An internal review is under way at Clare Holland House after workers complained the Canberra hospice was burdened by a "toxic culture", poor management, and "critical staffing levels".
A spokesperson for Calvary Public Hospital Bruce, which operates the hospice, confirmed it received an anonymous letter on March 3 this year.
The letter appeared to have been authored by staff, and it pinpointed two people as having "displayed" a toxic culture.
The authors complained one of those people was dismissive and had an attitude of, "If you don't like it, there is the door". They said the staff member swore in communal areas of the hospice, and didn't give workers guidance.
The authors said the second person had a poor attitude, underestimated staff continuously, and was prone to angry outbursts.
The letter said there were next to no senior staff left to support the "wellbeing and structure" of the hospice, and that it lacked some medical equipment and basic provisions like working curtains.
"The desired outcome of this letter is that the concerns will be addressed starting by a staff meeting that ... [involves the] hierarchy of Calvary who have the ability to support these critical concerns," the letter said.
"Ultimately patients are suffering due to the mismanagement and lack of care and guidance being delivered ... staff are burning out."
The authors of the letter said there were no staff meetings at Clare Holland House, no debrief sessions, and "nil education support". It signed off with Calvary's values: hospitality, healing, stewardship, and respect.
The Calvary spokesperson said the hospital took the matters raised in the letter "very seriously", and its leadership team, who oversaw the management of Clare Holland House, immediately instigated a review after it received the letter.
They said the team had worked with employees and management of the hospice to address a number of issues that were raised in the letter. More staff had been hired to fill vacant permanent positions, and a faulty steriliser had been replaced.
"[Changes in response to the letter also included] the implementation of training including an update to the debriefing process," the spokesperson said.
"Calvary continues to work with staff to ensure matters are managed in a timely and appropriate way."
The spokesperson said Calvary's mission was, as always, to ensure that patients at Clare Holland House received the highest quality end of life care.
They said employees at the hospice had an outstanding dedication to their patients' care and wellbeing, and that was reflected in feedback from patients of Clare Holland House and their families.
"It is of paramount importance that we care for our employees, in the same way that they care for others," the spokesperson said.
"Calvary thanks our employees for bringing these matters to our attention and encourage them to continue doing so, using a range of mechanisms in place to raise their concerns in confidence."
Australian Nursing and Midwifery Federation ACT secretary Matthew Daniel said the union had recently received the letter, and held a meeting with union members about issues at Clare Holland House.
He said the union was going to write to Calvary about those issues, which were primarily to do with workers' "psychological safety". In the context of Clare Holland House, that meant having mechanisms in place to make sure workers were psychologically well and not being overwhelmed by burnout and fatigue.
"We're working with members on those issues," Mr Daniel said.
A spokeswoman for ACT Minister for Health Rachel Stephen-Smith said the minister's office had also received the letter, and the concerns in it were raised with the ACT Health Directorate.
"We understand that Calvary is engaging with staff, patients and carers to work through the concerns that were raised," the spokeswoman said.
The Minister for Health had received an initial briefing following the letter, and expected to receive a further update soon on what action Calvary had taken and how it would continue to address the issues.
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