Some senior staff in Canberra Health Services may be shown the door with the new boss of the organisation saying it's time for those who bully to face the consequences.
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Staff from parts of the ACT's public health system have said bullying is still a huge problem, more than two years after a damning review that highlighted the extent of the issue.
A review into the culture of the territory's public health system found more needed to be done to ensure there were better expectations of workplace behaviour and that leaders in the system were addressing poor behaviour.
While some staff reported that bullying had decreased, most, particularly in Canberra Health Services, indicated bullying was still rife and little had changed.
"There is no respect for nurses - the behaviour has got worse," one person said.
Another said: "There have been no changes in staff when there should have been, known perpetrators are still in their positions."
Canberra Health Services chief executive Dave Peffer said people who had consistently exhibited poor behaviour would be exiting the organisation over the coming year.
"A primary focus for us over the next 12 months is looking at some of those individuals, and some of them are in quite senior roles in the organisation and shouldn't be," he said.
"We will need to make change because we have some great teams doing some terrific work with good culture but equally we have some teams that don't have that same beneficial culture and it's about to change."
Mr Peffer said the organisation would also work to make clear what the expectations were of staff. He conceded they hadn't been as strong on this in the past years but said now was the time as they continued to work through the implementations of the culture review.
"It's about accountability. To shape a great culture you need a couple of things, you need to be hiring the right people, promoting and recognising those who are living your values and really delivering in a strong way but also exiting those people from the organisation who don't," he said.
Complaints of bullying and inappropriate workplace behaviour have increased during 2020-21 at Canberra Health Services, but complaints had dropped in ACT Health and Calvary Public Hospital in Bruce.
Canberra Health Services said the increase could be attributed to the fact more people were aware of the complaints system. But the review also found more could be done to better understand the experiences of staff going through the complaints process.
The second annual review into the implementation of recommendations from the damning 2019 culture review was tabled in the ACT Legislative Assembly on Thursday.
The independent review, which was released in March 2019, found there were troubling levels of mistrust and bullying throughout the system.
There were 20 recommendations made in that review for widespread reform across Canberra Health Services, ACT Health and the Calvary Public Hospital to tackle the cultural issues.
The review of the implementation, released on Thursday, found good foundational work had taken place to address issues, including a greater focus on organisational values, training programs and there had been better procedures for handling complaints and addressing poor behaviour.
However, it said there needed to be better emphasis on areas which would have the most impact on staff. This was mostly around setting expectations of positive workplace behaviour.
"In particular, there needs to be greater investment in setting expectations of positive workplace behaviour, building the capability of leaders and managers at all levels to exemplify and facilitate that behaviour in their teams, and ensuring that positive behaviour is rewarded while poor behaviour is firmly addressed," the report said.
"Providing staff with clear and consistent communication about the importance of a positive workplace culture and the work under way to embed that culture will also be important."
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Health Minister Rachel Stephen-Smith said while important work had been undertaken there was still more to do.
"It is obviously a concern when we hear from front-line staff that they are not setting in all cases the impacts on the ground of the foundational work that we've undertaken to date," she said.
Eight recommendations from the culture review have been completed to date, Ms Stephen-Smith told the Assembly.
Opposition health spokeswoman Giulia Jones said the response to date of implementing the cultural review recommendations had been disappointing.
"With only eight of the 20 recommendations fully implemented, the findings of this review show that the problems go on and the Labor-Greens government does not have a transparent way of showing actual progress of the experience of staff working in the public health system in the ACT," Mrs Jones said.
"This is disappointing and there is still a lot to do.
"Nonetheless I will continue to push the government to get this work done and to demonstrate changes in the system which are desperately needed for staff suffering from a very difficult work culture."
The review was completed by the former head of the Department of Human Services Renee Leon.
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