One of SA’s biggest hospices at death’s door as fed-up staff quit

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One of South Africa’s biggest hospices is in danger of imploding amid a staff exodus and allegations of a “chasm” between top management and clinical teams, reports The Times. St Luke’s Combined Hospice cares for about 750 terminally ill patients a day in Cape Town and supports family members. But Liz Gwyther, who heads the Hospice Palliative Care Association of SA, is quoted in the report as saying: “We do have concerns about St Luke’s and I am aware that their staff turnover has been horrendous.”

Christine Nachmann, a counsellor, caregiver and trainer who was involved with the organisation for 13 years, said she and many others had resigned due to a management style that was threatening the organisation.

Dr Shelley Kibel, who was the chief medical officer when she resigned in 2017 after nine years of service, said things were already “problematic” when she got there but deteriorated before she left. “Any attempts to articulate the clinical staff concerns were met with hostility,” she said, and two chief medical officers had resigned since she left.

Dr Mary Ryan, who was head of the spiritual care section, said she left in 2016 after only 10 months. Issues making it “impossible” for her to stay included “a punitive culture in which staff were issued with warnings at the drop of a hat, with no attempt made to deal with conflict in a collegial way”.

The report says hospice CEO Ronita Mahilall denied staff turnover had been excessive and said allegations of an uncaring atmosphere were “completely unsubstantiated” and “appalling”. She said “a new culture of accountability and professionalism was put in place, with several platforms for engagements offered to the teams” and that she had “personally dealt with a number of matters which have been escalated”.

Gwyther said St Luke’s, which was founded in 1980 and has units in the suburbs and townships and provides home-based care, had always been a “flagship hospice”. It had done well in 2015, when it was last assessed by the Council for Health Service Accreditation of Southern Africa. Another assessment is scheduled for this year.

Gwyther said many long-standing staff members who had left had been trained in palliative care but she was “concerned many of the newly appointed staff were not”. She hoped this year’s accreditation process would “give us information on whether the current concerns are valid. But we do keep hearing another person has left or resigned,” she said.

The report says Nachmann characterised the hospice management style as “iron-fisted”, and said: “In an organisation with a mandate to care, it is imperative to care for the people who deliver that care, but this is not happening at St Luke’s.” She said management produced a “pie chart to explain why so many people had left”, but the underlying factor was that the hospice was a “brutal environment”.

A staff member, who did not want to be named, said clinical staff were not properly consulted on clinical issues and that several “key clinical staff members” had left as a result, and that a culture of fear persisted.

Ryan said in the report that she still referred patients to St Luke’s because “there is nowhere else to go”, but an “intractable management and structure” threaten to “implode the organisation”. She counsels staff who still work there and said, after a recent debriefing, that they were “traumatised” by how they are treated. “The stress I am witnessing makes me very afraid for them.”

The report says during her time there, she and other middle managers met to see how they could “shift” what was happening as there was a “departure of people in key positions”. From this came a petition and a letter, and a doctor was chosen to speak to top management and the board, but the doctor was “chastised and treated like a child” and the situation persisted.

Mahilall is quoted in the report as saying that “an average of 2.22%” of staff left between 2015 and 2019. When asked for actual numbers or the positions held by those who left, she said: “All companies and organisations measure staff turnover by percentage.”

Any attempts to articulate the clinical staff concerns were met with hostility, the report says.

Sunday Times report (subscription needed)

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