A damning report on Bermuda's hospital by consultants Kurron has highlighted mismanagement, millions of wasted dollars and lapses threatening the safety of patients and staff.

The review, released by Health Minister Patrice Minors yesterday, showed how $9.3 million could be saved every year while also pinpointing where $465,000 could be saved on a one-off basis.

The study was completed last June and some of the problems highlighted had already been tackled said Mrs Minors.

When asked what the problems were which threatened people's safety she cited the problems with air conditioning, water and laundry which were being tackled while long term the goal was a new hospital within the next 15 years.

"That will take care of many of the challenges," she said.

The report condemned management at the hospital saying communication was poor with staff, while many managers lacked knowledge on their areas of responsibility.

It said the Bermuda Hospitals Board (BHB), which covers King Edward VII Memorial Hospital and St. Brendan's sorely lacked "effective, responsive leadership at the CEO and senior management levels".

The review was conducted while former CEO Stephanie Reid was in charge. She has since been replaced by Joan Dillas-Wright whose contract expires in December 2005.

Management controls needed to be beefed up said the report which noted accountability was completely lacking.

It went on: "Replace the Chief Executive Officer and re-organise management structure to streamline reporting lines, facilitate communication and assign responsibility."

A specific plan was needed to mentor and train CEO succession candidates while ineffective recruitment and retention was also mentioned in the critique.

The report called for stronger financial controls and fundamental structural changes in administration and human resources after noting recruitment processes were dysfunctional.

It recommended increasing pay for certain critical positions while eliminating pay disparities in like positions.

The report said: "Our review of patient care and clinical support services reveals many inefficiencies as well as lapses and deficiencies that threaten the safety of patients and staff.

"Our assessment of nursing and medical staff reveals an absence of systematic performance review and many costly and missed opportunities to improve care delivery and enhance staff satisfaction.

"Despite the incomplete date available we were able to identify approximately $465,000 of one time and $9.3 million of recurring annual savings opportunities."

Most of the savings can be done by increasing staff efficiency said Kurron, who are based in America.

The consultants urged the immediate correction of unspecified environmental hazards and the implementation of an effective control programme with effective monitoring.

It noted an absence of systematic performance review among nursing and medical staff and many costly and frustrating missed opportunities to improve care delivery and enhance staff satisfaction.

The decision to table the report in the House yesterday was attacked by staff who said it should be shared with frontline managers first.

An e-mail sent to Government and hospital leadership said releasing it to the public would erode public trust in the hospitals and undermine staff relations.

Yesterday morning hospital managers met with around 400 staff to address concerns. E-mail copies and hard copies were distributed to staff ? who number around 1,400 ? simultaneous to the Minister's announcement.

Asked about her decision to release the report Mrs. Minors said: "I made the decision to do so. I think the time is right to do so.

"I am comfortable that the concerns met in that petition have been met."

She said the report was an objective review and the findings include recommendations designed to improve efficiency and effectiveness of the BHB, save money and improve quality.

Opposition MP Suzann Holshouser agreed management should have seen the report before its public release.

And she questioned why it had taken so long to address the issues in the report which had been completed in June last year.

However Mrs Minors said since the eight-week review, which started in March 2003, the BHB has implemented the following significant operational changes:

The appointment of a new CEO with both a strong administrative and nursing background in May 2003.

Creation of a separate Quality & Risk Department in May 2003 and appointment of a new director with a strong quality background.

Implementation of a review of BHB's reimbursement system (still ongoing).

Appointment of a PR and communications firm to increase communications with the BHB and its stakeholders, both internally and externally

Undertaking of a public perception study

Introduction of open Board meetings for employees and unions

Increasing communications through monthly Board briefings; introduced accreditation teams that look at how to improve hospital processes; introduced regular senior management visits to patients and employees

Revamping of Quality Council reporting directly to the Board

In July 2003, the introduction of an Environmental task force to look at the BHB's housekeeping and maintenance issues

Beginning of more thorough employee reviews at the management level

Introduction of weekly one-on-one meetings with the CEO and BHB Directors

Introduction of an open door policy with both the Chairman and CEO

Appointment of a Director of Facilities and Management with specialised hospital experience

Introduction of interest-based bargaining which enabled the Bermuda Public Services Union agreement to be signed off after a record seven meetings

Introduction of an Operational Review task force in January 2004 to review Operational Review report and implement appropriate actions

Creation of the Bermuda Hospitals Charitable Trust as an independent organisation to look after fundraising efforts

Implementation of a master estate planning exercise in March 2004

Mrs. Minors said a task force had been set up to implement other aspects of the review and priorities were still be worked out.

"We believe that we have already begun ? and will continue ? to make changes based on this review to improve the quality of healthcare available to Bermuda residents," she said.

Bermuda Hospitals Board chairman Jonathan Brewin said: "We have taken the Operational Review very seriously. However, there are a number of recommendations that we have rejected as they are not appropriate to Bermuda and our hospitals.

"There are a number of changes we have made at the BHB in line with our strategic plan and accreditation report, as well as the Operational Review. We have a very capable staff and we welcome an audit as part of our business processes.

"However, we recognise we have more improvements to make to ensure that we are operating as efficiently as possible.

"I am pleased with the progress we have made over the last year and we will continue to benchmark ourselves to ensure that we are providing the best possible healthcare to the local community."

He said they would be combined with the hospital's own strategic plan to improve the hospital.

He said the hospital's goals were quality, fiscal stability, good communications and staff relations. Most of the goals could be achieved this year with the some carrying on into 2005, said Mr. Brewin.

BHB CEO Joan Dillas-Wright said: "We have established an action plan with timelines and responsibilities at the senior management level to ensure swift implementation of Operational Review actions.

"It is our intention to continue to keep the community up-to-date with hospital developments and enhancements to reassure the public that quality of care is our number one priority."