Greater collaboration needed.

'What other sort of care could there be but patient-centred care?" asked Health and Disability Commissioner Ran Paterson as he began his presentation. Patients wanted to be treated with respect; they and their families wanted to be involved in their care; and having their psychological needs met was just as important to them as having their physical needs met.

While assuring his audience that the vast majority of health care in New Zealand was delivered safety, Paterson said those patients who did complain (one in 200 patients, though one in 10, according to recent research, experience an adverse event) gave health professionals and others "a wonderful window into our health system". What was needed was "a health system and work environments that were safe for patients and staff alike."

But he questioned whether some nurses were withdrawing from their caring role, with hospitals sometimes feeling more like factories than places of heating. Quoting from an article published in Kai Tiaki Nursing New Zealand in April this year ("Exploring the links between the lack of nursing leadership and poor care" by Heather Giles), Paterson talked of some patients experiencing technical rather than nursing care. He also referred to the enquiry into practices at Gisborne Hospital 1999-2000, which identified a lack of professional leadership, including no director of nursing at the time, no clear clinical pathway for nurses and a lack of responsiveness to complaints being made. "People need to be supported through these sorts of enquiries", he added.

"We will all work in systems that are overstretched, but we stilt have personal responsibilities. There are a tot of quality initiatives going on, but we need a greater collaboration of effort. Both the Quality Improvement Committee and the safe staffing unit have key roles to play and I support both of them. We need to find models that will work throughout the country and we need to strengthen nursing and midwifery leadership. "Although we will always face restructuring, over time we must look to achieve sustainable change. We must not accept slipshod standards in our selves or in our health systems. We must do the basics well, eg good handover, good listening to patients and their families, and keeping good records. We need to rise above the stresses of our current systems and work together for the benefit of our patients."

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In reply to a question from NZNO president Marion Guy about nurses being unable to care safely for increasing patient loads, Paterson advised nurses to document their concerns and put pressure on management to address them. Using NZNO's delegate structure was also important, he said.