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Auditor General: Victorian hospitals badly managed dangerous places for staff and patients

Public hospitals present hazardous challenges that demand OHS management of the highest standard. The audit found that while there are instances of better practice among the audited public hospitals, there are also significant shortcomings which put staff at unnecessary risk. In addition, weaknesses identified with the role of the department as the health system manager, and with WorkSafe as the OHS regulator, have contributed to the failure to achieve better management of OHS risk by public hospitals. Neither the department nor WorkSafe has a comprehensive understanding of sector-wide OHS risks or emerging trends in public hospitals.

Statements from the Auditor General's Report, November 2013

There is insufficient priority given to, and accountability for, OHS (Occupational Health and Safety) in public hospitals.

Staff safety needs to be given a higher priority by senior management and the department, and managers within public hospitals should be held to account for the OHS performance of areas under their control. Sustained improvement in the public hospital safety culture is not likely to occur without greater priority and clear accountability.

Neither the department nor WorkSafe has a comprehensive understanding of sector-wide OHS risks or emerging trends in public hospitals. WorkSafe cannot demonstrate that its project activity reduces OHS risk in public hospitals. Collaboration between the department and WorkSafe has been poor, with missed opportunities to reduce sector-wide OHS risk. Wide variability between public hospital OHS management practices—such as quality assurance of safety management systems and safety inspections—highlight the need fo r stronger sector-wide leadership.

These issues collectively warrant a future review of public hospital OHS risk to assess whether the level of protection for public hospital workers has improved.

Top down dereliction

The Victorian health services governance handbook states that the department plays a key system-level role in the performance of health services. This involves ‘shaping and enabling health services to function effectively’. The Health Services Act 1988 states that part of the department’s role is to enc ourage safety and improvement in the quality of health services provided by healthcare facilities.

However, the exact role of the department—as the health systems manager—in worker health and safety is not clear. Key documents governing the relationship between the department, the Minister for Health and public hospitals make no mention of OHS management in public hospitals, or outline the department’s expectations.

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Although policy at each of the four audited public hospitals states that the board of the public hospital, as employer, is ultimately accountable for OHS, there is a breakdown in the chain of account ability below the board:

- Unit managers who are responsible for the day-to-day management of work units are not held accountable for OHS performance—this is also the case for the executive directors of public hospital departments. While there is a policy commitment that managers are responsible for maintaining a safe working environment, there are no mechanisms or targets to hold these managers to account for OHS performance.

- Ownership of OHS risk does not reside with the manager where the risk occurs.

At an organisational level, risk registers identify the corporate services area as the owner of OHS risks, despite OHS risks presenting predominantly in clinical departments.

"Under the devolved governance model, described in Part one of this report, the board and Chief Executive Officer of a public hospital play key roles in providing a safe and healthy workplace."

Occupational health and safety priority and accountability
Victorian Auditor-General’s Report
Occupational Health and Safety Risk in Public Hospitals

Managers are not accountable for occupational health and safety performance

Although OHS policies at each public hospital did state that the board, as employer, is ultimately accountable for occupational health and safety, there is a breakdown in the chain of accountability below the board:

- managers of clinical areas, where OHS risks predominantly present, are not held to account for the OHS performance of that unit or department

- ownership of OHS risk does not reside with the manager where the risk occurs.

However, there was no evidence that they were ever held to account at the four audited public hospitals. The OHS Management Framework states that ‘performance of OHS responsibilities is part of established job performance assessment process’.

None of the four audited public hospitals could demonstrate that mechanisms were in place to hold unit managers to
account for OHS performance. For example, even though the position descriptions of nurse unit managers NUMs)—who have direct responsibility for frontline staff and daily tasks—allocate them responsibility for overseeing OHS at the work unit level, half of the NUMs interviewed were not sure of their OHS responsibilities. Even those who understood their OHS responsibilities were not required to demonstrate how they fulfilled those responsibilities.

Managers to whom NUMs report are also not held to account for OHS performance. Position descriptions of executive directors, who are responsible for the day-to-day management of the clinical departments, assign responsibility for OHS in these areas. However, there was no evidence that they were ever held to account at the four audited public hospitals. The OHS Management Framework states that ‘performance of OHS responsibilities is part of established job performance assessment process’.

The audit team did find some examples of better practice at public hospitals that were not part of this audit. For instance, one public hospital requires NUMs to report on OHS incidents and control measures in their unit. NUMs at this public hospital are also required to develop an action plan where gaps have been identified, and these action
plans form part of their annual performance review.

Lack of occupational health and safety reporting against set targets

Managers need to receive regular reports against the targets set on OHS performance in the workplaces under their control if they are to be held to account. Neither reporting nor target setting was found at the work unit or department level of the public hospitals audited. Unit managers and clinical executive directors do not receive regular reports or trend data of OHS incidents in the work units for which they are responsible. As there are several unit managers rostered on during any month, without aggregated reporting it is difficult for each manager to know whether OHS performance is deteriorating or improving, or how their unit compares with other workplaces in the
organisation. The OHS Management Framework emphasises that ‘Health and safety performance is regularly reported’.

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