Although the ACT Government has laid “strong foundations” to reform the workplace culture of the Territory’s public health services, bullying and harassment remain problems, according to a report released yesterday.

The ACT’s public health services include the ACT Health Directorate, Canberra Health Services (CHS), and Calvary Public Hospital Bruce.

Background

In 2019, an Independent Review, commissioned in 2018 by then-Health and Wellbeing Minister, Meegan Fitzharris, investigated systemic and institutional issues in public health workplaces, including inappropriate conduct and behaviours.

It revealed inappropriate behaviour, bullying, and harassment in the workplace; inefficient procedures and processes, including complaints handling; inadequate training in dealing with those inappropriate workplace practices; inability to make timely decisions; poor leadership and management at many levels; and inefficient and inappropriate human resource practices.

“There is little doubt the vast majority of staff provide high quality health care and strive for excellence,” the Review stated. “Less embedded are the values of collaboration, integrity, and respect.”

It made 20 recommendations to improve the public health system, including adopting an American early intervention program; strengthening relationships between CHS, health sectors, and the hospital; and better engagement with clinicians. So far, eight of those recommendations were completed, and good progress was being made on the remaining 12, ACT Health Minister Rachel Stephen-Smith recently stated.

Second Review: Commendable effort, but more action needed

Yesterday’s Second Independent Annual Review, Culture in the ACT Public Health System, found that several initiatives (including a Workplace Culture Framework) had positive effects on staff experience. Training programs encouraged staff to speak up, and complaints procedures addressing poor behaviour were improved. The three health services had given greater focus and meaning to organisational values, and embedded those values in strategic documents and staff training. Clinicians were expected to be involved in strategic planning and decision making.

“These are all very worthwhile steps that have taken considerable effort and resources to achieve across a busy health system and in especially challenging times,” the Review stated. “The three health organisations are to be commended for sustaining the effort to develop and implement these initiatives.”

However, the Review continued: “While these initiatives have had some positive effects on the experience of staff in the health system, there needs to be much greater effort on the aspects that will have the most impact.”

The ACT health services needed to set expectations of positive workplace behaviour; build the capacity of leaders and managers at all levels to exemplify and facilitate that behaviour in teams; and ensure that positive behaviour was rewarded, and poor behaviour firmly addressed. The health services also needed to communicate clearly and consistently about the importance of a positive workplace culture and the work underway to embed that culture.

AMA: Concerned about bullying in the workplace

The ACT branch of the Australian Medical Association said the Review marked a frustrating and disappointing stage in the process to improve workplace culture in ACT public hospitals.

“When we started the process of improving workplace culture two years ago, AMA ACT held high hopes that we could achieve real and sustainable change,” said Professor Walter Abhayaratna, president. “That hasn’t yet proved to be the case.

“While I know that many people have tried hard to improve our workplaces as part of the Culture Review, the latest Annual Review shows that even the limited improvements have been offset by backsliding in other areas.”

Worryingly, bullying and harassment of staff and junior doctors remained, the Review found.

“Most staff feedback, particularly in CHS, reflects a view that little has changed.” A survey showed that fewer CHS workers felt a strong sense of purpose and direction, or a climate of trust and respect, since 2019; in fact, the proportion of staff who would recommend CHS as a good place to work had declined.

“A major concern of AMA ACT in launching the campaign for an independent review some two years ago, was the bullying and harassment being faced by staff and particularly junior doctors,” Professor Abhayaratna said. “Some two years on, despite limited progress on the issue, our concerns remain.”

He believes the ACT senior executives’ contracts should include performance measures around bullying, a measure already adopted in South Australia.

CHS CEO Dave Peffer said his organisation would focus on fostering a positive workplace culture.

“While we’re off to a good start, it’s not enough to simply implement programs that are designed to make a difference,” Mr Peffer said.

“Our people need to be able to tell us they can feel a difference as a result of these programs. Work is underway to build team members’ courage and confidence to empower them to call out behaviours that aren’t consistent with our values, and to escalate those matters if required.”

Health Minister: Improving culture does not happen overnight

Ms Stephen-Smith acknowledged there was still a lot of work to do.

“We know that improving culture is not something that happens overnight, and I am pleased that the annual review confirms we have built strong foundations for system-wide reform,” the minister said.

“However, feedback from staff tells us we have more work to do to establish expectations of positive workplace behaviour and to build leadership and management capability to uphold those expectations in practice.

“We also know that completing the 20 recommendations is not the end of the culture reform journey, and we are committed to continuing this vital work with our public health system staff.

“In the final year of the program, we are transitioning our focus from the program’s specific actions to making culture improvement part of normal business.”

ACT Health Director-General Rebecca Cross and Calvary Health Care ACT Regional CEO Barb Reid welcomed the review, and would meet the remaining recommendations.

Professor Abhayaratna acknowledged Ms Stephen-Smith and the three public health services’ efforts in trying to move things forward. “I just wish we had more encouraging news to report.”

The Culture Review has one year of funding left.

“There’s a feeling that things are coming to an end,” Professor Abhayaratna said.

“While other work continues, it now seems sensible to consider what happens beyond the next 12 months, and how we take the reform process beyond that timeframe.”