- On January 15, 2019
- January / February 2019
Hospital Health Check 2018
The results are in from our second annual Hospital Health Check survey, which asked doctors-in-training to rate their workplaces. Did your hospital make the grade?
Doctors-in-training gave three different hospitals a failing grade in reference to staff wellbeing or their management of rosters in this year’s Hospital Health Check (HHC).
Westmead and Wollongong were both given Fs for wellbeing, and Canterbury received an F for overtime and rostering.
These are notable, not just because they are failing grades, but because they are the first Fs awarded by the HHC in NSW.
The wellbeing category includes questions relating to bullying, support for mental health issues, and reporting of inappropriate behaviour, while overtime and rostering deals with roster accuracy, overtime pay, and fatigue.
Each hospital was scored and graded in five categories with the results averaged to create an overall result.
While no hospital was given an F for its overall performance, three hospitals failed to rise above a D ranking, which is significant because the lowest overall grade last year was a C.
The hospitals awarded a D overall are: Blacktown and Mt Druitt, Canterbury, and Westmead.
The highest overall hospital grade given this year was a B.
This is the second year the AMA (NSW) / ASMOF (NSW) Alliance Doctors-in-Training Committee has conducted the HHC. It was encouraging to see an increase in respondents from year to year, with 1351 doctors participating in 2018, compared with 1107 in 2017 – a testament to the growing awareness of the importance of this survey.
This represents more than a fifth of NSW’s doctors-in-training workforce.
The increase in participation also allowed for 33 hospitals (or hospital groupings) to be graded this year, up from 26 in 2017.
Sixty-one per cent of respondents were female with 39% male, and the most well-represented hospital was John Hunter.
Comparing the results from the two surveys, there appeared to be a slide in performance in the wellbeing category from year to year.
About one-third of hospitals received a D in wellbeing in the 2017 survey compared with about two-thirds receiving a D or an F in 2018.
Additionally, four in 10 doctors-in-training reported experiencing bullying, and half said they had witnessed bullying of other staff.
And 62% of respondents said they thought there would be negative consequences for them if they reported inappropriate workplace behaviour.
These numbers were virtually the same as in the 2017 survey.
This is a disappointing result, considering the highly publicised attempts to reverse this trend by NSW Health since last year.
It was also interesting to note that there was a trend for the more senior doctors-in-training to more commonly report being bullied.
More than half of unaccredited specialty training registrar respondents reported being bullied in 2018 compared with just under a third of interns.
There were some improvements in terms of doctors-in-training reporting concerns over making clinical errors or about their personal safety due to fatigue.
That said, 65% of respondents this year were still worried about making clinical errors from fatigue due to hours worked and 60% had been concerned about their personal safety for the same reason.
In terms of the good news, the HHC awarded 12 As to hospitals in the remaining three categories: access to leave, education and training, and morale and culture.
The top three performing hospitals were: Wagga Wagga, Wyong, and Dubbo Base.
The best performing metropolitan hospital according to HHC 2018 was Royal North Shore, which ranked fourth overall.
Other hospitals to be awarded a B included Gosford, Mona Vale / Manly / Ryde, Orange and Bathurst, St George, Sutherland, and Tamworth.
Despite a downward trend on wellbeing, bullying was not what doctors-in-training reported as being their most urgent issue. The strongest demand from doctors-in-training was for payment of overtime.
Results from the survey reinforced what we already know about the gulf between overtime pay for surgical trainees and physician trainees.
Surgical trainees are much more likely to be paid for the overtime they work but even then, only 40% of them said they get paid for all of their unrostered overtime.
It should be noted, that this is much higher than the 16% of all doctors-in-training who said they got paid for all unrostered overtime.
The survey results also show that women are much less likely than men to even claim overtime (43% of women claimed no unrostered overtime worked compared with 33% of men).
Women are also more likely than men to not get paid for any overtime worked.
The second and third highest priority improvements requested by doctors-in-training are for more staff, and better and fairer rosters.
This is certainly reflected in the results for the overtime and rostering domain, with the three lowest-performing hospitals overall receiving a D or an F in this category.
While it narrowly escaped an F rating in overtime and rostering, Westmead respondents reported it had the rosters least likely to match the hours they were expected to be at work.
Of the bigger hospitals, Westmead and Liverpool also had the highest proportion of respondents working 25 hours or more of unrostered overtime a fortnight.
In terms of the access to leave category, nearly two-thirds of women who applied for maternity leave said their access to it was good or very good.
However, only about one-third of respondents said the same about access to paternity leave.
More than half of the doctors-in-training surveyed said they rarely or never take sick leave when they are too ill to be at work.
And touching on the morale and culture category, it was refreshing to note that more than 95% of respondents said they had not been asked any inappropriate or discriminatory questions in the interview process for their jobs at the hospital.
Additionally, there was only a small variation on the answer to this question when filtering the results by gender.
And while 899 respondents said they had never experienced discrimination from other hospital staff, 311 said they had been discriminated against based on gender, 142 on race, 34 on sexuality, 55 on marital status, 51 on pregnancy or being a carer, and 83 for other reasons.
This question allowed respondents to choose all categories that applied, so the numbers above do not add together to the total number of people who took the survey.
The HHC results in 2017 helped The Alliance guide its advocacy for doctors-in-training and achieve some great outcomes for them in the 12 months following their release.
We will be using the 2018 results to the same end and, as per the survey results, our number one aim is to improve rates of unrostered overtime pay for junior doctors.
However, clearly, there are many areas that need improvement and we will be working to improve life for doctors-in-training and their workplaces in a number of ways.
You can read the survey online.