Pamela Hansen talks to Mater Dei CEO Marion Rizzo and finds she is not fazed by the huge task she has taken on - Marion Rizzo, Mater Dei’s Chief Executive Officer, has always worked in hospitals; she has a BSc in biology and chemistry and a Master’s degree in Health Service management.
She started her career in 1979, in the medical laboratory at St Luke’s Hospital. She was promoted to laboratory manager in 1996 and in 1999 she joined the Foundation of Medical Services to work on the Mater Dei project.
Her job as the head of institutional operations was to act as the interface between the engineers, architects and clinical staff, and by 2006 she had become Mater Dei’s CEO.
I wondered whether she was at all fazed by the huge task she had taken on?
“The year before migration from St Luke’s to Mater Dei was extremely challenging. The construction and equipping of the hospital was completed in July 2007 and the migration of patient services from St Luke’s was completed in November of that year.
“We had been working hard on the complexities of the move for a year. In the first months we encountered problems with the realities that the staff were facing and the high expectations of the public because of all the hype in the media.
“But we had moved in to a new purpose-built hospital with the very latest new equipment and a staff of 3,800 of a very high standard, so we were equipped to meet the challenge,” she told me.
There is no doubt that we can see the enormous improvement in the wards and generally in the new hospital, but it is plagued with the inordinate long waits at the Casualty (Accident & Emergency) Department as well as long queues in other departments. I asked her if this was going to improve soon.
“Health reform is in hand and any restructuring in the other health sectors will lead to improvements at Mater Dei. The inputs and outputs at the hospital are all related to the rest of the health sector. Unfortunately, the hospital always pays the price for all the deficiencies and shortcomings.
“We have not yet caught up with supply and demand – outpatients’ appointments alone have increased from 1,000 a day at St Luke’s to 1,500 at Mater Dei. We now have afternoon appointments daily in all departments and more operations are being done. At the moment, 110 surgical operations are carried out daily.
“Besides, the proposed reform will strengthen health centres, which will be providing x-ray and diagnostic services and that will take some of the pressure off the hospital. Mater Dei currently carries out 11,000 laboratory tests and 500 radiology tests daily.
“As to the A&E department, 300 patients a day are seen there, out of which 100 emergency patients are admitted. We operate a triage system, which should prioritise patients according to need. The first assessment by a nurse should happen within minutes and classification into the most urgent, those who can wait and the non-urgent follows, ” said Ms Rizzo.
However, in my experience – having been to the A&E Department at Mater Dei with friends and relatives – patients being seen by anyone within minutes is just not happening, I told her.
“Admittedly, the A&E is a worrying area and we are aware that the system needs to be improved. Ideally, we should have a doctor as well as a nurse at the first assessment and we are currently working to implement this.
“We do not have enough doctors that specialise in emergency medicine and the medical staff work on rotation,” she said.
As the Health Minister already explained in an interview with this newspaper on 28 March, another problem is that the post of chairman (the consultant responsible for the A&E department) has still not been filled.
This is because the selection committee decided that none of the applicants were suitable for the post. Until that post is filled, two consultants – who have their own departments to run and who nonetheless are on call 24/7 – are overseeing the department.
People’s nerves get very frayed when they have to wait for hours on end, especially when they are unwell, yet I have experienced a young nurse completely misreading the signs of a potentially volatile situation. I asked Ms Rizzo if they are trained to tackle that kind of
situation.
“Training is important for dealing with difficult situations. We review where training is needed and there is a practice development nurse specifically dedicated to the training of A&E nurses. This includes both clinical training and the sensitive handling of patients and their relatives,” she replied.
Another issue that often hits the news is the lack of beds and whether they being taken up by social cases. I asked what is being done about this.
“Yes, we have had a problem with situations where we did not have enough beds for acute cases because they have been taken up by non-acute cases, but rather than social cases, it is people needing rehabilitation that are taking up beds.
“Mater Dei Hospital has 825 in-patient beds and around 100 day-care beds. Apart from the 100 emergency patients admitted every day, there are another 75 booked in-patients a day and another 100 booked as day-patients.
“The beds at the hospital should be for acute cases and are not intended for people recovering, but we cannot just throw out people who require rehabilitation if the hospitals like Karin Grech and Zammit Clapp are full. The plans to build a rehabilitation hospital on site should resolve that problem,” she told me.
Another area where queues seem unending is at the Pharmacy at Mater Dei. I asked Ms Rizzo if there any plans to remedy the situation.
“The pharmacy deals with 350 patients daily. We are going to introduce a booking system for regular customers but, unfortunately, we also get many patients who use the hospital pharmacy as the last resort when they cannot get their medicines elsewhere,” she said.
One of the things that stands out at the hospital is the large number of security personnel. I asked if the hospital really needed so many.
“Yes, we do. We have quite a number of incidents, not only where a member of staff is involved but also disputes between visiting relatives. We have, for example, had a fracas ensue in a labour ward where three men were claiming paternity of the child about to be born.
“We have since instigated strict rules regarding who is allowed into the labour wards and the mother has to sign a declaration with only one putative father allowed in,” she told me.
This anecdote certainly puts paid to all the publicity about fathers not wanting to recognise their offspring!
“We also have to be careful with security on children’s wards. The security personnel,
supplied by Group 4, cover a variety of duties including reception and clerical work and they also help in directing patients.
“Last year, there was one rescue from a
suicide attempt; 65 responses to panic alarms, 165 responses to intruder alarms, 45 trapped people were released from lifts, 79 responses to incidents involving patients, 71 responses to incidents involving visitors and 44 responses to incidents involving staff.
“Security personnel also coordinate Helipad operations with traffic management; they coordinate and provide assistance during the execution of Care Orders; they escort patients to Mount Carmel Hospital and find missing patients,” she added.
I asked Ms Rizzo how much the hospital was costing and what she saw as the challenges ahead.
“The recurrent expenditure of the hospital is in the region of €150 million per annum. The greatest challenges facing us now are partly due to a very high and continuously increasing workload.
“We need to optimise the use of the available facilities in the hospital; increase the quantity and quality of clinical work; increase the number of nursing, medical and other pro
fessional staff to allow for service expansion, including
surgical operations; and we need to ensure that the hospital’s facilities are used by patients requiring acute care, while de-
centralising those health care services that would be best given in the community, or in other health care institutions. Ultimately, our biggest challenge is to meet the very high expectations of the public, the authorities and the staff.”