Patient safety depends on keeping the Clinical Director in the Royal Hobart Hospital operations centre
Tasmanians are aware of the pressure our hospitals are under: ambulances are often parked outside the emergency departments (ED), patients are treated in corridors, and surgeries are cancelled at the last minute. These are not abstract management problems. They are the lived reality of a system battling to move patients safely and quickly to the right bed.
Which is why AMA Tasmania is deeply concerned and overwhelmingly against a proposal to remove the Clinical Director (CD) from the Royal Hobart Hospital’s (RHH) Integrated Operations Centre (IOC), the team that coordinates beds, flow and capacity.
Gone are the days when doctors and matrons ran the hospital. Hospitals are now businesses, run by accountants and project managers. While running a hospital is not a core business for doctors, they shouldn’t be sidelined in these decisions either.
On paper, the IOC is described as “operational.”
In practice, the decisions it makes every hour carry direct clinical consequences. The Governance and Clinical Management Review acknowledged this reality when it retained a CD to ensure senior medical accountability for whole-of-system prioritisation.
That was the right call then; it is still the right call now.
The IOC was created to relieve ED access block by coordinating safe and timely movement to sub-acute care, hospital in the Home (HITH), NDIS, and aged care pathways, and by managing scarce bed capacity across specialty silos. Put simply, it marries system flow with patient safety.
Removing the only senior medical decision maker from this environment would be a step away from modern practice in hospitals that treat flow as the complex, multidisciplinary, clinical operational problem it is.
Our members have been blunt: taking out the CD disempowers medical practitioners from decisions that are fundamentally clinical in nature.
When the people who are ultimately responsible for clinical outcomes are sidelined from the decisions that shape them, systems become slower, risk appetite collapses, and accountability blurs. That is bad for patients, demoralising for staff, and corrosive to trust.
Importantly, the incumbent CD has delivered tangible results: improved patient flow, pragmatic infection control settings that unlock safe bed capacity, better coordination and support of nighttime junior doctor deployment, and a respected escalation point across specialties. This is not theory; it is what works on the ground.
Why does consultant-level clinical leadership matter here? Because the hardest decisions sit at the intersection of risk and time.
Bed allocation is never a simple logistics exercise. It weighs acuity, deterioration risk, infection control, escalation thresholds and suitability for sub-acute or community-based care, often with incomplete information and after hours. A senior medical decision maker is essential to own those risks.
Within the ED, the Transfer of Care protocol has contributed to an increase in bed demand. A CD with system-wide authority is often the only person able to unlock constrained capacity, override local barriers, and accept calibrated short-term risk to prevent greater system-level harm, thereby freeing crews and reducing corridor care.
The CD also keeps elective surgery moving. Sustainable theatre lists depend on predictable bed flow. Balancing booked surgical load with unscheduled emergency demand is a delicate, daily task, one that needs senior clinical oversight to avoid cancellations or unsafe early discharges.
And when pressure peaks, with code yellow events, flu surges, and staffing shortfalls, the hospital needs a clearly identified senior doctor to set the risk appetite, make defensible calls, and document the reasoning.
We recognise the Tasmanian health service’s financial pressures and the desire for uniform structures across regions. But removing the RHH IOC CD is not a smart saving; it is a false economy.
The real costs of access block and poor flow are borne elsewhere in the system, including longer lengths of stay, ramping penalties, overtime, cancellations of elective surgery, adverse events, and representations. Those costs routinely dwarf the salary of a single senior medical FTE.
If statewide alignment is the goal, align to what is safest and most effective: the current RHH model. Better yet, extend it to the north and northwest, where similar challenges demand the same level of clinical leadership.
This is not about elevating one profession over another. It is about shared accountability and putting senior clinical judgment at the point where operational choices have clinical outcomes.
A CD at the IOC interface reduces inter-specialty conflict, standardises hospital-wide protocols and drives daily, multidepartment coordination.
A simple truth lies beneath all the acronyms and flowcharts: the IOC makes decisions that directly affect clinical outcomes. Removing senior medical leadership from that function will increase risk, slow safe decision-making, and undermine ED and elective performance. Tasmanians deserve better than that.
Our call is straightforward.
Withdraw the proposal to remove the CD from the RHH IOC, commit instead to a statewide operations model that embeds senior medical leadership in flow, across all three hospitals, with clear decision rights, after-hours coverage, and transparent performance measures. That is how we protect patients, support staff and use scarce resources wisely.
In healthcare, structure follows purpose. The purpose here is safe, timely care.
Keeping the CD at the centre of hospital operations is not bureaucracy; it is common sense, and it is the right thing for patients.>>>ENDS.
