AMA (NSW) 2022 Hospital Health Check

AMA (NSW) Hospital Health Check 2022

The results of 2022 Hospital Health Check mirror the pressure on our public hospitals, particularly as the system grappled with staff furloughing and increased emergency room presentations, coupled with heavy inpatient loads.

IN 2022, WE EXPERIENCED a rapid rise in Omicron infections and record numbers of healthcare workers furloughed as result. Consequently, it comes as no surprise that doctors-in-training revealed a spike in the number of unrostered overtime hours worked and higher levels of fatigue in this year’s 2022 Hospital Health Check results.

The 2022 Hospital Health Check survey is our sixth year on reporting on working conditions for doctors-in-training across NSW.

We were exceptionally pleased by the number of doctors-in-training who participated in this year’s survey. There were 1766 respondents to AMA (NSW)’s 2022 Hospital Health Check, which surpassed our total last year. 

Considering the high demand on DITs, pressure in hospitals and pandemic stress, as well as the competing surveys from other health stakeholders, we feel particularly privileged that DITs took the time to respond to our questions about their working lives.

Each year, we tweak the survey format to improve our reporting. In addition to our usual questions around rostering, overtime, access to leave, bullying & discrimination, and fatigue, we included questions that were introduced for the first time in 2021. These included: Do you feel valued? What do you like about your hospital? What would you improve? We also included questions around the types of facilities available such as common areas, sleeping accommodation, lactation rooms, childcare facilities, etc. 

We’re hoping that by incorporating these questions (and answers), we will gain a more complete picture about the experiences of DITs at their hospitals and provide a better guide for hospitals on what they can do to improve.

Survey period

We launched the 2022 survey in May, one week after the Federal election, and gave doctors-in-training a six-week window to participate.

In that time, NSW announced its 2022-2023 Budget, which included a lift to the public sector wages cap, a $3000 thank you payment to doctors for their pandemic response efforts, and a commitment to recruit 10,000 more health staff over the next four years (with three-quarters of that number to be recruited in the first year to alleviate the pressure on hospitals). 

While the Budget promises were welcomed, they came off the back of a few gruelling months for hospital workers.

Premier Dominic Perrottet’s ‘let her rip’ pre-Christmas strategy coincided with the arrival of a new, highly transmissible strain of coronavirus.

For hospitals, that were already under pressure, underfunded and under-resourced, the timing over the holidays was crippling. Within weeks, hospitals were hit by the one-two punch of holiday leave/staff furlough combination. Doctors who felt over-stretched before were at breaking point.

As we moved from summer to winter, the system was forced to contend with increases in flu case numbers on top of COVID. 

It’s important to provide this context as it helps provide insight into the experiences that inevitably help shape responses to the 2022 survey.

Rostering & Overtime

Last year, we found that 60% of respondents reported working more than five hours of unrostered overtime in an average fortnight. In 2022, that number ballooned to 72%.

“This figure shows that DIT workforce shortages continue to plague the NSW health system with underlying workforce issues getting worse and compounded by COVID related leave. We can only expect this number to continue to get worse unless the underlying reasons for DITs leaving NSW health are dealt with,” said Dr Sanjay Hettige, co-chair of the Doctors-in-Training Committee.

When asked if their rosters matched expectations, there was a slight change in responses in 2022. More than one-third (35%) said their rosters ‘almost never’ matched expectations, while 41% said ‘sometimes’ and 24% said ‘almost always’.

Fatigue

In 2022, we also noticed a pick-up in the number of doctors-in-training who felt concern for their personal safety due to fatigue associated with long hours, from 47% in 2021 to 56% in 2022. Almost half (46%) responded ‘yes’ when asked if they had made a fatigue induced clinical error caused by hours of work, which was also an increase over last year, when 38% reported the same.

UROT Claimed and Paid

We noticed little change this year in the unrostered overtime claimed and paid measurements.

In 2022, 33% of respondents claimed all of their overtime, this is only a slight increase from the 2021 survey, in which 30% claimed all of their overtime. However, on the other end of the spectrum, fewer respondents indicated they claimed none of their overtime in 2022 (15%) compared to 2021 (18%). These are small differences but considering the sample size is consistent between the two years, it is pleasing to see some improvement, albeit small.

Similarly, there was not a huge difference in the number of DITs who indicated all of their unrostered overtime was paid. In 2022, 73% received all (compared to 74% in 2021). Meanwhile, in this year’s survey just 6% of respondents indicated none of their unrostered overtime was paid, compared to 7% in 2021.

Gender differences

One of the most exciting differences noted with the 2022 HHC is the increase in the number of women claiming overtime. Not only is that number moving in the right direction but the gap between the number of men claiming all of their overtime and women claiming all of their overtime is shrinking.

We found 30% of women claimed all of their overtime in 2022, compared to 39% of men. We also broke down the gender differences in overtime claiming by specialty. In surgery, we found 38% of women claimed all of their overtime, compared to 57% of men. In emergency medicine, 23 of women claimed all of their overtime, which was on par with their male counterparts.

“It’s pleasing to see an increase in the number of women claiming all of their overtime and seeing the gap between men and women decreasing,” said AMA (NSW) Doctors-in-Training co-chair, Dr Jacqueline Ho.

“This discrepancy between men and women is a hallmark of the deep-seated and entrenched systemic and cultural sexism in the profession that we continue to address. Encouragingly, this improvement reflects progress towards gender equity, recognising that women are just as capable, competent, and worthy as their male counterparts, but there is still a long way to go across the board.”

Unacceptable workplace behaviours

Last year, the Hospital Health Check survey found half of respondents (50%) indicated they experienced bullying, with the most likely source being senior medical colleagues. While bullying is inexcusable, it coincided with some very negative results from our Senior Doctor Pulse Check survey, which found senior clinicians were reported extremely high levels of stress related to excessive workloads. 

Interestingly, despite continued stress on the health system, there was a significant decrease in reported levels of bullying in our 2022 survey. In 2022, 37% of respondents reported experiencing bullying. While it remains a distressing problem in hospitals, it is pleasing to see that figure do down.

According to Dr Hettige, “LHDs have recognised that having adequate systems to deal with bullying and harassment in their workplaces is essential to maintain a healthy workforce hat can provide the best patient care. AMA (NSW) has been working with NSW Health and LHDs to implement systems that can better deal with bullying and harassment and the reduction in reported bullying and harassment is a reflection in this work. While acknowledging this reduction, more work needs to be done as more than 1/3 of respondents reporting bullying and harassment is still much too high.”

The survey also revealed a 10-point drop in the number of respondents who said they felt intimidated at work, from 37% in 2021 to 27% in 2022.

As in other years, the main sources of intimidation are patients’ families (the dominant source), senior medical colleagues, and nurses.

The 2022 survey also found a drop in the number of respondents who experienced discrimination. This year, 25% of respondents reported experiencing discrimination, compared to 32% in 2021. We also found 31% of women indicated they experienced discrimination, compared to 16% of men.

Wellbeing

As previously mentioned, we introduced new wellbeing measurements in 2021. In our first year ever reporting on these questions, we found 63% of respondents indicated they felt valued by their hospital, while 75% said they would recommend their hospital to another doctor-in-training.

It was great to see such strong results last year, particularly given the unique pressures the pandemic placed on hospitals and frontline workers. It was therefore disappointing to find a significant drop of both of these measurements in 2022.

This year’s survey found less than half (46%) indicated they felt valued by their hospital, while just over half (54%) would recommend their hospital to another doctor-in-training.

Dr Hettige said this year’s bonus payment was not enough to offset the relatively poor working conditions NSW DITs face compared to counterparts across the country.

“As AMA (NSW) have reiterated time and time again, the one off $3000 is like a very bad Band-Aid to the underlying issue. NSW Health provides some of the poorest working conditions for DITs in the country with very few protections in the JMO award. The Award needs to be completely overhauled to at least be in line with other states so that DITs actually feel valued for the excellent healthcare they provide to the residents of NSW.”

Co-chair, Dr Ho added, “This year has been one of the toughest periods as a JMO – as COVID and other respiratory illnesses resulted in increased sick leave, as well as an increasing number of JMOs experiencing burnout and unprecedented resignations meaning that our hospitals have been more understaffed than before. It’s no wonder that during this time, hospitals have become more service provision and less focus on teaching and wellbeing, and this ultimately impacts on the doctor-in-training experience. 

“But this is not an excuse to go backwards from the positive changes that have been implemented in previous years. I’m hopeful that next year, we’ll see a significant improvement as hospitals and JMO units re-focus on our doctors-in-training so that we are better able to look after our patients, as well as ourselves,” she said.

Grades

As a result of changes made to our survey format, the calculations for domain grades in 2022 differ slightly from 2021. Consequently, the grades do not provide an accurate comparison to the previous year. However, they are a useful measure against the NSW overall grades and good comparison to how hospitals are performing compared to other hospitals in the State.

This year, hospitals achieved slightly higher marks in the Overtime and Leave categories, with Coffs Harbour, Manning Base, Tweed and Wagga Wagga all achieving an A in the Overtime category, while Tweed and Wagga received As in the Leave category.

While a more complete picture of how individual hospitals performed in all of the domains is available online, we did want to briefly touch on the ‘facilities’ domain. The questions in this domain asked respondents to indicate how satisfied they were with the facilities provided at their hospitals, including things such as access to rest areas, common rooms, car parking, computer access, library, etc. Hospitals that performed best in this category included Calvary Mater Hospital, Hornsby, Tamworth, and Tweed.

Areas for improvement for most hospitals included facilities such as places to sleep, pager free meal breaks and access to quality food.

To find out more about the 2022 Hospital Health Check, please go here: amansw.com.au.