Review prescribes long-term treatment plan for ailing ACT health system

A damning review of the ACT’s public health services, particularly its hospitals, has called for an overhaul of management and training, and the adoption of a proven US model to remedy a disturbing culture of bullying and harassment.

They are among 20 recommendations in the interim report released today that also found complaints are badly handled, training is inadequate to deal with bad behaviour, decision making is tardy, leadership and management is poor, and Human Resource (HR) practices, including recruitment, are inefficient and heavy-handed.

The findings – based on submissions, interviews and an online survey – reveal a ‘worrying and pervasive poor culture across the ACT Public Health System’.

Health Minister Meegan Fitzharris ordered the Independent Review into the Workplace Culture within ACT Public Health Services last September in the wake of unrelenting complaints about practices at the Canberra Hospital in particular.

The report also takes aim at doctors, most of whom did not participate in the review, saying their general disengagement from the management of ACT public hospitals and health services has contributed to the problems, and that their greater active involvement was critical to achieving a better health system.

The survey results revealed that 60 per cent of respondents had witnessed bullying over the past 12 months and 35 per cent had experienced bullying themselves, with most of it staff-on-staff.

Disturbingly, 12 per cent of staff indicated they had been physically hurt, sexually harassed or abused at work. Of these, 46 per cent indicated it was by someone they worked with and 37 per cent said it was by a member of the public.

“Almost three in four who experienced bullying or were subjected to harm did not submit a formal complaint, and worryingly, only 22 per cent of staff had confidence in the way grievances were resolved once they were identified and reported,” the report said.

The survey results were similar across all arms of the public health system and were worse than comparable data for NSW Health.

“Pride in working for the ACT Public Health System is low, bullying is common and confidence in how the system resolves grievances is extremely low,” the report said.

It urges that a program based on the Vanderbilt University Medical Center should be adopted as a matter of priority throughout Calvary Public Hospital, Canberra Health Services (Canberra Hospital) and the Health Directorate.

“The program is designed to build a culture of safety and quality in the workplace by training and thus empowering staff to better support each other and raise concerns early. All evaluations of that program demonstrate its effectiveness,” it says.

Programs adopting Vanderbilt principles are being implemented in an expanding number of health service organisations across Australia.

The reviewers said turning around the health services would be a long-term process, with the key being a re-engaged workforce, better communication with NGOs and external stakeholders and an improved relationship with NSW Health.

Among the recommendations are calls for multi-level initiatives to re-engage staff; an overhaul of management, training and recruitment practices; and new leadership and mentoring programs.

The Minister’s message to those in leadership positions was clear – get on board or go, with review panel chair Mick Reid saying some senior staff may have to be relieved of their positions.

Among measures to get doctors more involved in the running of hospitals, the report says there should be a ”clear requirement for senior clinicians to collaboratively participate in clinical governance activities”.

While there is no doubt that doctors continue to provide quality care to their patients, “disengaged clinicians are often cynical, distrustful of the system, lack pride in their organisation, and are unhappy in the workplace”.

“A critical success factor to improving the ACT Public Health System workplace culture is to enhance clinical, in particular medical, engagement within the health system,” the report says.

It proposes that, in line with many other health services across Australia, the divisional structure in Canberra Health Services should progressively adopt Clinical Divisional Directors with Business Manager support.

Mr Reid acknowledged that health staff were sceptical but the panel hoped the recommendations were ‘pragmatic, implementable, transparent and measurable and will effect the change and people will trust the process’.

He said an important major thrust of the review was to change the way complaints were handled, so they were dealt with early and clearly so they did not escalate into major problems

The report acknowledges that work is already under way to deal with longstanding issues, with the new CEO of Canberra Health Services implementing strategies to reduce occupational violence, establishing an employee advocate role and running workshops for teams and departments with recognised problems.

It says that an oversight committee chaired by the Minister and representing all stakeholders in the health system should be established to ensure the review recommendations are implemented and to follow up on their progress.

The ACT Government has agreed to all of the recommendations in principle.

“The report released today provides difficult reading, and I’m sorry that there are people who work within our health services who have experienced bullying, intimidation and harassment,” Ms Fitzharris said. “This is not acceptable and we will need to work together to stamp it out.”

The review panel – Mr Reid (Chair), Fiona Brew and Professor David Watters – will now conduct a final round of consultation with key stakeholders before finalising the report in coming weeks.

“I have commenced discussions with the leadership within our public health services to determine how we respond to these findings and start implementing the recommendations as soon as possible,” the Minister said.

A new Implementation Steering Group and Team is to be established, and will include the Director-General of ACT Health and the CEO’s of Canberra Health Services and Calvary.

The implementation of recommendations will be supported by the establishment of a new Implementation Steering Group and Team. Recruitment of the Implementation Team, which will operate for three years, will begin shortly.

A final report is due before the end of March.

The report can be found here.