This appeared a few days ago!
Put patients first: let’s fix the conflict between hospital administrators and doctors
Patient safety should never come second to cultural problems in the health care sector.
Hospital administrators and doctors must co-operate better in the interests of patient safety.
12:00 AM May 17, 2025
A series of stories in The Australian have revealed, in shocking detail, how widespread dysfunction in relationships between public hospital administrators and specialist doctors is putting patients’ lives at risk around the country.
Workplace conflict is rarely productive, but in our health system it has the potential to be catastrophic.
Our public hospitals can be dangerous places. There should be no excuses for accepting risk to patients as a consequence of cultural problems between healthcare workers and those who administer our hospitals.
I was given the responsibility of analysing the recent national doctors’ survey, undertaken by the Australian Salaried Medical Officers’ Federation – ASMOF. The findings of the survey were deeply concerning.
Only one quarter of responding doctors described their relationship with hospital administrators as respectful. More than two thirds of those doctors felt that health bureaucrats had little or no understanding of the clinical work of frontline doctors.
Perhaps most worrying of all, a staggering 75 per cent of hospitals doctors reported that they felt uncomfortable reporting safety concerns due to fear of retribution.
More than half of the public hospital specialists in the survey reported being aware of colleagues who had suffered retribution after raising concerns with management.
Australia’s public hospitals have never been under greater pressure. Already challenged in meeting demand before Covid-19, the post-pandemic landscape has left record waiting lists for surgery and other medical procedures, overwhelmed public hospital specialist clinics, and swamped emergency departments.
Emergency departments around the country are being swamped.
There is no prospect of demand on our public hospitals reducing any time soon. Indeed, with a deluge of chronic conditions such as diabetes and mental health problems and challenges in securing GP appointments, our hospitals will face only greater and greater demand.
The only way we can ensure that Australians continue to have access to a world-class health system is with our public hospitals working at maximum efficiency and with a top-class healthcare workforce. There is no plan B for millions of Australians.
Workplace safety and high-performing healthcare staff are not luxuries. The Australian Commission on Safety and Quality in Healthcare estimates that more than 10 per cent of all activity in public hospitals is the result of mistakes and adverse events. That represents billions of dollars wasted from an already cash-strapped hospital system.
If we are to minimise the risk of harm and medical mistakes, maximise the efficiency of our health system – and protect Australians – then improving the relationship between those who run our hospitals and those who provide the clinical care is not optional.
Doctors and fellow healthcare workers must feel safe in reporting safety and other concerns to hospital management.
Australians want to trust the care they receive in our public hospitals. They also want to have surgery in a timely manner, specialist clinic appointments before their conditions deteriorate, the best emergency department experience possible, and safe care when they do end up admitted to a hospital.
For these things to happen it is critical the health workforce is functioning at a peak, not burnt-out, frazzled and working in a hostile environment. Safety must be first and foremost and no doctor, nurse, or other hospital worker should be fearful of raising concerns for fear of reprisal.
Doctors and hospital workers should be able to raise concerns about process without fear of reprisal.
Ongoing negotiations of the National Health Reform Agreement offer the perfect vehicle to address these issues. Incentives to smooth out relationships between managers and healthcare workers should be baked into the final agreement. The Federal Health Minister should expect – indeed, demand – proof from state and territory counterparts that dysfunctional relationships are repaired. Australians expect no less.
Spending on health is the single biggest item on every state and territory health budget, and hospitals are the largest cost. With so many demands on the public purse, Australians have a right to expect that the health workforce is functioning at the highest level possible.
Righting the ship so that often-toxic relationships between hospital administrators and senior doctors are fixed must be a high priority. Every dollar spent on our public hospitals should yield the maximum benefit for Australian patients. Patient safety should be our prime goal.
Dysfunctional hospital workplaces put everyone at risk and are a drag on our economy at the worst possible time.
Steve Robson is professor of obstetrics and gynaecology at the Australian National University and former president of the Australian Medical Association. He is a board member of the National Health and Medical Research Council and a co-author of research into outcomes of public and private maternity care.
Here is the link:
What an amazingly naïve comment!
The clinicians and the administrators have fundamentally different drivers, interests and KPIs!
I am lucky enough to have been on both sides of these arguments and it really is a matter of perspective and motivations. Good clinicians know that they need good administrators to support them and administrators have no purpose without great clinicians to support.
The bottom line is that if both groups do their jobs well pain is minimized and success pretty much guaranteed! Basically it is a false and pretty silly dichotomy!
The class acts on both sides of the fence understand the game and just get on with their jobs!
Friday evening drinks can be a good way to sort most irritants out I have noticed! – but sadly it can be problematic with people needing to drive home! I am still not sure how to manage that issue! (Have partners come and pick people up at end of day?)
David.
2 comments:
It's terrible. Doctors are told they cannot be critical of overnight ICU management by the registrar or it's bullying and don't dare ask a medical student a hard question because that's also bullying. Everyone is following guidelines but not thinking. Experience is a dirty word and disputing any dominant narrative is misinformation.
I am aware that a very eminent, highly respected retired surgeon, whom I worked with when I was a registrar has been excluded from attending morbidity and mortality reviews held in a lecture theatre named after him! This was because he basically said there was a bad outcome with a patient and mistakes were made and we need to talk about why. That's apparently bullying?
I am aware of bad outcomes locally in the children of friends because of extremely poor management in the public hospital where people were sent home without the primary problem being addressed, or adequately investigated. They have instituted surgical "Teams" and patients are not under a named consultant and the old ways of 7 days a week monitoring of your patients has been replaced with continuous transfer of care between surgical team members as people have days off.
The local private hospital has suspended after hours endoscopy and GI bleeds have to be transferred to the public hospital. You can't even add a case to the end of the routine lists.
This would have not happened with competent medical management running the hospital. I have had zero respect for the new generic management that has gradually taken over hospitals over the last decades. Luckily I can still run my own day surgery where quality of care can take priority, but it is a day surgery so very sick patients have to take their chances in a system that is collapsing before our eyes. I guess I am being a bully, but bad luck, it's atrocious
Spreadsheets over bedsheets - same cohort that follow the axe the fax rubbish. It has been long in the making, everything is seen as a cost and nothing is seen as an asset.
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