This report details the Office of the Health Ombudsman’s (OHO) investigation into the quality of health services provided by Logan Hospital audiology department (Logan audiology).

All babies born in Queensland’s public and private hospitals receive free hearing screening through Queensland Health’s Healthy Hearing (HH) program. The HH program aims to ensure every child reaches optimum speech and language development, through early detection of permanent childhood hearing loss and early intervention. Logan audiology is one of 12 paediatric audiology clinics in Queensland that receives referrals from the HH program to provide specialised support services, including diagnostic services for newborns and babies. Audiologists assess babies referred by the program, recording all test results and audiological outcomes for every child assessed.

In October 2015, the then Health Ombudsman made the decision to investigate a notification from the Chief Executive of Metro South Hospital and Health Service (MSHHS), to which Logan Hospital belongs. The notification concerned serious clinical and operational issues found to have impacted on the performance of Logan audiology.

The OHO’s investigation into Logan audiology sought to determine if MSHHS had implemented appropriate strategies and governance processes to ensure children attending Logan audiology receive a quality audiology service that meets contemporary practice standards.

Issues

The office identified three areas of concern and sought to determine if MSHHS had identified and implemented processes and measures to adequately address these issues. During the investigation, the office reviewed extensive documentary evidence and information provided by MSHHS and met with clinical and operational staff from Logan audiology.

The issues identified were:

1. inadequate clinical expertise of Logan audiology’s paediatric audiologists
2. inadequate response to issues identified
3. inadequate governance processes and systems.

Issue 1—Inadequate clinical expertise of Logan audiology’s paediatric audiologists

The HH program conducted its first audit of audiological practice at Logan audiology in July 2011, which revealed significant shortcomings in diagnostic case management. The HH program provided training and supervision to the audiologists identified through the audit process, in an effort to improve clinical practice and the department’s performance outcomes.

In 2014, a larger sample audit was repeated and again revealed significant shortcomings in audiological practice at Logan audiology. Consequently, all paediatric audiologists at Logan audiology managing cases referred by the HH program commenced an individualised supervision program and undertook further training. In response to further investigations into the performance and management of Logan audiology, MSHHS identified two audiologists considered to have practised below accepted clinical standards; the practitioners were suspended while disciplinary action commenced. The two practitioners were referred to the office in December 2015 and the then Health Ombudsman took immediate action to prohibit the audiologists from providing any health services.

Issue 2—Inadequate response to issues identified

Logan audiology underwent three external quality assurance activities from 2011 to mid-2014, including the two HH audits and an external review commissioned in November 2013. Multiple items were identified for follow-up, including urgent action to address inaccurate infant testing, interpretation of results, and replacement and calibration equipment; recommendations relating to staff training; and the revision or introduction of protocols and guidelines.

At the time of these activities, the director position was responsible for managing the findings and determining when appropriate action had been taken to adequately address the item or recommendation. This process did not involve higher level clinical or corporate oversight of the quality or adequacy of improvements implemented.

In late 2014, the Executive Director, Allied Health, MSHHS, was formally notified of a case involving a child with delayed diagnosis of moderate-severe permanent hearing loss as a result of inaccurate reporting and failure to follow up by Logan audiology. MSHHS responded by immediately commencing a clinical audit of all diagnostic referrals sent to Logan audiology from the HH program of children born in 2011 to 2014; every appointment was examined and a total of 228 cases were identified.

Issue 3—Inadequate governance processes and systems

Prior to 2015, Logan audiology comprised a small team of audiologists with limited training and competency in critical areas of service delivery, particularly paediatric diagnostic testing. The team was physically and professionally isolated, with minimal corporate oversight, or professional collaboration or development. Additionally, the team was operating without appropriate child-specific protocols and guidelines, and were providing services to children inconsistent with best practice.

In 2015, MSHHS initiated a restructure of Logan audiology, with key changes comprising:

• merging the audiology and speech pathology departments
• creating and commencing additional audiology positions within the newly formed department
• relocating audiology services to refurbished facilities and co-locating with the Integrated Specialist ENT Service
• ceasing the provision of paediatric diagnostic services at the Gold Coast University Hospital.

Findings

Following the 2015 restructure of Logan audiology, a substantial amount of work has been undertaken to improve performance and patient outcomes, significantly reduce waitlist timeframes, and improve staff workplace satisfaction. Critical to this has been:

• recruitment of highly skilled and experienced professional staff, including paediatric diagnostic audiologists
• introduction of a comprehensive clinical supervision framework within the department, incorporating peer-to-peer review and a competency-based training program
• participation in professional advisory and advocacy working groups, including the HH program’s Audiology Working Group and Queensland Health’s Audiology Governance Group
• merging the audiology and speech pathology director roles into one position with operational management responsibility of the department.

The restructuring of the department has ensured audiology services are now assessed for accreditation under the National Safety and Quality Health Service Standards. The newly formed department also brought audiology services under a governance structure that provided oversight of clinical and corporate systems and processes, ensuring it connected with the broader hospital and health service framework.

It is evident the governance changes implemented by MSHHS have ensured the recommendations have had appropriate oversight and have been effectively implemented; this has significantly improved the quality of the service audiology patients—in particular babies referred by the HH program—received at Logan Hospital. In July 2011, Logan audiology was described as one of the poorest performing services in the state, however in March 2018 the HH program confirmed Logan’s diagnostic reporting rates are among the best in Queensland.

The office is satisfied children receiving audiology services at Logan Hospital are receiving high quality professional healthcare services and encourages MSHHS to continue to review its clinical and corporate governance processes to ensure the service remains of a high standard.