Wednesday, 29 November 2023

Victorian Auditor-General’s Office

Employee Health and Wellbeing in Victorian Public Hospitals

Sarah MANSFIELD (Western Victoria) (17:40): I rise to speak on the Victorian Auditor-General’s Office report tabled on 15 November into the wellbeing of health practitioners in the hospital setting. This is a scathing report, and one that demands an urgent and thorough response from the minister. It vindicates what I am hearing from healthcare workers, who say that morale has never been lower. Although this VAGO report focuses only on three public hospitals, I believe the findings can be applied broadly across our health system, and while it focuses on the deterioration in worker mental health and wellbeing since the COVID pandemic, the decline in mental health and wellbeing and morale has been brewing for decades. Back in 2006 the World Health Organization acknowledged that health services around the globe engaged in poor human resource practices that focused on cost-cutting, leading to low staff morale, heavy workloads, long work hours and unsafe workplaces.

In 2008 as a junior doctor I became involved in the Australian Medical Association because of a desire to advocate for improved working conditions for junior medical staff and for cultural change in the public hospital system. Even back then it felt like staff were viewed by the system only as units of labour there to fill gaps in a roster and meet arbitrary performance targets motivated by politics rather than evidence. It bred a workplace culture across the whole system where bullying and harassment were common, tolerated and even normalised.

Over recent years brave whistleblowers have exposed this culture in our hospitals, and I was thrilled for the junior doctors in Victoria who recently succeeded in a class action to get paid thousands of hours of legitimate overtime claims, but too little has been done to address the systemic issues that take a toll on health worker wellbeing. Demand continues to rise due to a lack of preventative health investment, and resourcing of services has not kept pace. To this point, the VAGO report identifies that this stems from the top. The Department of Health does not place enough value on employees’ welfare. It does not even collect sufficient or timely data to assess how hospitals are performing as employers or protecting employees’ mental health and wellbeing. This in turn means hospital boards do not prioritise these issues, and that lack of expectation flows down.

Hospitals are inherently stressful working environments. Workers experience difficult and emotionally challenging situations and traumatic events, and deal with members of the public who are also experiencing distress or who may exhibit violent or challenging behaviours. The department’s own survey of health workers in 2022 identified that 70 per cent of health workers had experienced aggression, violence or abuse from patients. But the VAGO report identified that hospitals are failing to report gaps in processes and psychological hazards that can lead to increased risks of occupational violence, aggression and bullying. Given the nature of the work and inevitable strains this places on all hospital employees, it should be all the more reason to do everything we can to prevent additional avoidable stressors arising in that environment.

Hospital employees should feel valued and recognised as individuals with basic needs and working rights. The consequences of failing to do this do not just negatively impact employees – although this should be enough for us to care – the Victorian public who attend hospitals as patients and their families also suffer when staff do. For example, in a 2020 Australian Medical Association survey of junior doctors, it found that 47 per cent of respondents reported making a clinical error because of fatigue, yet none of the hospitals audited by VAGO have a structured approach to assessing and managing fatigue.

Employee safety should be a priority in all workplaces. In the healthcare context, it is not about hard hats and earmuffs; it is about reducing patient demand through investment in prevention and better resourcing of existing services, for example, fatigue-minimising rosters, adequate staffing levels to meet demand, sufficient backup when staff are sick, and appropriate supervision and support. Creating a health system that values employees and their wellbeing is not impossible, but it requires a massive shift in the priorities of governments and administrators. If we do not, we will continue to see health workers walk away from the system at a time when we need them the most, and all Victorians will bear the consequences.