Heads may roll within Canberra's public health system after a review into workplace culture found troubling levels of mistrust and bullying, as well as deep scepticism change will be implemented.
The government on Friday morning released an interim report from the independent review which received almost 400 submissions and more than 1900 responses to a staff-wide survey.
Chair of the review, former Queensland Health director-general Mick Reid, said he believed the issues in the system would have been happening for 20 or more years and would require years of work to fix.
He suggested the heads of those who had shown poor behaviour for years would have to roll because of the findings.
The review found troubling practices of bullying and harassment, an inability to make timely decisions, poor leadership and inappropriate recruitment practices.
Pride in working for ACT's public health organisations was low and most staff had witnessed misconduct in the past 12 months.
The survey also produced concerning results far worse than comparable data for NSW, with 35 per cent of respondents saying they had been bullied over the past 12 months, and 12 per cent of staff indicating they had been subjected to physical harm, sexual harassment or abuse at work.
Of the staff subjected to physical harm or abuse, the source of the abuse was more likely to be a colleague than a member of the public or a patient.
The independent review was announced by Health Minister Meegan Fitzharris in September after a string of scandals and mounting pressure for change.
The review, which did not investigate specific claims, was a step down from the royal-commission-type inquiry called for by the Australian Medical Association and the ACT Liberals.
It made 20 recommendations, and called for changes to be overseen by a committee which would include the minister, ACT Health employees, the Australian Medical Association and unions.
The report found the overwhelming majority of submissions were negative and came from staff, consumers, non-government organisations and unions.
“The information gathered from submissions, individual and group interviews and the staff survey reveal a worrying and pervasive poor culture across the ACT public health system,” the report said.
“There are pockets of high performance where staff are proud of the quality of their work and were keen to demonstrate it to the reviewers.
“By contrast, there were areas where a very poor culture had persisted over many years, and where bullying and other poor performance had not been addressed."
The report found significant scepticism among staff that the review would lead to change and the recommendations would be implemented, noting previous reviews had been forgotten.
“Talking to my ex-colleagues, I have asked a number of them if they wish to make a submission to the review," a submission read.
"They all replied 'no' as they believe that nothing will come of it.
"I want the review team to prove them wrong, just this one time so we can improve the health of all Canberra residents.”
A nurse's submission, partially published in the report, said there was endless emotional abuse and manipulation that had forced many staff members to seek work elsewhere.
She said the culture at ACT Health was the worst she had seen in all her years working in the public health system in Australia and overseas.
“When I think about the culture within ACT Health and what I have experienced in my time here, I feel shocked and disgusted," the submission said.
"The culture within the division is the most toxic, dysfunctional and prehistoric that I have ever worked in.
"In the [xx] years I have worked, I feel that I have been a target for bullying from managers and colleagues. As a result, in 2019 I will be looking to leave the public health system.”
Mr Reid said it was a difficult review to do because of the distressing stories and long histories of inappropriate behaviour in the workplace they heard.
He said a major issue found in the review was the way in which complaints and human resources issues were handled.
He said too many complaints against staff were automatically escalated to a system which became quite opaque.
"There is healthy skepticism based on a good history that change won't occur," he said.
"But I am confident that the CEOs that I met with.. are capable of leading this change, together with the implementation committee."
Doctors were the least likely to engage with the review, which the reviewers found indicative of clinicians' general disengagement from management.
This means the local health system does not benefit from the knowledge and input of individual clinicians
to improve the quality of care across the system.
"The majority we met with who did engage expressed their skepticism that anything would change," Mr Reid said.
Health Minister Meegan Fitzharris has agreed to all the recommendations in principle, noting it is an interim report.
"Clearly today there are some findings in there that I am really sad and disappointed to read," she said.
“The report clearly shows that people want to see change, and were keen to be involved in this review.
"Through this level of engagement, we are in a much better place to understand the issues and respond appropriately, so thank you for putting your faith in this process.
“The report released today provides difficult reading, and I’m sorry that there are people who work within our health services who have experienced bullying, intimidation and harassment.
"This is not acceptable and we will need to work together to stamp it out.”