Health Minister Meegan Fitzharris must be hoping the year's restructure and personnel overhaul will finally show results and lead to a few more positive headlines in 2019.

But deeply ingrained structural and cultural problems do not change overnight, and if the government is truly committed to improvement it must not minimise the problems plaguing the system and instead see them as an opportunity for leadership.

It is no coincidence that allegations of poor culture occur alongside the undeniably poor performance of Canberra’s health system when compared to its peers.

ACT residents are simply not getting the health system they deserve.

Accreditation woes

The year got off to an exceptionally bad start when in March the Canberra Hospital had a disastrous visit from national accreditors.

The draft report found significant failings including some which were classified as “extreme risks”.

The hospital was able to fix the long list of issues to the accreditors’ satisfaction, and was eventually accredited.

Confusingly, Ms Fitzharris jumped on the eventual accreditation of Canberra Hospital as an example of great success and reform.

But the public is rightly not going to applaud a hospital getting accredited - this is a basic expectation of a health system.

The initial report showed deeply ingrained management and cultural problems which could never be fully solved in just a few months’ time.

Staff in rebellion

There’s no hiding the fact sections of clinical staff at Canberra Hospital have been in outright rebellion at different times during the year.

Maternity staff were so concerned for patient and staff safety they wrote a scathing anonymous letter to the minister and, as a sign of their scepticism that management and government would act, also sent it to The Canberra Times.

This letter and the reporting of it led to a flurry of women sharing their stories of giving birth at understaffed and under resourced Centenary Hospital.

These issues should come to light further when public hearings for a committee inquiry into maternity services are held next year.

Fed-up staff within the radiology department similarly took matters into their own hands after losing faith in hospital management’s ability to deal with staffing and clinical issues, with the leaking of rosters and meeting notes.

A confidential public interest disclosure was sent to The Canberra Times in an act of frustration. The doctor who sent the disclosure received legal advice it was legal to do so because ACT Health failed in its obligation to deal with the disclosure properly.

Among the disclosure’s claims was that ACT Health engaged in inappropriate recruitment practices for management positions.

There has been ongoing criticism of the decision by management to outsource the reporting of medical imaging, sometimes for months at a time.

The decision to outsource was widely criticised by doctors from a number of departments who believed it had put patients at risk.

The department was also at risk of losing its teaching accreditation after a scathing report by the college of radiologists early in the year.

While there is no doubt that personality issues have come into play - in both the maternity and radiology departments - the dysfunctional relationship and lack of trust between management and clinical staff has been the greatest source of tension.

A new direction

The much-hyped split of ACT Health into two directorates - one looking after governance, the other looking after clinical operations - came to a head with the announcement of the organisations' new bosses.

Acting director general Michael De’Ath was given the ACT Health role permanently, while NT Health bureaucrat Janet Anderson was appointed Canberra Health Services CEO.

But just days after the announcement, Ms Anderson suddenly announced she would not be taking the job after all.

Fed up with poor performance and a long list of health scandals over many years, the Australian Medical Association - joined by the salaried doctors' union ASMOF - called for a board of inquiry into the culture of ACT Health.

A board of inquiry - which was previously called for by the opposition - is the territory’s version of a royal commission.

Ms Fitzharris rejected the idea, saying a judicial inquiry was uncalled for and would likely turn into a witch hunt.

Instead, she announced an independent review of ACT Health. The review has been criticised for having few powers or protections. Most believe it will produce a watered-down report that does not get to the heart of issues in the ACT, nor expose those who need exposing, simply because it does not have the power to.

Ms Fitzharris’s handling of the crises in ACT Health stands in stark contrast to that of the Victorian Labor government.

When Victoria's mental health system came under increasing pressure and public criticism, premier Daniel Andrews announced a royal commission. The move was praised by the public.

Moving forward

In December, interim Canberra Health Services CEO Bernadette McDonald was given the role on an ongoing basis.

Her tone is decidedly different from some of her predecessors in top health positions, and she seems genuine in her talk of collaboration and listening to staff on the ground.

Of course it would take more than a well-meaning CEO to change the culture of an organisation which is deeply divided. The divide between clinicians on the ground and middle and upper management is palpable, with doctors and nurses frustrated their messages are usually filtered significantly before they reach the minister or CEO.

Moving forward, everyone from Ms Fitzharris to upper and middle management must not downplay the problems, acknowledge and own the fact there are deeply frustrated staff and patients, and show a real commitment to leadership.