An ongoing dilemma for Boards and Senior Management teams is the balancing of competing priorities. Every day health care providers face decisions based on clinical need, quality measures, national targets, financial performance, and the need for innovation. In an ideal world these would all be aligned but we know the harsh realities of providing high quality and safe health care within budget, and within a political environment. Boards and individual Directors are constantly faced with difficult governance decisions and the need to balance competing priorities.
My 95 year old Mum had a stroke a couple of years ago. She was given excellent care and has made a full recovery. However, the outcome could have been different if the ward manager had perceived the need to conform to national targets as a higher priority than achieving the best local clinical care for Mum. Mum was admitted to the stroke ward late in the evening; she needed a high level of specialist clinical care. A bed was not available in the female bay of the stroke ward, the only bed available was in the male bay. I was with Mum, and as we entered the ward the manager asked me if Mum minded being with male patients. My response, not surprisingly, was that as long as she would be able to receive the level of specialist care needed to give her the best chance of a full recovery then she (and I) wouldn’t mind whether she was with male or female patients. After all, there are plenty of curtains around the bed to provide privacy.
The following morning, I overheard a conversation between the Ward Manager and the Bed Manager, which went something like this:
Bed Manager: “You realise that we have breached our MSA (Mixed Sex Accommodation) target by admitting Mrs X last night. We should have admitted her to a female bay in the Elderly Care Ward.“
Ward Manager: “I’m aware of that, but from a clinical perspective Mrs X needed to receive the level of specialist stroke care that only our ward could provide, and could not be provided in the elderly care ward. I admitted her to the only bed that was available at the time.”
As her main Carer I was totally in agreement with the ward manager’s decision to admit to a male bay. However, I wonder how this occurrence was reported upwards to the Board, how the Board reacted to the breach, and how they provided support to the clinical manager for making a difficult but correct decision from the patient’s perspective.
For many years I have used the following model to help Boards and individual Executive and Non-Executive Directors explore how they manage competing priorities. Each Board needs to ensure that it takes a central position whilst also balancing the needs of each axis.