Review finds problems within state’s peak emergency rescue organisation

A major independent review into the state’s emergency rescue and retrieval service MedSTAR has revealed long-standing “cultural issues”, leadership problems and staff behaviour concerns, as well as highlighting issues with fatigue.

Apr 04, 2022, updated Apr 04, 2022
Photo: Twitter

Photo: Twitter

The review, launched in 2020 by Zed Management Consulting on behalf of the SA Ambulance Service which runs MedSTAR, delivered a 129-page report, outlining multiple problems within the organisation and calls for reform.

InDaily obtained a copy of the report a short time ago and alerted the doctors’ union to its findings.

SAAS staff were due to be updated on the report’s findings in an all-staff email this afternoon and SAAS says a hard-copy has been sent to the doctors’ union.

The report found a “siloed leadership structure” of the Rescue Retrieval and Aviation Services, in which MedSTAR sits, resulting in “organisational inertia due to confusion regarding accountability for service delivery and performance, and the inability of MedSTAR leaders to effectively address cultural differences, staff behaviour and performance problems”.

“Furthermore, cultural issues within the organisation have been a long-standing problem, with ongoing issues arising not only between SAAS and MedSTAR staff, but also between MedSTAR and MedSTAR Kids staff,” the report states.

“As the only medically led retrieval service for the state, the MedSTAR Kids Service Delivery Model has not been agreed and is currently being supported by tenuous arrangements with two metropolitan LHNs (Local Health Networks).

“Prior to and for the duration of this review, changes were still being made to the resourcing arrangements for the MedSTAR Kids service.”

The report says long shifts of up to 24 hours are causing fatigue.

It says a medical retrieval consultant might be rostered from 8am to 6pm and be on call from 6pm until 6am the next day.

Consultants who complete this shift are then rostered onto an eight-hour non-clinical shift the next day.

MedSTAR was established in 2009 as South Australia’s single 24/7 aeromedical emergency medical retrieval service for adults and children (paediatric and neonate).

The $25.8 million public health organisation operates as a division within the Rescue, Retrieval and Aviation Service (RRAS) of the SA Ambulance Service (SAAS).

“It has a unique integrated service model for adults and kids led by Medical Consultants, who are supported by teams of highly trained clinical staff with extensive experience and training in trauma, intensive care, and emergency care,” the report says.

“Together these teams coordinate, treat and transport critically ill and injured South Australians from any location within the state to the nearest health facility.”

The report says however that over the past 10 years, SA’s health system has changed in capacity and capability, “particularly public health services in regional and remote parts of the state”.

“Ongoing regional health workforce shortages and changes in birth rates have resulted in closures in birthing services in regional South Australia such as Ceduna, and GP practices in the Riverland,” the report states.

“The GPs servicing these regions often do not have the specialist skills or equipment to provide complex and specialist care for patients, and inter-hospital transfers from country to metropolitan hospitals continue to be in high demand, reflecting changes in country hospitals capacity to treat patients with various conditions, that may not be life threatening.”

The report explains that during this time MedSTAR became a sub-service within SAAS and “the integration with SAAS has been challenging”.

“It has introduced, almost lost and has reinstated informal arrangements to provide the state with a retrieval service for paediatric and neonate patients,” the report says.

“The organisation has also had several external independent reviews, with several key recommendations still remaining unaddressed but relevant today.

“Activity over the last 5 years has been steady yet costs to provide the service are increasing annually.

“SAAS does not receive full funding appropriation and therefore budget overruns are funded from the SAAS operating budget.”

The report says MedSTAR does not have agreed service level standards for adults or kids, upon which it is resourced to meet.

“While the MedSTAR team’s response time is excellent, its service partner the Royal Flying Doctor Service has not met their KPI response times for P1 and P2 retrievals over the last 12 months, and Babcock have also not met their response target time during the day for the last 12 months,” it says.

“Neither SAAS nor MedSTAR are responsible for contract management and are therefore unable to effect any change to its service partners’ performance.”

The report says there are many immediate improvement opportunities that SAAS MedSTAR can make to address “long standing issues that will improve its people, process, and performance issues”.

It says the changes will also “pave the way to a more agile service model which will be more readily adaptable to future service changes”.

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The recommended changes include:

  • Clarifying, strengthening, and investing in a clear single dedicated leadership structure.
  • Adopting a flexible resource model, where nurses and paramedics are skilled and trained to 
undertake both retrieval and coordination roles within the service.
  • Addressing structural employment issues such as roles created 10 years ago that do not have a clear role within the service today, and the role of the Special Operations Team.
  • Resourcing MedSTAR Kids and making roster changes to Medical Retrieval Consultant rosters to address non-sleep related fatigue.
  • Establishing clear protocols for rostering, and continuous improvement processes to embed outcomes from clinical audits.
  • Adopting a more contemporary learning approach to the clinical case review process.
  • Addressing service provider performance and contractual changes with the Department of Health 
and Wellbeing, and Attorney-General’s Department.

The report says that in the longer term, SAAS MedSTAR, together with health system leaders should develop a new strategic direction for the retrieval service “to ensure it aligns with the changing health care system and public health needs”.

“The new strategic direction should define the scope of the service to be provided for the next 10 years based on need, evidenced based research, feedback from service users and patients with a lived experience,” the report says.

“It should define the service level standards required by the state for MedSTAR adults as well as paediatric and neonate patients. This in turn should give rise to the development of a clear sustainable MedSTAR Kids Service Delivery model for the future.”

The doctors’ union told InDaily the report was “an opportunity to reset and address the concerns raised regarding the culture, fatigue, understaffing and low morale in the service”.

“Noting the report calls for additional resources to address these chronic problems which need to be dealt with sooner rather than later,” SA Salaried Medical Officers Association chief industrial officer Bernadette Mulholland said.

“South Australians should not have to wait for a consultancy firm to release a report on a health service before action is taken to address long-term known issues.

“Respecting the importance of clinical engagement and acceptance by the health administration including listening to frontline staff should be a priority. This has been sorely lacking in our health system and is why we see an ongoing decline in services, increasing fatigue, low morale and high levels of resignations.

“When these recommendations and changes are implemented by SAAS and the Department of Health and Wellbeing the administration of both must ensure clinicians are involved at all levels and are listened to by the health bureaucracy, otherwise no consultancy report is worth the money paid for it.

“The administrators of our health system need to be held accountable and responsible for ensuring the recommendations are implemented and not shoved in some administrator’s bottom draw until the next consultancy report is requested.”

In a statement, SAAS said the review “confirms that the service is providing exceptional care to South Australians” but said it would start work immediately on all 40 recommendations made in the report.

Dr Andrew Pearce, director of clinical services at SAAS MedSTAR, said with emergency medical services constantly evolving due to technological advancements, regional changes, ageing populations and changing disease and injury patterns, and after a decade of governance under SAAS, “it was timely to look at opportunities for improvement”.

“The review confirms that our highly skilled teams deliver outstanding results and excellence in patient care, and that South Australia is well-positioned by having a single aeromedical and road retrieval capability that spans adult and paediatric services,” Pearce said.

SAAS chief executive officer Rob Elliott said it provided an opportunity to make improvements to the leadership structure, operations and rostering arrangements, training, and culture for clinicians who work within SAAS MedSTAR.

“SAAS is committed to ensuring that all staff receive the support they need to consistently deliver the very highest standards of patient care and maintaining an outstanding service,” Elliott said.

Health Minister Chris Picton questioned why it had taken so long for the report to be released.

“This report was commissioned more than 18 months ago, preliminary findings were provided to SA Ambulance in January last year, and the final report completed in August last year,” he said in a statement.

“SA Ambulance also informed the former Health Minister’s office about the report last year.

“(Former minister) Stephen Wade needs to explain why this report which was completed in August last year was never released.

“The report makes a series of recommendations about improving MedSTAR’s performance.

“SA Ambulance has indicated it has started work to address the recommendations.”

Wade declined to comment.

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