Patient safety at Albury Wodonga Health has been called into question after internal staff surveys revealed only 52 per cent of staff agree the organisation does a good job training staff.
Five years of internal staff survey data obtained by The Border Mail revealed staff confidence in patient safety had fallen significantly since 2013, and 23 per cent who responded to the survey reported they had experienced bullying in 2018.
Health Service Union national president Gerard Hayes labelled the results ‘deeply concerning’.
But Albury Wodonga Health chief executive Leigh McJames said the People Matter Survey data was only one means to gauge the service’s success, and other key performance indicators showed the service was excelling.
Mr McJames said residents should be confident in the service.
“The hospital is going exceptionally well,” he said.
“It’s a large organisation of 2800 people, so you have to be careful not to generalise, like any large organisation there will be pockets [of issues] for various reasons.”
Analysis of the surveys, over five years, shows a 25 per cent decrease in the number of staff who believe patient care errors are handled appropriately in their work area, from 91 per cent in 2013 to 66 per cent in 2018.
All statistics refer to the amount of staff who responded to the survey and agreed with the relevant statement.
Only 72 per cent of Albury Wodonga Health staff would recommend a friend or relative be a patient at the service, while barely half of staff agreed the organisation does a good job of training staff.
“That’s an area that we’re actively addressing in terms of why do staff think that or why are there  per cent of staff that don’t think they’d encourage someone or recommend it to a relative?,” Mr McJames said.
Mr McJames said being a staff survey, it was impossible to know what people were considering when answering the questions.
[They] provide a critically important insight into staff morale and wellbeing and that insight is deeply concerningGerard Hayes, HSU
He said the fact only 52 per cent of staff agreed the service did a good job of training new and existing staff (down from 76 per cent in 2013) and only 55 per cent agreed trainees in their discipline were adequately supervised (75 per cent in 2013), did not mean people were not properly trained or supervised.
“It doesn't mean they’re not adequately trained, that’s a stretch,” he said.
“What some are saying is there are periods there where they believe – and it could be trainees answering so it could be skewed – where they believe there could be more supervision, that’s a subjective assessment.
“People could say I didn’t receive my training on IT systems so I’m going to negatively respond to that.
“It could mean that we can improve our induction and certainly that’s an area where we’re putting in work.”
In 2016, 47 per cent of staff respondents believed the service did a good job training staff and 51 per cent agreed trainees were adequately supervised.
Mr McJames highlighted that although staff confidence in all eight patient safety criteria had decreased since 2013, most had increased steadily since 2016 and were trending in the right direction.
Only one criteria – asking if patient care errors were handled appropriately in ones work area – had decreased from 67 per cent in 2016 to 66 per cent in 2018.
Responses to all eight questions in the patient safety category remained below the state target of 80 per cent staff agreement.
But Mr McJames said many criteria were very close to the benchmark and on par with the answers of comparable health services.
“I can’t explain from 2013, but I can look at it and say there was a real rethink of culture in 2016,” he said.
“The majority [of answers] have trended the right way and are within a whisker of being on the benchmark.”
Mr McJames said the community should have faith in the high level of care the service provides.
“You can have great confidence that you can come here and get great service,” he said.
“The important thing with quality and safety is you constantly are striving to improve which we’re doing and the People Matters Surveys actually show that.
“You’ll never be perfect at it, the important thing is that you are constantly striving to be perfect.
“Can we do better? Yes. But it is a major priority and in all the trendlines we look at we’ve made significant improvements.”
Mr McJames said since he became chief executive in 2016 the organisation had worked hard to shift the culture of the organisation and address bullying.
In 2013, 40 per cent of people had experienced bullying in the past year; in 2016, 33 per cent and 29 per cent in 2017.
In 2018, just under a quarter of respondents, 23 per cent, had personally experienced bullying in the previous 12 months while 59 per cent of staff agreed that bullying was not tolerated within the organisation.
“It’s easy to see that there’s been significant improvements in the last two years,” he said.
“We had some rough points, some cultural rough points and issues in 2016.
“But I just point to the trajectory, it's really strong and there's not too many organisations the size of Albury Wodonga Health that can show that kind of improvement in a two-year space… there has been just a lot of consistent action to shift the attitudes and shift the culture.”
Mr McJames said although it was a significant improvement since 2013, 23 per cent of staff having experienced bullying was still too high.
“One per cent is unacceptable,” he said.
“People have the right to come to work and not be bullied or harassed.
“You can’t change behaviours and how people behave in the workplace overnight. It takes time.”
But Mr Hayes said the service needed to do more.
“The hospital needs to recommit to eradicating bullying,” he said.
“A happy, motivated workforce is the crucial ingredient to achieving the highest levels of patient care.”
Mr McJames said the service was focusing on five main areas to improve and strengthen the organisation’s culture; leadership, education, training, robust HR processes and the work environment.
“There’s no silver bullet with culture,” he said.
But the number of people who would recommend the organisation as a good place to work had risen steadily from 51 in 2013 to 61 in 2016 and 68 in 2018.
But in 2018, only 48 per cent of respondents were confident they would be protected for reprisal for reporting improper conduct, and only 51 per cent were confident their grievance would be investigated in a thorough and objective manner.
Only one measure
Mr McJames said according of sources – accreditation audits, an independent patient experience survey, the hospital’s medication and sepsis safety programs as well as complaints and compliments – the hospital was doing ‘exceptionally well’.
He said the staff surveys were just one measure to consider when assessing the service’s health or progress.
“This is one set of KPIs, staff attitudes, there is a whole raft of other ones in terms of quality and safety where we are in the top quartile percentile compared to other regional health services,” he said.
“[A patient survey found] more than 95 per cent of patients had a positive experience within this service – the highest of any regional health service as of quarter one 2018-19.”
But Mr Hayes said the staff surveys were important.
“These surveys provide a critically important insight into staff morale and wellbeing and that insight is deeply concerning,” he said.
Looking back and looking ahead
AWH chief executive Leigh McJames said there was always room to improve, which the organisation had been doing over the past two years.
“You can look at this one way if you go back to 2013 and say it’s dropped over a five-year trend,” he said.
“Or you can look [and say] it dipped at its worst point in 2016 and now it’s on an upward trajectory.”
Mr McJames said at the end of the day, “management of the organisation holds responsibility for those  results”.
“We’ve had a high priority on addressing that, you’ll note in 2018 the improvements,” Mr McJames said.
“We’ve put out a new code of conduct, HR processes, so people know they can make a complaint ... action will be taken and it won’t come back and bite them.”
Mr McJames said on many criteria the organisation was recording similar results to other comparable health services.
“If you compare the results of what staff are telling us to other health services, we’re about average,” he said.
“It’s not where we’re going to finish, we’re going to continue improving… we strive to be the best in terms of a place to work.”
“If it’s a great place to work you attract staff, good staff and you keep your good staff,” he said.
“Secondly culture is really important in terms of your quality and safety.
“If staff take pride in their workplace, if it's a good place to work … they take care in their job, you get buy in, it has all these multiplier effects.”
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