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LIA WESTERN AUSTRALIA
Journal of the Australian Medical Association WA | April 2021 Volume 61 / Issue 3 | amawa.com.au
80
COVER STORY
of doctors call out
sinking morale at Bunbury Hospital
%
CODE
A ruptured relationship between doctors and
WACHS Senior Executive has triggered a pressure
cooker situation at Bunbury Regional Hospital
“WACHS remains absolutely committed to improving our engagement and culture,
and recognises that employee satisfaction is integral to our mission of delivering and
advancing high quality healthcare in country WA.”
T
he above formed the grand opening to an article The results reveal an utterly disengaged clinical workforce
by the WA Country Health Service (WACHS) in the that feels subjected to dangerous levels of intimidation and
November 2019 edition of Medicus. Responding disregard by the WACHS senior executive, all at the expense
to the Minister for Health’s Your Voice in Health (YVIH) of patient safety and employee wellbeing. These issues
survey results, WACHS wrote at the time about its overall were all previously raised directly with WACHS’ Board Chair
intent to improve general communications with its medical and the Director General of WA Health.
workforce. In both AMA (WA) system-wide senior doctor engagement
It appears WACHS’ commitment doesn’t extend to staff at and morale surveys (2017 and 2019), WACHS twice produced
Bunbury Regional Hospital (BRH). some of the lowest scores. Equally concerning, is the fact
that WACHS was one of two health service providers (HSPs)
A recent AMA (WA) survey of doctors at the WA Health-
to report a deterioration in results for some key measures in
operated hospital reveals defective communication
the 2019 survey.
pathways between WACHS senior executives and clinicians,
and a pervasive fear amongst doctors when it comes to The 2020 Minister's YVIH engagement survey reported
raising concerns with management. some improvements for WACHS medical practitioner
results, when compared to 2019 data. WACHS Chief
The Bunbury Regional Hospital Clinical Engagement and
Executive Jeff Moffett lauded the progress and pointed to
Morale Survey exposed other equally alarming issues, with
the increase in the survey’s Employee Engagement Index
scores eclipsing all previous AMA (WA) surveys to date.
18 M ED I CU S APRIL 2021
"
COVER STORY
for WACHS doctors, noting: “WACHS While WACHS Another said: “A critical safety issue
will continue focusing attention on is currently staff’s fear to speak
engagement
improving staff recognition, collaboration, up. Our most vocal spokesperson
communication and wellbeing”. and morale ratings was essentially dismissed without
What stood out for the AMA (WA), remain a concern, BRH any transparency, leading staff to
assume that it may be related to
however, was the small number of medical is, without doubt,
practitioners from WACHS who completed his advocacy for patient and staff
an exposed nerve. safety.”
the 2020 YVIH survey – a mere 68 doctors
from more than 650 potential respondents.
The AMA (WA) has Yet another colleague referred to
This marked a 70 per cent reduction in received numerous BRH doctors being fearful of saying
WACHS medical practitioner responses, calls from clinicians things that management didn’t
compared to the 2019 survey. want to hear. “The phenomenon
at the hospital,
While WACHS engagement and morale of Heads of Department across
ratings remain a concern, BRH is,
reporting adversarial WACHS being told their contracts
without doubt, an exposed nerve. The bureaucratic won’t be renewed has a chilling
effect on the exercise of
AMA (WA) has received numerous calls intervention, poor
from clinicians at the hospital, reporting leadership,” they wrote.
decision-making and
adversarial bureaucratic intervention, poor AMA (WA) President Dr Andrew
decision-making and a lack of engagement
a lack of engagement Miller raised the arbitrary non-
from management. More often than not, from management. renewal of Dr Coulson’s contract in
the managerial approach is one the AMA a letter to WACHS Chair Dr Neale
(WA) would characterise as disingenuous, Fong in December 2020.
opaque and punitive.
THE NEED FOR A SURVEY
NO CONTRACT, NO REASON Following a lacklustre response to concerns raised by the
Any review of the ongoing issues at BRH would be AMA (WA) at several levels of WACHS leadership and the
piecemeal without mention of the catalyst that triggered a clinicians themselves, we felt compelled to survey BRH
great deal of concern and fear amongst the doctors at the doctors in an effort to clearly identify issues that exist at the
hospital. hospital and the degree to which they exist. The aim was to
On 30 September 2020, long serving and much-admired elicit a meaningful response to these issues from WACHS,
head of BRH’s emergency department, Dr Adam Coulson, the Director General of WA Health and the WA Government,
was advised his contract would not be renewed. He was and to address the problems besieging the hospital.
offered no alternatives or any meaningful reason for the Fifty-six doctors at BRH participated in the AMA (WA)
decision, which sent a frisson of alarm through the entire survey – a high proportion of BRH’s clinical workforce,
hospital. The non-renewal of Dr Coulson’s contract occurred almost matching the total number of all WACHS medical
despite him receiving good formal performance reports (the respondents to the 2020 YVIH survey. The next few pages
last taking place mere weeks before) and multiple verbal present some of the results, which tell a tale of disquiet and
assurances from senior managers that his contract would be utter despondence.
renewed. Employee wellbeing is overwhelmingly identified as being
No less than 43 staff specialists engaged at BRH contacted negatively impacted by workplace culture and morale.
the AMA (WA) independently to express their profound lack Equally concerning, is the reported negative impact
of trust and confidence in WACHS Executive as a result of on clinical outcomes, identified by a large majority of
Dr Coulson’s experience. respondents.
Those same sentiments are echoed in the ‘comments’ Fear of victimisation as a result of raising concerns about
section of the recent AMA (WA) survey. decisions taken by senior executive is pervasive. Through
One doctor wrote: “It is an absolute travesty that this natural Dr Coulson’s example, BRH doctors have witnessed
leader and extremely talented emergency physician is firsthand the impact of questioning senior executive
losing his tenure.” decisions, and consequently are concerned about the future
impact of such action on their employment.
Continued on page 20
APRIL 2021 ME D I C US 19
80 of doctors call out
sinking morale at Bunbury Hospital
Continued from page 19
COVER STORY
CODE
WORD FROM THE WARDS been immense. All staff in the ED have been impacted by
the recent events and keenly feel the loss of a respected
Medicus independently contacted two doctors – one a
leader.
senior consultant, the other, an RMO – both of whom prefer
“A number of consultants have chosen to leave or reduce
to remain anonymous.
their hours. Junior medical staff throughout the hospital
According to the junior doctor, there are several positives
have also expressed concerns about their ongoing
to working at BRH.
commitment to WACHS.
“Bunbury Hospital is privileged to have a large cohort of
“We are left wondering – where is the patient in all this?”
senior clinicians and heads of department who place a
large emphasis on teaching and junior doctor welfare.”
They acknowledged, however, that improvements were
THE WAY FORWARD
needed in communication between consultants and junior The AMA (WA) strongly believes that the unreasonable
doctors, the payment of overtime and provision of formal flexing of contract renewal muscle and continued inaction
teaching. and neglect by WACHS has brought doctors at BRH to
their knees. Given the deleterious survey results and
They also pointed to the ED as a particular minefield.
the consequent risk to patient outcomes and employee
“A number of consultants have handed in their notice
wellbeing, the Association:
because they’re unhappy with the loss of a great head of
y has reported WACHS to WorkSafe WA, seeking a
department in Adam Coulson, or their contracts haven’t
health and safety investigation;
been renewed. This seems absurd given the department is
permanently short-staffed, reliant on locum registrars and y is calling for the establishment of alternative pathways
consultants to fill a deficit. No help from WACHS with new for BRH staff to raise and communicate safety
contracts or a staff drive appears to be at hand.” concerns;
The RMO recognised that steps have been taken to y will liaise with the WACHS Board, communicating
improve these situations with permanent executive staff on our concerns and survey results, and seeking
long-term contracts, and a fully staffed medical workforce transparency and accountability in relation to recent
on site who have done an exceptional job at picking up the decision-making and immediate action to address
pieces of last year. However, the aftershocks are still being the systemic communication and engagement issues
felt. at BRH. This is in addition to action to demonstrate to
staff at BRH that destructive bureaucratic decision-
“Multiple departments are short staffed, and leave is hard
making cannot happen again; and
to come by with a reduced cohort of juniors available on
leave relief terms,” they explained. y will communicate the issues at BRH to Premier Mark
McGowan, Health Minister Roger Cook and WA Health
The senior consultant we approached also acknowledged
DG Dr David Russell-Weisz to once again illustrate the
the loss of Dr Coulson as having had a devastating effect
damaging impact of five-year contracts on doctors’
on morale in the ED and the hospital as a whole.
wellbeing and service delivery. An active and genuine
“Senior clinicians have been left wondering if their jobs are
commitment to support clinical engagement and
secure and feeling that they can no longer ‘speak up for
workforce wellbeing is needed.
safety’,” they said.
Representing WA’s medical profession, the AMA (WA)
“As senior clinicians, our focus is on offering excellent care
stands willing to work together with management at BRH,
for our patients while also providing education, support
WACHS Senior Executive, and the State Government to
and mentoring for the others with whom we work.
improve engagement and culture at the hospital and drive
“The flow-on effect on the morale of senior clinicians has constructive change. ■
APRIL 2021 ME D I C US 21
COVER STORY
THE RESULTS ARE IN
Here are the responses to some of the questions posed to
doctors at Bunbury Regional Hospital
The Bunbury Regional Hospital Which best describes your current
(BRH) Clinical Engagement and classification level?
Morale Survey was open to all
BRH doctors as well as those Doctor in Training (DiT) 37%
clinicians who had worked at the
Senior Doctors (inc. Head of
hospital in the last 12 months. Departments [HoDs]) 54%
Of the 78 doctors at BRH
Hospital Executive 2%
who were sent the survey, 56
completed the questionnaire – a Visiting Medical Officers (VMOs) 7%
72 per cent response rate.
Senior doctors were asked to rate the following
statements as they apply to the Senior Executive FLASHBACK
(positions above their Head of Department) at
Bunbury Regional Hospital In 2019, the AMA (WA) conducted its Senior
Doctor Clinical Engagement & Morale
100% response rate
Strongly Agree & Survey. Responses from the WA Country
Disagree & Neutral Strongly Health Service (WACHS) indicated that the
Disagree Agree environment state-wide was not particularly
wholesome. At the time…
Questioning Senior Executive
y 52 per cent ‘strongly disagreed’ or
decisions will not impact my future 86% 9% 6%
employment. ‘disagreed’ that questioning Senior
Executive decisions would not impact their
You have a positive and future employment.
constructive relationship with the 69% 20% 11% y 69 per cent ‘strongly disagreed’ or
Senior Executive at your workplace.
‘disagreed’ that the Senior Executive
The Senior Executive enable at their workplace were effective at
strong medical leadership and 80% 11% 9% communicating with clinical staff.
participation in decision-making.
y 69 per cent felt decisions made by the
Senior Executive were not reasoned and
The Senior Executive at your
influenced by clinical engagement.
workplace are effective at 91% 6% 3%
communicating with clinical staff. Bunbury Regional Hospital (BRH) is just one
hospital within the WACHS network, and the
The Senior Executive at your
AMA (WA)’s recent survey included DiTs. Still,
workplace are effective at 86% 9% 6% the overwhelmingly disappointing results
consulting with clinical staff.
as far as interactions with Senior Executive
Decisions made by the Senior is concerned, would suggest a marked
Executive are reasoned and 89% 9% 3% deterioration since 2019.
influenced by clinical engagement.
Percentages have been rounded to the nearest whole number.
22 M E D I CU S APRIL 2021
COVER STORY
Senior doctors were asked to answer the following questions as
they apply to Bunbury Regional Hospital.
Yes Neutral No
100% response rate
Do you fear victimisation as a result of raising concerns about decisions taken by Senior Executive? 83% 9% 9%
Have you considered resigning or relocating from this hospital due to adverse work conditions? 69% 3% 29%
DID YOU KNOW? FLASHBACK
The AMA (WA) Bunbury Survey asked participants if they
The AMA (WA) asked senior doctors in WACHS a similar
considered certain incumbent position holders to be
question in both 2017 and 2019 iterations of the Clinical
honest and trustworthy in their interactions with clinical
Engagement & Morale Survey. The result – 35 per cent and
staff. We have chosen not to publish those specific
45 per cent of respondents respectively indicated they
results in this cover story but can report that the ‘Head
feared victimisation as a result of raising concerns about
of Department’ position recorded by far the highest
Senior Executive decisions.
percentage (92%) of YES responses.* The discouraging
results in the other categories reflect an increase in no Although just one part of the overall WACHS presence,
confidence in those positions. BRH’s result in this particular category (83 per cent) should
ring alarm bells. Undoubtedly, patient and staff safety is
* Responses marked as N/A have been removed.
compromised when clinicians feel they will be targeted or
victimised for raising any concerns.
Culture represents the shared attitudes, values and beliefs
manifested in organisational behaviour. All respondents Very Poor Good &
Fair
& Poor Excellent
rated culture at Bunbury Regional Hospital as:
98% response rate
75% 20% 5%
FLASHBACK DID YOU KNOW?
58 per cent of BRH doctors feel that
WACHS’ culture ratings in both the 2017 and 2019 AMA (WA) Senior Doctor culture has deteriorated over the
Clinical Engagement & Morale Surveys were disappointing. In fact, 57 per cent past 12 months, 21 per cent believe
of WACHS respondents in the 2019 survey rated culture as either ‘poor’ or ‘very culture has remained unchanged
poor’– the worst results amongst all health service providers for that question. and just 11 per cent feel that culture
If the BRH survey result in this category is anything to go by, WACHS needs to has improved.
closely examine how it can reinvigorate culture across all of its health facilities.
Continued on page 25
Percentages have been rounded to the nearest whole number.
APRIL 2021 ME D I C US 23
COVER STORY
Continued from page 23
Morale describes the overall outlook, satisfaction and
confidence that employees feel at work. How would you rate Very Poor Good &
Fair
& Poor Excellent
medical practitioner 'morale' at Bunbury Regional Hospital?
98% response rate
80% 16% 4%
DID YOU KNOW? FLASHBACK
64 per cent of BRH doctors feel that
morale has deteriorated over the past WACHS didn’t fare too well in the 2017 and 2019 AMA (WA) Senior Doctor
12 months, 20 per cent believe morale Clinical Engagement & Morale Surveys, recording low morale scores –
has remained unchanged and just 9 45 per cent and 55 per cent of WACHS doctors respectively rated morale
per cent feel that morale has improved. as ‘poor’ or ‘very poor’. Only North Metropolitan Health Service recorded
a lower morale score than WACHS in 2019. WACHS has clearly failed in its
efforts to address poor morale at BRH.
BRH doctors who feel current workplace culture How would you rate Bunbury
and morale have a SOMEWHAT NEGATIVE or VERY Regional Hospital's support for the
NEGATIVE IMPACT on: clinical workforce?
98% response rate 98% response rate
Clinical outcomes 75% Very Poor & Poor Fair Good & Excellent
Service delivery 82%
85% 13% 2%
Clinical staff turnover 89%
Employee wellbeing 91%
All doctors were asked to rate the following issues as they currently impact
culture and morale:
98% response rate
Strong Negative or Strong Positive or
No Impact
Negative Impact Positive Impact
Five-year contract of employment 71% 7% 22%
Contract of employment renewal process 82% 8% 10%
Access to professional development leave 33% 20% 48%
Access to annual leave 33% 22% 46%
* Responses marked as N/A have been removed. Percentages have been rounded to the nearest whole number.
APRIL 2021 ME D I C US 25COVER STORY
VOICES & VIEWS
Here are a few extracts from the pages of comments and concerns from
Bunbury Hospital doctors, received as part of the AMA (WA) survey
“There are silos (departments) that do “I am making
things well, so it isn’t a 100 per cent plans for a new
negative experience. However, the current life anywhere
treatment from medical admin is abhorrent but here... unless
– varying from casually unpleasant to there is some
outright bullying.” astonishing
miracle and
“The hopelessness “Morale has improved, rapid dramatic
and powerlessness thanks largely to a change improvement.
I feel is profound. Things just go
We are essentially
in leadership that appears
gagged from positive. I am hopeful, but from bad to worse
speaking up for several of my more jaded to desperately
patient safety.” colleagues are not convinced." awful.”
“Bullying, harassment, intimidation, providing incorrect information to
junior doctors about the AMA Agreement, not following the AMA Industrial
Agreement, violation of the AMA Agreement on multiple occasions…”
“With so many of the “There is no access to non-clinical time
for any of the junior doctors. This means
doctors at Bunbury that mandatory training is significantly
Hospital being a poorly complied with because the
expectation is to complete it during
transient fixture, clinical hours (which is not possible) or
most of us are like complete in our own time at home.”
ships in the night and
“The initiation of a JMO society and recent
so there is not much employment of JMO support officer this
in the way of 'culture' year is heartening, however it will do very
little to address the bigger underlying
from a doctor’s systemic issues that feed into the perpetual
perspective.” low morale amongst doctors at Bunbury.”
26 M E D I CU S APRIL 2021COVER STORY
“There is no flow in “The hospital has a sad feel to it in
the ED. The nurses comparison to a few years ago.”
seem fairly low/
run-down and “There is a teaching effort from the Medical
there is really no Education Unit, and this is respected by the
drive for clinical departments, making sure we have access to
excellence.” protected teaching time.”
“There is a major redevelopment supposed to occur, yet
clinical input seems to be left to the last minute as usual.”
“It seems the WACHS head office feels they know best how to manage the hospital and
healthcare in the South West… and this has been shown very clearly to be false with
increasing adverse events. Those senior clinical and admin doctors who live and work in
Bunbury will continue to work to provide the best care for our patients and community, and
improve the hospital, but we are now very confident that doing so, and especially providing
strong local leadership and speaking up for patient care and safety, is likely to result in
disciplinary action or the end of our careers.”
“Management of non- “I would have a lot more respect for the
clinical time, annual and executive… if they dropped their anti-doctor
professional development narrative, apologised for their obvious mistakes
leave and rostering and made a sincere effort to regain the trust
within my department and respect of clinicians. Instead they have
is compassionate sacked people, doubled down on their anti-
and fair and good for
doctor rhetoric and made vague insinuations
morale. However, there
of ‘more change’ to come.”
is significant pressure
to reduce non-clinical
time...The ongoing “There are still persons in senior
culture of over-managing
management who have been involved
and morale-bashing
behaviour continues. in bullying and pressuring of senior
It is embedded within clinical staff – using five-year contracts
WACHS.” as a blunt but effective tool.”
"The exec are trying to divide, bully and conquer with no
regard for proper clinical governance, employee wellbeing
or following the core values of the organisation." ■
APRIL 2021 M E D I C US 27You can also read
