ACT ambulance culture is plagued by bullying, blame, distrust verging on paranoia, and poor, ad-hoc and erratic management, a leaked report has found.
The damning conclusions of the long-awaited cultural review of the ACT Ambulance Service - commissioned in October 2013 and handed to government last month - have come with recommendations for a major effort to reform organisation.
Emergency Services Minister Joy Burch and Commissioner Dominic Lane say they won't ignore or back away from the findings, but have assured Canberrans the cultural problems are not linked to the service's clinical and technical performance, which is among the best in the country.
The authors of the report, consultancy firm O2C Solutions, pulled no punches in their scathing assessment of ambulance culture, based on a series of confidential submissions, workshops, a survey of staff, station visits, staff meetings, and a literature review.
The O2C report found distrust and fear, common in many ambulance organisations, was "manifest" throughout the ACT Ambulance Service.
Distrust, the authors wrote, often verged on paranoia of others in the service, usually more senior staff. There were high levels of conflict, and some workers were afraid to speak out, even anonymously, for fear of what would happen to them.
In one workshop, the authors said the anger of participants was both "palpable and visible".
Evidence of widespread issues of blaming and bullying was also uncovered, although the authors said such issues were common across ambulance services.
"Blame is widespread and so common is blame and blame avoidance that this colours the environment," the authors wrote.
"For example, accurately separating the appropriate checking of cases and clinical actions from the blame and blame avoidance mindset is almost impossible."
"Efforts to audit patient treatment decisions with a view to maintaining clinical standards are met with suspicion and defensiveness."
It said daily relationships within the ACT ambulance service were characterised by "unprofessional, harassing (in the broadest sense of the word) and at times intimidatory behaviour".
Ms Burch says the report, obtained by Fairfax Media, is so inflammatory and potentially damaging and dangerous to some individuals, including ambulance officers who spoke in confidence, that she has been advised not to release it.
The government will instead publish on Wednesday a blueprint to reform the organisation that includes the O2C report's findings and recommendations, one of which will see all senior ambulance managers subjected to performance evaluations.
The government will create an action plan and install an oversight committee, including union and external representatives, to regularly report to Ms Burch on progress.
"To not act on this is not in my game, it's just not an option," Ms Burch said.
The O2C report also noted the organisation was given a "strikingly poor result" by surveyed workers for its performance against the ACT public service respect, equity, and diversity framework, which the reports said it neither adhered to or endorsed.
Some workers surveyed by the consultants spoke of the service being a boys' club, rife with nepotism, and institutionalised bullying by senior staff.
Another spoke of a culture of shifting problems or covering them up.
The authors said the service needed to investigate a different leadership style and framework, was poor at talent management and succession planning, and lacked a strategic vision.
The service had also failed to match its own rapid growth in recent years with a simultaneous improvement in managerial skills and professional standards.
There has been a failure to develop "professionalism as a cultural standard", due largely to a lack of training in human relations, management, and leadership, and the failure to develop proper guidelines linking organisational structure, role responsibilities, professional healthcare standards, and the paid deployment of staff in an optimal manner.
"Without these systems and professional development training ACTAS is managed in an uneven and often ad hoc fashion.
"Certainly, senior managerial responses to problems appear to be slow and sometimes erratic, allowing hostility, suspicion and jealousy to thrive."
There were eight recommendations made in the report, including signing an agreement to transition to a better culture, a "cultural commitment" from the emergency services commissioner, and the development of an ambulance leadership framework, which would set out the expectations and requirements at all relevant levels within the service.
Significantly, it has recommended rigorous performance reviews of all managers in the ambulance service.
A series of staff workshops were also called for to reinforce the equity and diversity requirements and address acceptable and unacceptable behaviours.
It also called for additional surveys to check the progress of any reforms.
Ms Burch has incorporated all of those recommendations into the government's blueprint for the ambulance service, and has developed an action plan and oversight committee to ensure changes carry through.
Mr Lane said the report would be used to help professionalise the workforce, and said it would help drive the national discussion of a registration scheme for paramedics.
"It's an opportunity for improvement, not only in ACTAS, but across the broader [Emergency Services Agency]," he said.
The blueprint is expected to be released on Wednesday morning.