Tackling toxic workplace culture in hospitals

Australia’s healthcare industry has recently revealed one of its most pressing challenges. In August last year, an article surfaced describing the extreme exhaustion, lack of training and underpayment experienced by a junior doctor in a Victorian public hospital. The article alleged doctors faced 60-hour working weeks with no time allocated for clinical training, and a culture of bullying and intimidation by senior doctors. According to the Australian Medical Association, the hospital in question had breached its legal obligations.

A similar case emerged in December, where a survey of over 1000 junior doctors found the vast majority had made errors in their practice due to the exhaustion and burnout caused by excessive workloads and inadequate staffing. Survey respondents said they had raised these concerns with their employers, only to have them “brushed off” with no action taken.

Most recently, a survey of close to 10,000 doctors-in-training found one in three had either witnessed or been targeted by toxic behaviour in the workplace in the last 12 months.

In an industry centring on the care and preservation of life, and the promotion of both physical and mental wellbeing, this is a concerning trend. When our healthcare professionals are struggling at the hands of an industry that neglects the wellbeing of its most valuable players, we are all at risk.

Yet as alarming as these cases are, they’re all too common — not just in the healthcare industry, but in the broader workforce too. Our six-year study of more than 25,000 participants found that 55% of Australian workers worry excessively, 45% experience distress symptoms and 30% experience excessive work intensity. And more often than not, toxic workplace cultures play a key role.

A toxic workplace culture is one that causes serious and ongoing stress to those operating within it. Stress can be mental, physical or emotional, and can result from co-worker or manager behaviours, the work environment or the work itself. Characteristically, toxic workplace cultures tend to bleed into other areas of life, often having negative repercussions on people’s relationships, health and self-esteem.

One of the most sinister traits of a toxic workplace culture is that it’s often difficult to detect until after you’ve fallen victim to it. However, there are key signs to look out for. Withdrawn and disengaged employees, a fear-driven environment, an absence of trust and a high level of absenteeism are all tell-tale signs of a culture in need of change.

Like any toxic substance, long-term exposure to these environments can be deeply detrimental to our health and wellbeing — evidenced, as of late, by too many health professionals. Bullying, intimidation and high levels of workplace stress caused by short staffing, time constraints and inadequate clinical training can quickly result in burnout — a condition recently classified by the World Health Organization as a legitimate occupational phenomenon.

In any other industry, when burnt-out staff are forced to function in toxic environments for extended periods, workplaces suffer from high rates of turnover and decreased productivity, ultimately compromising the bottom line. It’s more or less the same when it comes to the healthcare industry, with one critical difference: it puts patient care at risk. In the survey of junior doctors mentioned earlier, three out of five had reported making clinical errors as a result of severe stress and understaffing, while further research found burnt-out doctors often displayed hostility towards patients and frequently made poor decisions relating to patient treatment.

As the growing pressures of an ageing population mount, it’s evident that Australia’s health industry is in need of an urgent culture shift. For the sake of both patients and medical professionals alike, meaningful change requires commitment and understanding from every level of the organisation. It must be led by senior leaders and those in governance — not just frontline practitioners — and it requires cultivating a high-trust, resilient environment where communication and collaboration are encouraged, and staff are supported in not only their practice, but in their mental and physical wellbeing. Importantly, it requires recognising the indisputable link between the welfare of doctors and the welfare of patients.

Though the concept of overhauling an entire industry will seem impossible at the least, enacting cultural change begins with the simplest of steps:

Build trust in senior leadership: We know trust underpins patient relationships; however, it must also underpin relationships within the organisation, particularly between senior leaders and staff. Supporting a culture of trust is crucial for individuals, teams and organisations to function efficiently and, indeed, to thrive. Investment and skill development for senior leaders within the 36 leadership trust factors provides a framework for cultivating high trust within the team and the organisation, and helps to shift a fear-based culture.

Equip and educate staff: Start by ensuring all staff understand the distinction between ‘mental health’ and ‘mental distress’ and can identify the symptoms of poor mental health. Ensure staff who are experiencing mental distress can access comprehensive and confidential support by making sure the relevant systems and structures are known across the organisation.

Prioritise resilience: Resilience is more than the ability to withstand adversity — it is the ability to navigate adversity with purpose and clarity. Our research has shown that actively building resilience leads to a 32% reduction in symptoms of anxiety, while improving focus, positivity, optimism and decisiveness. Encourage staff to invest in building personal resilience and ensure that rosters are structured to enable adequate rest — including those of doctors that are rostered as on-call.

Open communication: A high-pressure culture is often conducive to hypervigilance, fear and divisiveness amongst staff. Offset this by encouraging open and frequent communication, ensuring staff are able to share feedback, concerns and ideas through clear communication channels. This is particularly vital for junior doctors who are typically the most vulnerable to stress and excessive workloads. Enabling staff to speak up — and importantly, be heard — is the first step to creating a culture of cooperation and belonging.

Call for accountability: Efforts to shift a toxic workplace culture will inevitably raise questions around accountability, yet it’s important to avoid playing the blame game. Meaningful change requires personal accountability across all levels — from the C-suite down. Ensure staff are clear on roles and responsibilities, and that leaders are responsive to the concerns of those under their care.

The change required within our healthcare industry is significant, but so too is the risk of leaving the situation unaddressed. The truth is, the problem facing our healthcare professionals is a problem for all of us — if our wellbeing depends on that of our doctors and nurses, then it is in our best interests to ensure they are supported and cared for in their work.

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