In his email to Dr Clark he said that he could no longer continue in the role of senior doctor while Ms Chan challenged his clinical judgments and did not give him the respect he deserved. The chair, Dr Clark, knew that there has been simmering discontent between the two but did not know things were this bad. He wants to support Ms Chan as the board thinks she has done a very good doctor and has strong support from the other medical staff. Dr Clark fears that if Dr Gosling leaves, many of the senior medical staff will also leave.