Centenary Hospital obstetrics and gynaecology department fails to meet training standards

The damning draft review of the department found it failed to meet most of the required standards needed to maintain its training accreditation.

The Royal Australian New Zealand College of Obstetricians and Gynaecologists, which completed the review, has given the department six months to improve with provisional training accreditation granted until December.

The draft review found there were high workloads, "chronic understaffing" and high levels of burnout within the department, while trainees reported being spoken to in a "disrespectful manner" and being given feedback in "inappropriate settings".

The review found a "clear divide" between front-line medical staff within the department at the Centenary Hospital for Women and Children and the hospital's executive.

"Top-down communication is poor and there is no trust that concerns will be heard or acknowledged. Extreme escalation is required to achieve any engagement at an executive level, and this was not seen to have any meaningful effect," the draft review, seen by The Canberra Times, said.

"The organisation appeared to be highly reactive and even when future plans were identified, there are a lack of actionable steps and appropriate communication to the workforce to demonstrate that their concerns were being taken seriously."

The draft review has been handed to Canberra Health Services to respond to the concerns.

The review found trainees were unable to access clinical experience and opportunities to meet the training program's requirements.

Training supervisors were burdened with a high workload and were unable to spend much time with trainees.

"Concerns were raised about training supervisors' health and wellbeing; the impact of burnout at this level was evident and inhibited trainees going to them for support as they did not want to overburden the training supervisors further," the review said.

Consultant staffing levels within the unit were at a "persistently critical level" and there were increasing levels of burnout among the cohort.

"Decreasing consultant numbers have severely impacted the workplace culture, with those who remain overworked and in some cases burnt out," the review said.

"This has allowed poor behaviour and attitudes to fester, and acts as a barrier to further recruitment which would otherwise help in addressing some of the issues."

This also had a negative effect on trainees and it was reported consultants "rarely have the time to consistently attend rounds, handover, or be involved in education sessions".

"Trainees reported being spoken to in a disrespectful manner, with feedback provided in inappropriate settings and a less than constructive way. There is a blame culture within mortality and morbidity meetings which has led the trainees to disengage for fear of being singled out and bullied," the review said.

But there was also a feeling of a "perceived lack of executive leadership and support" for consultants.

The review said the hospital had "repeatedly" been made aware of areas where the training offered was insufficient.

"Engagement from the hospital to address training concerns has not been sufficient to this point," the review said.

The review found the current ratio of training supervisors to trainees was "sufficient to meet the minimum requirements" but there were concerns the workload was "unsustainable and contributing to overall fatigue".

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The college visited Canberra Hospital on June 5. Its report was based on interviews conducted on the day of this visit along with pre-visit documentation, questionnaires from current and recent trainees, questionnaires from consultants and training supervisors and informal meetings and discussions with staff.

The hospital's fetal medicine unit lost its training accreditation last year.

A Canberra Health Services spokesman said the organisation acknowledged it needed to provide a better experience for trainees.

"There is already a significant program of work under way in a partnership between our clinical leaders and executives to address the areas highlighted in the report," the spokesman said.

"Obstetrics and gynaecology is a complex area of clinical practice that can be professionally and emotionally challenging. While the report from RANZCOG on accreditation in obstetrics and gynaecology is a draft report and has yet to be finalised, we recognise that the last year has been particularly difficult for the obstetrics and gynaecology team.

"The busy clinical workload of our clinicians has meant that there is less time to dedicate to ongoing training of our obstetrics and gynaecology trainees. As a teaching and learning hospital, we know this is not acceptable."

ACT Health Minister Rachel Stephen-Smith said she had recently met with the president and chief executive of the college. She said they discussed a shared commitment to supporting the training accreditation in obstetrics and gynaecology. She said they also discussed workforce challenges across the country.

"We know there is more work to do to in supporting training accreditation for obstetrics and gynaecology at Canberra Hospital and remain committed to building a collaborative and positive team environment," Ms Stephen-Smith said.

"The Division of Women, Youth and Children and the broader executive at Canberra Health Services has been working closely with RANZCOG and looks forward to receiving the final report."

ACT Opposition Leader Elizabeth Lee said the unit was at breaking point and there had been similar reviews in 2010 and 2014. She questioned the actions being taken.

"If the challenges have been known then why are serious management, cultural and governance issues continuously noted in these reports? Why has the Labor-Greens government failed to listen to the concerns from front-line health workers and their colleges? And most importantly why have solutions not been implemented?" Ms Lee said.

"The Labor-Greens government is more interested in obfuscation, grandstanding and accusing others of scaremongering than fixing the ongoing issues in the public health system."

Ms Stephen-Smith was asked in June about the accreditation review of obstetrics and gynaecology. She said informal feedback on the day of the review expressed some concerns already shared by the hospital.

She said suggestions the unit was at risk of losing its accreditation were "scaremongering".

"There is nothing in the information I have had to date that would indicate that is the case," she said.

The Canberra Health Services spokesman said some of the issues could be completed quickly, including better and earlier shift rostering for team members. Senior staff specialists had also been employed from overseas, he said.

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