3 Nov 2022

Revealed: The hospital radiology departments at high risk

7:21 am on 3 November 2022
In Control Room Doctor and Radiologist Discuss Diagnosis while Watching Procedure and Monitors Showing Brain Scans Results, In the Background Patient Undergoes MRI or CT Scan Procedure.

Te Whatu Ora Health NZ says all services are safe and are all still doing MRI, CT and other scanning. Photo: Gorodenkoff Productions OU / 123RF

RNZ can reveal which other hospital radiology departments are at high risk of failing to meet international standards.

They are Wellington, the Hutt and Hawke's Bay hospitals.

Nelson and Whanganui are at medium risk.

The five radiology services could not be identified previously by the independent standards inspection body IANZ for contractual reasons.

At RNZ's request, Te Whatu Ora Health NZ has now given out their names.

All services were safe and were all still doing MRI, CT and other scanning, the central health control agency insisted, as it has for the last week.

"While IANZ accreditation is an important gauge of the quality of our public radiology services, it is by no means the only one," Health NZ said.

It cited internal checking systems, when RNZ asked how it knew the services were safe.

IANZ said in response:

"In our experience, quality assurance programmes inevitably slip if there are not regular independent checks."

The risks at the various radiology departments revolve around staff and space shortages, and dysfunctional and ageing IT and equipment.

Southland and Palmerston North have failed the standards for lack of staff and lost their accreditation.

IANZ said it was monitoring the way risks were being handled at the Hutt, Hawke's Bay and Whanganui.

How are services being kept safe?

Accurate scanning, and reading of scans, is vital for most patients.

But many differences have emerged about how to be sure that is being maintained, between what Health NZ says, and what International Accreditation NZ (IANZ) says.

"IANZ offers one accreditation option for healthcare providers. There is a cost associated with it," Health NZ said.

It was "preferable" to have it, but not mandatory.

There were many reasons for not meeting the standards, including the cost and "administrative resourcing required to make an application", a challenge for smaller, regional hospitals, it said.

IANZ, though, said even small private radiology providers all got accredited (they have to, to do high-tech scans for either ACC or on-insurance).

Health NZ said HealthCert provided external oversight, and the Health Ministry said this, too. But HealthCert, which did not respond to emails, does not go inside hospitals to check.

Hospitals also had "numerous internal levels of oversight" such as layers of administrators, auditors and committees, Health NZ said in a statement.

All radiology services held regular quality and peer review processes, it added.

Opted out

Waikato is relying on those internals, because though it is a major tertiary hospital, it has opted out of getting accredited at all.

"It does not currently undertake external radiology contracts and has therefore not opted to engage in the IANZ programme," said Health NZ.

"Waikato Hospital's radiology department has a quality assurance programme which requires regular audit and review."

But IANZ said Waikato's internal systems "do not review or provide assurance of technical competence".

"The 'programme' described by Waikato Hospital is not a form of accreditation," its chief executive Dr Brian Young said in a statement.

Its "audit ... does not provide independent assurance of compliance with a standard".

Greymouth and Wairarapa have opted out too.

Greymouth did not do many high-tech scans and the "the revenue generated doesn't cover the IANZ fees", Health NZ said.

That surprised IANZ's Young, who thought the ACC revenue would "easily" cover the fees.

"We have never been asked to provide a quote for Greymouth Hospital Radiology Department so I am not sure how they could make this claim," he said.

"Furthermore, the value of accreditation in terms of underpinning the service delivery competence extends well beyond enabling access to ACC funding."

Greymouth was contravening the Standards and Accreditation Act because reports implied the service was accredited, when the actual scans were being done in a non-accredited facility, then later read by the private Pacific Radiology practice which was accredited, Young said.

Greymouth seemed to have enough technicians, "but appears there are no radiologists, which raises the question of adequate clinical oversight", he said.

'Resilience and determination'

Health NZ pointed out that all radiologists and technicians had to undergo ongoing professional development; that all imaging equipment was regularly inspected, and some of it came under the oversight of the Office of Radiation Safety; and any building used for MRI had to conform to safety standards.

"The above items are all independent of IANZ accreditation (although usually included in IANZ assessments)," it said.

As for Palmerston North Hospital, Te Whatu Ora MidCentral leader Lyn Horgan said IANZ had told them the suspension did not relate to "quality of services" and had noted the department's "resilience and determination".

Palmerston has fewer than half the radiologists it needs; it has 45.3 technicians, and is budgeted for 52.5.

It had nine lined up to begin between now and January.

IANZ has emphasised the suspension of accreditation was not about quality, Horgan said.

Te Whatu Ora said accreditation was historically driven in the early days by ACC.

Public hospitals only sought it "much later ... the motivation being to add another layer of quality assurance and to identify and quantify areas where better systems and/or resources were needed".

IANZ, however, was unequivocal about the value of independent, hands-on assessment, which it said only it provided.

"New Zealand was one of the first countries in the world, if not the first, to accredit radiology services" in 1994, Young said.

'Feedback loops'

"Accreditation ensures that the organisation has the right people with the right qualifications and skills, an appropriate quality system, appropriate equipment and processes, quality assurance, internal audit and feedback loops together with continuous improvement," said Young.

"These elements are all required to ensure effective operation and competent results" and accreditation gave independent assurance they were in place.

It helped the county keep up with international trends and standards via input from technical experts and a Programme Advisory Committee, Young said.

"To view accreditation as a cost without considering the benefits, and the reasons for introducing it in the first place, is very short-sighted."

It could also help Te Whatu Ora with a principal objective to smooth out healthcare delivery and access nationwide, he said.

Te Whatu Ora said it had inherited what various health boards had done about accreditation.

It was changing this to get national consistency across accreditation, recruitment, funding, and operational delivery.

"This work continues and has been accelerated.

"In the meantime, the public can have complete confidence in the quality and ability of our radiology services because of the many oversight measures that are in place and because of the dedication, experience, and skill of our qualified radiology workforce."

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