Bunbury Hospital: Shocking leaked report highlighted dysfunction months before death of new mum Melody Taripe

The level of dysfunction at Bunbury Hospital was so dire, staff would be “reluctant to recommend the hospital to their friends or family”, a confidential report reveals. The report paints a picture of a hospital at war with itself, with rampant infighting between “tribes” of clinicians and other management, while overwhelmed nurses and fearful junior doctors struggled to hold the place together. The “toxic” and “destructive” work culture was impacting patient care, the 26-page report — based on interviews with 42 staff — found. Consultants PwC handed the damning report and a list of recommendations to the WA Country Health Service in January last year, after being commissioned to conduct the high-level probe. Sources claim recent high-profile incidents at the hospital were symptomatic of the deeply rooted and systemic issues. These incidents include the death of “healthy” mother Melody Taripe, 35, who died in childbirth at Bunbury Hospital last July. On Tuesday, The West Australian reported the claims of Erica Hay that blood thinners given to her at Bunbury Hospital caused complications in her pregnancy. Her baby, Hope, was born 14 weeks premature and is still in intensive care. These came to light after the West reported on the death of newborn Zyeen after his mother Mansurin Hassan was given a massive dose of morphine in a tragic bungle at St John of God Bunbury Hospital, which is on the same campus as Bunbury Hospital. The “strictly confidential” independent report showed: The review was prompted by letters sent from clinicians to the WACHS board. When PwC interviewed staff, many expressed anxiety about repercussions. “A number of interviewees were clearly distressed ... highlighting the impact of the behaviours in the hospital on staff wellbeing,” the report stated. “It was described that there are clear factional groups within each discipline and this created concern of being targeted if involved in the review.” Mistrust “led to a breakdown in communication between the departments”. “This mistrust is also present between the leadership and the Regional and WA Country Health Service,” the report stated. The report, titled the Bunbury Hospital Medical Workforce Review, cited a frequent “lack of values-led behaviour” by clinicians, with limited consequences. “On a number of occasions this was referred to as ‘mob’ and ‘tribal’ behaviours,” it added. “Several people spoke of the behaviour ... as having a ‘mob mentality’ where they ‘ganged up’ ahead of meetings to plan how to ‘attack’ management.” As an example, it cited an administrative medical meeting in which the behaviour of attendees was described as “appalling” by a senior official. “Overall there appears to be a reluctance from some key clinical leaders to embrace the changes required and work collaboratively, both between clinical departments, and with the management teams,” the report stated. “Some clinicians do not agree with recommended best practice and refuse to follow evidence-based clinical pathways ... On a number of occasions, clinicians interviewed demonstrated an unwillingness to implement or comply with recommended clinical pathways or WA Health’s requirements to follow certain standards, stating that it would require more (employees), the right equipment and additional time. “Many of the challenges being faced at Bunbury Hospital are not solely attributed to a lack of processes and systems, but also a lack of motivation, a number of ‘difficult’ clinician personalities and a resistance to change,” the report added. “There are examples of clinicians actively disrupting processes in ‘protest’, including a clinician refusing a planned transfer to a regional hospital and keeping the patient for additional days, clinicians pressuring other clinicians and warning them against supporting changes at the hospital. “It was indicated by many interviewees that there were no evident repercussions for poor behaviour and many of the clinicians are reluctant to change.” The report suggested some medicos were motivated by financial incentives. “It was inferred on a number of occasions that the number of procedures in a particular area was higher in Bunbury Hospital than for other peer organisations suggesting that the ‘fee-for-service model was potentially driving an ‘over servicing of patients’,” the report stated. “There is limited transparency and monitoring of external appointments held by the medical staff. It was implied that clinicians may be on-call at Bunbury Hospital and SJGBH at the same time and receiving double payments for the same period of time,” it added. “Many interviewees said that they would be reluctant to recommend the hospital to their friends or family. This was mainly due to the variability of experience that they may receive in different areas of the hospital or from different clinical teams and they could not be confident that they would receive the best care. “Many of the interviewees felt that nursing was perceived to be ‘holding the hospital together’ but in an environment where they are not authorised to make decisions and there is a reluctance by many clinicians to solve the challenges.” The report said junior doctors felt they were being put in positions to make clinical decisions “without adequate information or experience, such as having to complete discharge summaries or having to look after 30-40 patients themselves on a weekend in general surgery without any support”. “It was mentioned that (they) often get told what to do and do not receive support ... but instead they have to work with other juniors if they require assistance,” it said. “There is a feeling of frustration amongst the (junior doctors) due to inefficiencies and a lack of clarity in processes. It was mentioned that there are some clinicians who do not complete the workload, which means (junior doctors) are left to make sure everything gets done.” Health Minister Roger Cook said he had previously seen the report. “WACHS has been acting on the recommendations and I expect them to work with clinicians to ensure a workplace culture that is both collaborative and supportive of all staff.” Dr Neale Fong, WA Country Health Service board chair, said improvements had been made since the report was delivered. He said none of its findings indicated concern with obstetric services at Bunbury Regional Hospital. “While we accept that there is still work to do, our improvement in this space has been reflected in our annual staff survey with significant increases across culture and engagement indicators at the hospital,” he said. WA Country Health Service chief executive Jeff Moffet insisted the issues identified in the report had no bearing on the recent cases featured in The West. Mr Moffet said he accepted “cultural issues identified within any health service can impact patient experience”. “However, specialist-led reviews on the matters reported do not indicate shortcomings in the clinical care provided,” he said. “Maternity services at Bunbury Regional Hospital are benchmarked at a State (quarterly) and national (annual) level and compare favourably to peer maternity services.”