Health & Lifestyle

Internal documents reveal ‘toxic’, ‘fearful’ culture at Victorian hospital

An internal report obtained by the ABC under Freedom of Information (FOI) laws has revealed a “toxic” and “demoralising” culture of bullying and mismanagement at a hospital in south-west Victoria, where staff were forced to grapple with a cluster of patient suicides without immediate support.

It is the first time the workplace review has been released publicly, or seen by those other than top executives at South West Healthcare, despite a push by the Health and Community Services Union to access the report.

The workplace review report, overseen by the former state director of mental health, Leanne Beagley, was undertaken in 2016 in response to what that the union described as “systemic and sustained” bullying within mental health services at South West Healthcare, which is based in Warrnambool.

It identified serious issues relating to workplace structure and culture, including a lack of confidence in senior management to act ‘consistently and fairly’, and concerns accountability for patient care had been “compromised”.

Staff ‘shamed’ for expressing concerns

The report found ongoing issues within senior management, including personality clashes, a lack of accountability and a perceived failure to uphold agreed policy and procedures, created a culture that “struggled to support” staff.

Operational decision-making was viewed as “idiosyncratic, confusing and even impulsive”, and staff reported being excluded from decisions or meetings that formed part of their duties.

“The internal culture was described variously as ‘toxic’, ‘fearful’, ‘hampered’, ‘distressing’, ‘blaming’, ‘scrutinized’, ‘ashamed’, ‘silenced’, ‘punitive’ and not supporting of either staff or managers,” the report read.

Staff reported they were made to feel inadequate or shamed if they expressed concerns, and in one case, employees managing three patient suicides within a short time frame were not immediately offered debriefing until it was specifically requested.

It found issues around staff morale were exacerbated by a proposed restructure, which was subsequently withdrawn, where four employees were advised via rumour that they would be made redundant.

Workplace culture ‘driving away’ employees

The report also identified systemic issues centred around inter-service collaboration, or a lack thereof, where the mental health department was seen to operate as a “silo”, leading to an “erosion of trust”.

GPs were noted to be particularly frustrated with the service delivery capability and responsiveness of the acute and community mental health teams, and the mental health service was “not found to be seen favourably by the community”.

Internally, the report found inadequate linkages or shared accountability for recruitment, retention, supervision and support across leadership in medicine, nursing, social work and occupational therapy, and a lack of consultant psychiatrists, who were viewed as critical in leading patient care and managing risk.

“The culture within the mental health service is seen to undermine and even ‘drive away’ high calibre people’,” the report noted.

“It was reported that problems with retention of experienced staff have been entrenched over some years.”

‘Significant change’ underway, hospital says

South West Healthcare refused to be interviewed over the report, but said in a statement that it had developed an “immediate action plan” to address the report’s recommendations, including reviews of workplace management and culture.

The overhaul has been led by new Executive and Management team appointments, including a new Director of Mental Health Services and Director of Clinical Services.

“Immediate work was undertaken to develop positive and collaborative working relationships with all staff, consumers and key stakeholders, including other health services, GPs, alcohol and other drug services, and emergency services,” the statement said.

“[This] has resulted in significant change that is focused on improving care to consumers, while supporting staff to deliver this in a productive and positive working environment.”

The Health and Community Services Union said staff had begun returning to South West Healthcare since the changes in leadership were implemented.

“This is an area that has a really high toll on workers, and if they’re not supported, all they do is leave the organisation,” area organiser Angela Carter said.

“It takes time. The trust in leadership has improved already [but] trust in the organisation and HR processes takes a bit longer, [so] we’ve still got a way to work with that.”