Royal Hobart Hospital junior medical staff set to issue ultimatum over ‘safety’

Medical team at Royal Hobart Hospital.
The “deep irony for those of us who leave is, the worse it will be for those who remain”, the letter states.(Supplied: Royal Hobart Hospital)

Key points:

  • The ABC understands more than 70 junior medical staff have put their names to a letter which alleges a “lack of commitment to the safety of its most junior staff and their patients” by Tasmanian Health Service management
  • The letter says junior staff are “so very tired of a culture that tolerates our fatigue in the pursuit of ‘patient flow'”
  • The letter also says “either through incompetence or malice” staff concerns are disregarded

Junior doctors at Tasmania’s largest hospital are en masse putting their name to a scathing critique of safety and working conditions, claiming internal morale is so bad most want to leave, and warning no-one will take their place due to trainees seeking to “avoid this institution for its reputation”.

The ABC understands more than 70 junior doctors, who make up the bulk of medical staff at Royal Hobart Hospital (RHH), have so far put their names to a 10-page letter in which they “express grave concerns over the safety and sustainability of medical staffing at RHH as a result of a flawed corporate culture within the Tasmanian Health Service”.

The interns, resident medical officers (RMOs) and registrars have addressed the letter to Australia Medical Association Tasmania chief executive Lara Giddings, with Tasmanian Health Service (THS) management also set to receive a copy.

The letter, which is currently being circulated among hospital staff, is to be delivered on Monday — with demands that must be met within a week.

The action comes a day after the announcement of the removal of Professor John Burgess from a leadership role at the hospital, a doctor the junior staff have described in their letter as “a true ally and advocate of all doctors-in-training”.

A man sits at Royal Hobart Hospital emergency reception counter.
The letter says “patient flow” is prioritised ahead of the safety and proper training of junior staff.(ABC News)

In the letter, staff call on “assistance in resolving an increasingly dire and damaging impasse with the management of the THS”.

Yesterday in Parliament, Health Minister Sarah Courtney described Labor’s assertion Professor Burgess’s role was being abolished due to his public criticism of health management as a “slur” and said the Government was “empowering local leadership, local hospitals, to make the decisions that are right for them”.

Royal Hobart Hospital’s executive director of operations, Susan Gannon, yesterday defended the decision, saying it was aimed at “streamlining administration … to provide better patient care”.

‘Contemptible relationship’ between RHH, junior staff

The letter said junior doctors regularly considered leaving Tasmania due to the culture and working conditions at the hospital, and revealed a planned mass exodus of this year’s interns.

Emergency sign at Royal Hobart Hospital
The letter is scathing of what is described as a “flawed corporate culture” within senior health management.(ABC News )

“In most years, the number of RHH interns who leave the state can be counted on one hand,” the letter said.

“For the first time in institutional memory, more than one third of interns intend to leave the RHH for interstate training programs in 2020.

“So contemptible is the relationship between the Royal Hobart and its most junior clinicians that many are leaving the institution which trained them, without a clear plan to return.

“Colleagues have failed to progress through their careers because the institution has failed to commit to their progression through training for the short-term gains of patient flow,” it said.

The doctors said there had been less competition for trainee positions at the RHH, which had “led to Tasmanians missing out on top-ranked trainees who avoid the hospital due to its reputation”.

“The deep irony of this situation is that many of us know that the more of us leave, the worse it will be for those who remain,” the text of the letter states.

Ambulances parked at Royal Hobart Hospital.
The doctors’ letter follows long-standing concerns over patient capacity at the hospital.(ABC News: Rob Reibel)

‘Do you ever leave?’, doctors asked

The junior doctors said they and their predecessors had expressed concerns to management “for many years without success” and had made their recommendations for improvement clear over the past 10 months.

“We have lost our faith in an institution which thrives on a culture in which we’re asked by our patients ‘do you ever leave?’

“We maintain that the current lack of leadership from the THS and inadequate resourcing from the Department of Health has resulted in a short-sighted response by the RHH to meeting the needs of patients.”

The signatories to the letter agreed the Tasmanian health system was:

  • “Neglecting its obligation to provide safe working hours and conditions for junior medical staff”
  • “Neglecting its responsibility to be a training institution for Tasmania’s next generation of consultant GPs, physicians, surgeons and leaders”
  • “Either through incompetence or malice, seems content with disregarding our concerns when raised at every available opportunity and preventing us from providing the high-quality healthcare that Tasmanians have rightly come to associate with the RHH”

If they took sick leave or time off for personal reasons, the letter states, staff felt burdened with the knowledge “there wouldn’t be anyone to cover them”.

Medical staff tend to patients
The letter says junior doctors felt “if they took sick leave or time off for personal reasons … there wouldn’t be anyone to cover them”.(Supplied: Nadine Cotton)

“Either our overstretched colleagues work to cover our position as best they can, or our patients would go without,” it reads.

“We are extremely concerned for the health of the current final-year medical students when they enter the profession, given again the worse conditions they will face when [the new] K-Block opens without a sustained increase in junior medical officer staffing.

“We are so tired of a culture that tolerates our fatigue in the pursuit of ‘patient flow’.”

The doctors said they were resigned to the fact that an operating level “patient flow level 4′ would “likely never change” — a code up until last year represented an “internal disaster” threat.

The letter also details what is described as “rostering that is putting both patients and staff at risk”, “high levels of stress felt amongst our trainees”, “more than 40 nightshifts with only two doctors overnight … a breach of the requirements for accredited training” and a “culture that is clearly jeopardising our own health and the provision of safe and effective patient care”.

Junior staff ‘welcome to speak with supervisors’, RHH says

The letter makes four demands which junior doctors want agreed to within seven days, including:

  • The minutes of the “meeting which decided not to employ additional medical interns, as recommended by the Department of General Medicine’s business case”, be released “to all interns and RMOs at the Royal Hobart Hospital”
  • A “face-to-face meeting” arranged between interested doctors and senior THS management “to discuss how we can resolve the above discussed issues”
  • A “clear proposal” on how RHH will “achieve safe working hours for interns and RMOs at the RHH” going forward
  • That “strong advocates are afforded a fair and transparent process in ensuring the institution achieves its high quality of service and care for the Tasmanian community”

Junior doctors ‘bullied’ into working more

Rural GP and health advocate Bastian Seidel has urged the State Government to take action.

He said junior doctors were vital and without them “the whole system is going to fall apart”.

“Doctors need to be supported, there needs to be a cultural shift, there needs to be demonstrated leadership, we need to make sure doctors can do their job,” Dr Seidel said.

“They’re being put under pressure. They’re being bullied to work more and more, and more.”

Royal Hobart Hospital Staff Association’s Frank Nicklason said he understood the frustrations of the junior doctors.

“I think people who choose the career of medicine are generally people who want to do the best for the patients they are working with,” he said.

“It’s intensely frustrating to know what is required to provide good care and to be working in an environment that really doesn’t allow that to happen.

“The hospital has become all about trying to get people out of hospital as quickly as we can because we are acutely aware of the large number of people always present in the emergency department who require admission every day.”

Dr Nicklason said there was, “immense pressure on that service aspect of work which eats into the education and training side, which is part of working at a big teaching hospital like the Royal”.

Dr Frank Nicklason
The RHH is “all about trying to get people out as quickly as we can”, Dr Frank Nicklason says.(ABC News)

In a statement, a spokesman for the RHH said the hospital was “focused on junior doctor welfare and will be implementing changes to rostering in the coming months to better support them”.

“Staff members are always welcome and encouraged to speak with supervisors or management.”

The spokesman said suggestions a third of this year’s intake were planning to leave were “not accurate”.