Loyalty among staff in hospitals can be dangerous and can put patients at risk, the author of the Lourdes hospital inquiry, Judge Maureen Harding Clark, warned yesterday.
Addressing a conference attended by directors of nursing and midwifery from across the State, she said loyalty in hospitals "can inhibit the raising of concerns relating to confidence in colleagues" and can lead to staff failing to speak out about practices about which they have concerns.
Referring to her inquiry into the high rate of Caesarean hysterectomies at Our Lady of Lourdes Hospital in Drogheda, many of which were unnecessarily carried out by the now struck-off Dr Michael Neary, she said she found there had been no attempt by Dr Neary to cover up the numbers of such operations he performed.
Dr Neary, however, worked in the hospital from the mid-1970s to the late 1990s and Judge Harding Clark said because he was a respected doctor, it was assumed if he did something, it was for a legitimate reason.
She referred to the "cosy family climate of familiarity" in the hospital as dangerous, "where nurses were familiar with the quirks and foibles of each consul-tant and anticipated each consultant's needs without question".
She added: "A disturbing thing is that values like respect, loyalty and continuity of service, which in another age were applauded, must now be recognised as dangerous unless there are systems in place which provide safety nets.
"Loyalty without considering patient safety can be dangerous. Loyalty can inhibit the raising of concerns relating to confidence in colleagues long tenure often contributes to club-like attitudes where seniority carries privilege without any commensurate responsibility.
"Long tenure can and does lead to comfortable acceptance of fossilised procedures and poor leadership."
Furthermore she said, hospitals should not be run like clubs. "There must be continuing analysis and comparison of practices and outcomes against known benchmarks.
"We have to recognise that nice and charming consultants may not necessarily be the best doctors. Only objective audit of practices will determine that sometimes the most caring doctors do not recognise their limitations," she continued.
She urged nurses present to speak out if they were concerned about patient safety. When a number of delegates suggested there was still a fear of complaining or speaking out, Judge Harding Clark responded: "If the directors of nursing are afraid to speak up, there is very little hope for our healthcare system."
She urged the nurses to put their concerns in writing, saying there was nothing managers hated more than a paper trail. "If something doesn't seem right, follow your instinct."
Asked if there should be legislation to protect whistleblowers, she said she hadn't considered that, adding: "I'm not entirely sure that I would go down that route yet."