Executive Summary

Ballarat Health Services

Workplace Review Confidential Report

5 July 2016

Executive Summary: Ballarat Health Services Workplace Review Confidential Report

Justitias Brief
In November 2015, The Department of Health & Human Services (DHHS) requested that
Ballarat Health Services (BHS) appoint an industry expert to conduct a review with respect
to the culture that exists within BHS (the Review).
BHS Board of Management authorised a comprehensive inquiry into BHS policies,
practices and workplace culture in response to the above request from DHHS and a number
of other factors, including: complaints from staff and unions about a bullying culture;
information gathered about the Mental Health Adult and Youth teams at BHS from various
consultants and organisational surveys; the strong recommendation of BHS HR department;
and intense media scrutiny.
Justitia Lawyers and Consultants were retained to carry out the Review and the Terms of
Reference (TOR) were finalised in January 2016. The TOR headings are:
1.
2.
3.
4.
5.
6.

Staff interviews and review

Policies Review
Culture & Engagement Survey Review / Analysis
Internal Complaints / Resolution Processes & Procedures Review
Education & Training Review
Quantitative Statistics Review (Turnover analysis)

Justitia acknowledges BHS for demonstrating good governance in the decision to invite its
workforce to participate in the Review. We believe there was significant value in providing
both current and former staff with the opportunity to be heard with respect to their personal
stories relating to their employment.

Executive Summary
This Executive Summary is a high level overview of the Ballarat Health Services Workplace
Review Confidential Report (the BHS Report), its findings and recommendations. The BHS
Report is a confidential report that was commissioned by the BHS Board of Management.
The information contained in the BHS Report is to remain confidential as, amongst other
things, it contains quotes from many of the 200 interviewees who participated in the Review.
Interviewees participated in the interviews with Justitia on the basis that their confidentiality
and anonymity would be protected. Quotes are therefore de-identified in the BHS report to
ensure that the anonymity of the individual interviewees is protected.

Review Process
The data collected and considered in the Review included interviews with 200 current and
former BHS employees, meetings with the Victorian chapters of the Australian Nursing and
Midwifery Federation, the Australian Medical Association and the Health and Community
Services Union as well as a review of organisational data provided by BHS to Justitia (See:
Findings Other Data for an explanation of the other data considered in the Review).

Executive Summary: Ballarat Health Services Workplace Review Confidential Report

At the commencement of the Review, BHS invited current and former BHS employees to
meet with Justitia to report any experiences of bullying and harassment at BHS. In response
to this invitation, Justitia received 240 contacts from current and former BHS employees
which ultimately resulted in 200 interviews. Interviews with former staff made up 43.5
percent of all interviews.
A team of four interviewers from Justitia conducted the interviews. Interviews were mostly
conducted in person, however some interviews were conducted over the phone. Interviews
were conducted off site from BHS. During the weeks when the interviews took place, and at
the conclusion of the interview process, the four person interview team discussed the
content of the interviews and identified themes. These themes were strengthened by
ongoing analysis and review of interview notes and data collation.
It was anticipated that an open invitation to report experiences of bullying and harassment
would predominantly solicit negative workplace experiences from interviewees. It was not
anticipated that such a large number of individuals would come forward to share their
experiences and that their observations would be overwhelmingly of a similar nature and
reveal consistent themes.
The themes identified from the interviews described a culture where:

inappropriate behaviour and bullying were tolerated;

favouritism and nepotism were significant;
employees feared retribution if they spoke out;
the role of Human Resources (HR) was ineffective;
individuals were harmed;
recruitment and supervision practices were not always appropriate; and
workloads were excessive and at times overwhelming.

It is correct to observe that a subjective version of events has been provided in these
interviews, which in almost all 200 cases will remain untested. However, given the
consistency in what was described by a large number of individuals, we consider that there
is sufficient basis to make our findings and recommendations. Indeed, the sheer volume of
consistent information provided to us is confronting. This is particularly the case when one
reflects that the experiences shared by the 200 interviewees occurred in the one workplace
and that the primary function of this workplace is to provide health care to members of the
community. We consider that our findings and recommendations will provide valuable insight
into the organisation and its recent journey.
We acknowledge here the contribution of the interviewees to the Review. Their desire for a
more caring workplace was abundantly clear and well demonstrated by their willingness to
be interviewed by us in their own time. We believe that the issues raised in this Report will
provide a sense of urgency and focus on what measures are required to address various
organisational failings. The overwhelming majority of responses from the 200 interviewees
point to serious deficiencies in BHS culture and leadership, as well as gaps in BHS training,
policies and practice. These organisational deficiencies have led to a range of detrimental
outcomes for many staff.
We summarise below the findings and recommendations that appear in the BHS report.

Executive Summary: Ballarat Health Services Workplace Review Confidential Report

Findings - Interview Themes

Justitia identified seven overlapping themes from the interviews.
1.

Inappropriate Behaviour and Bullying

All 200 interviewees reported that they had either experienced or witnessed inappropriate
behaviour and bullying. A cross-section of various alleged inappropriate and bullying
behaviours included:

criticising unnecessarily
micromanaging
yelling and screaming
slamming the door behind oneself before another could enter the room
ignoring and not inviting staff members to meetings
excluding
nit-picking
not being given the same information as others
being criticised in front of colleagues
threatened if a complaint or issue was raised
counselled for using the term bullying in the workplace
throwing things at an individual
dumping things on a desk
telling others about how another was not doing their job well
unrealistic or changing expectations
taking shifts away
rostering on for additional duties
threatening staff members certification
putting pressure on staff to come into work when very unwell
putting inappropriate comments on social media
taking projects away from staff members with no explanation
many backhanded comments and undermining
being the subject of a direct campaign by management to remove an individual from
their position
attacked in team meetings
being moved to areas where a staff member did not have skills or qualifications
negative remarks made about race, sexuality, personal appearance, or religion
disclosing confidential and personal information to colleagues
insisting on medical certificates only from some individuals and not others who had
been ill.

Many interviewees described their manager as aggressive, rude, intimidating, belittling or

thoughtless towards staff. Interviewees described being yelled at by their immediate
supervisors at handovers, in team meetings, in front of other staff and sometimes in front of
patients. Unwanted shift changes and changes to hours were also common. Physical
threats and intimidation were also raised by some interviewees.
Inappropriate behaviour and bullying was allegedly accepted and normalised by some BHS
employees. Interviewees described ineffective processes for the management of bullying
allegations when they were reported, which led to the view that such behaviours were
tolerated. Staff frequently worked around or ignored bad behaviour.

Executive Summary: Ballarat Health Services Workplace Review Confidential Report

Interviewees reported that some staff members were considered to be protected, in that
their bad behaviour was known and tolerated by their supervisors and sometimes by HR
because they were friends or family of a senior staff member(s). Often this occurred due to
a lack of managerial capability to address poor behaviour appropriately and hold staff
accountable.
Inappropriate behaviour and bullying was allegedly unchecked, which created an
atmosphere of fear, lack of safety and an environment in which individuals felt targeted.
Many staff stated they were very distressed about the organisations inability to address
inappropriate and bullying behaviour. Their distress was compounded as there were few
opportunities to avoid situations where they were subjected to this behaviour aside from
leaving the organisation.
2.

Favouritism and Nepotism

Of the 200 interviews conducted, 81.5 percent stated that nepotism or favouritism is a
problem at BHS. By nepotism, interviewees were referring to the tendency for family
members and friends of existing BHS employees, and particularly those in senior positions,
to be given roles for which they were underqualified, or for which others were better
qualified. By favouritism, interviewees were referring to the way in which some staff
members are favoured over others, giving them a range of advantages such as increased
opportunities for training and development or preferable shift times. Hence, in this context,
nepotism refers to practices preceding engagement in a role, whereas favouritism refers to
practices during employment.
Interviewees frequently made statements to the effect that the BHS community is insular and
that managers prefer to hire people from the Ballarat area. In these circumstances, standard
recruitment practices would not be followed, such as advertising positions or conducting
interviews.
Employees who were perceived to receive preferential treatment from their supervisors were
often described by the interviewees as favourites. Examples of preferential treatment
included being allocated better shift times, receiving promotion ahead of others with the
same skills and qualifications, being given first preference when choosing leave dates,
receiving more training, and having poor conduct or performance overlooked.
The interviewees expressed the view that these practices were unfair and yet difficult to
complain about due to fears of retribution. Interviewees stated that such practices ultimately
decreased staff morale and negatively affected the quality of care provided to
patients. Further, it was suggested that favouritism and nepotism perpetuated and
entrenched a culture of bullying because under-skilled or unqualified staff strongly protected
their jobs from any perceived threats.
3.

Fear of Retribution

Fear of retribution was reported by 85 percent of interviewees. These fears were real, as
interviewees observed that those that did speak up were often subjected to less favourable
treatment, generally by their manager. Examples provided by the interviewees included
unnecessary performance management, not being considered for a job promotion or having
rosters created or changed for punitive reasons. As a result, interviewees stated that staff
members generally chose not to report inappropriate or bullying behaviour.

Executive Summary: Ballarat Health Services Workplace Review Confidential Report

4.

Recruitment and Supervision

Of the 200 interviewees, 74.5 percent reported that recruitment and supervision practices
were not appropriately followed. For example, interviewees claimed policies around
submitting expressions of interest for a position, performing higher duties, acting up in roles
and promotions exist, but are often not followed. There were complaints about the lack of
position descriptions and training. Poor practices in this area were alleged to have resulted
in managerial appointments for individuals who either did not have the skills or did not have
the qualifications to adequately perform in the role.
5.

Workload

Excessive workload was identified as an issue by 75 percent of interviewees. Interviewees

in three areas of BHS complained in particular about their workloads. In these three areas
interviewees reported that they were not paid overtime but were nonetheless told that they
had to work the additional hours. Some interviewees reported that they had been offered
time in lieu but alleged that there was no system in place for them to take it.
It was also reported that workload distribution was a tool used for the punishment and
reward of employees. For instance, interviewees observed favoured staff receiving lighter,
easier duties while those who were not favoured were allocated heavier, more challenging
work.
6.

The role of HR

An experience with HR in the context of dealing with a complaint of bullying or harassment

was mentioned by 70 percent of interviewees. Of those interviewees, 97 percent described
the experience as a negative one. These experiences can be summarised as follows:

Processes for dealing with complaints did not occur in a timely manner. In some
cases the process took several months, the complaint was not followed up at all or
there was no follow up after an initial meeting.

Many interviewees said they were told that no action would be taken by HR until a
written complaint had been received. In some of these cases, the interviewee stated
that they did not wish to make a formal, written complaint as they feared retribution.

Interviewees recounted being called into meetings with HR without knowing the
nature of the meeting or who would be in attendance, and without the opportunity to
have a support person present, indicating a lack of procedural fairness.

Interviewees said they did not have a good sense of how information about their
complaint was being kept or whether records of their complaint even existed.
Interviewees explained that in some cases no notes were taken during their meeting
with HR or they were told that the notes would be shredded after the meeting.

Dispute resolution processes were not always appropriate or applied in a standard

way. For example, many interviewees described a process that was called
mediation by HR but that did not conform to legal norms of mediation, in that an
employee complaining of bullying or harassment was encouraged to face the alleged
perpetrator one-on-one to discuss the matter in circumstances where this did not
appear to be appropriate.

Many interviewees stated that they felt HR only appeared to value the managers
point of view. Interviewees alleged that HR demonstrated a strong bias in favour of
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Executive Summary: Ballarat Health Services Workplace Review Confidential Report

the manager during a complaint process. As a result, interviewees described feeling
unsupported and disadvantaged.

After reporting a complaint against a manager, complainants often found themselves

responding to a counter-claim from their manager or alternatively they reported that
performance management would be initiated.

Where there was a disagreement between the complainant and their manager and
no clear path forward, interviewees reported that there was often a range of other
negative outcomes for complainants. These outcomes included the complainant
going on sick or special leave, resigning, or leaving BHS with a pay-out.

Many interviewees said they were very angry with HR and HRs inability to effectively
address poor and bullying behaviour. The interviewees reported that they did not
trust HR and that they felt their confidence was breached.

We note the allegations and claims raised by interviewees were not tested by Justitia as part
of this Review or put to HR for a response, but rather were obtained for the purpose of
providing insight as to possible shortcomings in organisational culture and practice.
7.

Harm to staff

All interviewees discussed the harm that experiences of bullying and harassment had
caused them or others at BHS. Of the past employees interviewed, 93 percent stated that
they had left due to bullying. Just over half of all interviewees stated that they had witnessed
or experienced victimisation as a result of making a complaint or raising a workplace issue.
Most interviewees (both current and former employees) said they experienced ongoing
stress, anxiety and depression as a result of their experiences at BHS. They said their
experiences had lasting negative effects on them and their families. Many interviewees
were moved to tears during their interviews for this Review.
Many of the interviewees felt their careers had been ruined by their experiences at BHS.
This was generally reported as being due to loss of confidence, declining performance in
their role or because managers at BHS had refused to provide references to prospective
employers (some staff members were told they could only obtain a reference from their
direct manager and so they felt they were unable to leave).
Some interviewees reported that, as a result of their experiences at BHS, they had been
diagnosed with post-traumatic stress disorder or major depressive disorders. Some
interviewees reported that they had engaged in self-harm or had suicidal thoughts.
A high percentage of former employees who left due to bullying said they received a payout or package to leave BHS (often with a union representative involved in the discussions)
and had signed confidentiality deeds.
A high percentage of interviewees reported taking periods of sick leave (in some instances,
long-term sick leave), special leave or other leave due to bullying or harassment.

Executive Summary: Ballarat Health Services Workplace Review Confidential Report

Interview Themes Other Comments

Although not explicitly identified as a theme from the interviews, Justitia found failings in
relation to leadership and accountability as well as systematic failures to follow policies and
procedures across BHS.
The information provided by some interviewees led us to conclude that certain leaders at
BHS do not work collaboratively and, as suggested by the BPA survey results, their
preferred leadership style is autocratic and passive-aggressive. This was not assisted by an
apparent lack of training for managerial staff on BHS policies and procedures, as well as
management skills.
It would appear that a preoccupation with financial and budgetary imperatives may
sometimes have resulted in fewer resources and less attention being allocated to the
measures required to maintain a healthy workplace culture. Some interviewees also
reported concerns about patient care because of poor management practices. Interviewees
reported that there was a culture where reporting of risks or problems was resisted or that
there was a fear of retribution for reporting risks.

Findings - Other Data

The other data considered during this Review were policies, engagement survey material,
reviews conducted by others, internal complaints processes and procedures, education and
training and quantitative statistics including turnover and other HR data.
Strong themes emerged in our analysis of this data that confirmed the experiences shared
by interviewees. We observed a lack of consistency in approach towards inappropriate
workplace behaviour and bullying. Policies, processes and training were not clear to staff,
nor consistently applied or offered, or in some cases were out of date. Interviewees said
they experienced an incoherent complaint handling system that was not easily navigated by
them. The system produced inconsistent outcomes and was characterised by an overall
lack of confidence in BHS processes. The themes identified during the interviews are
consistent with those revealed by recent BHS survey data (particularly the 2015 BPA Survey
results) and other internal documents.
We are aware of recent BHS initiatives which have the potential to significantly improve the
culture and processes at BHS. The changeover of personnel at the Board and senior
executive level, the development of strategic aims since the BPA Survey, together with the
recent focus on face-to-face training and a revamped online training system, all represent
important steps forward for BHS. There are also a number of teams that are reporting
strong engagement and good leadership, which is resulting in those teams performing well.
The BHS Report considers the themes and evidence canvassed in a variety of other recently
released public reports both within the health sector as well as other public sector
organisations. These reports highlight that BHS is not alone in tackling issues of workplace
bullying and harassment and that there are particular challenges for the health industry in
Victoria. Being the largest employer in a regional centre can also present its own unique
challenges, exacerbating the issues that some interviewees experienced at work and limiting
their opportunities to move to another employer.

Executive Summary: Ballarat Health Services Workplace Review Confidential Report

Recommendations
It will be essential for the Board to take a strong and visible leadership role in directing and
monitoring the implementation of any cultural change at BHS. Justitia makes the following
recommendations to the BHS Board:
1. VALUES REVIEW
BHS has a new CEO commencing in July 2016. This is an opportunity for the organisation
to re-visit its Values. BHS will want to:

Determine how the Values can be re-enforced (and consider how the qualities of
inclusivity, democratic decision-making and respect at leadership level can be
incorporated)
Consider what changes will be required of leaders/managers in the organisation
Consider what the findings of this Review mean for the organisation
Consider what interventions are required, what its short term aims are and what
can be achieved in the long term regarding an improvement in organisational
culture, particularly in the areas requiring the greatest improvement.

Justitia understands that BHS is considering a values-based change programme (such as

Studer) to be rolled out through the organisation. This is something that must be led from
the top. The Board has an important role to play in setting the strategic agenda in any
cultural change.

2. BOARD INFORMATION REVIEW

The Board to review whether it receives adequate information in the following areas (and
consider whether the data can be benchmarked against similar organisations):

Amounts and types of leave taken by BHS staff

Data on casual and contract staff utilised
Detailed analysis of data from employee satisfaction/engagement surveys
Early capture of grievances and complaints data
Turnover, exit and exit interview data (and as compared to the last 5 years)
Information about the training programmes provided by BHS to the
Executive/managers, and staff and attendance rates at these programmes
The amount of collaboration and information sharing occurring at the Executive level
with the Department and other best practice health service providers
Information in relation to regular 360 degree surveys of each executive in the
executive team.

3. CAPABILITY AUDIT
Perform a capability audit of all those in leadership positions at BHS, including at the Board,
the Executive, HR and management levels. A capability audit should take into account
technical and as well as management/leadership skills and should identify specific skills
deficits. BHS should also consider whether any skills deficits are capable of being remedied,
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Executive Summary: Ballarat Health Services Workplace Review Confidential Report

and how this could be achieved. Any measures taken to remedy skill deficits should be
recorded and followed up to track progress.

4. ORGANISATIONAL STRUCTURE REVIEW

We see that BHS (its Board and new CEO) now have an opportunity to assess whether it is
being adequately served by the current organisational structure, in particular the reporting
structures for HR. Concomitantly, we recommend BHS consider if the HR team is currently
adequately resourced and structured to adequately carry out its role and implement the
recommended cultural change.

5. POLICY AND PRACTICE REVIEW

Review current HR policies in light of the detailed comments in the Report. We recommend
BHS liaise with other health service providers, which model best practice, to consider if their
policies and practices can be adopted. Based on the analysis of BHS policies and practices,
and the themes from interviewees, we recommend that the following steps be considered:

Review the current capacity of the HR team to deal with employee relations issues
(so that it is not allocated to one person only)
Review complaint handling processes generally to ensure they are best practice and
supported by staff who are trained to deal with complaints
Review the budget allocation for each area of BHS and benchmark this with other
public health providers (consider budgetary changes if necessary)
Review the areas within BHS where overtime has not been paid or time in lieu has
not been provided and how practices need to be changed. This may require
obtaining feedback from staff and having recourse to the BPA survey data
Review all forms of leave (e.g. sick leave and special leave) taken at BHS and
benchmark this with other similar organisations
Consider whether HR is receiving adequate external support for their functions (e.g.
benchmark their budget compared to other similar sized organisations)
Review whether online training is appropriate in all the areas it is currently being
provided and whether face to face training should be introduced in some areas
Set up systems that ensure that recruitment policies are followed correctly
Create a Code of Conduct for BHS which identifies the types of behaviours that
highlight the values of the organisation and the types of behaviours that are not
condoned at BHS. The process for creating this document could be a positive
initiative arising from the listening exercise BHS has embarked upon. BHS could
consult with the BHS workforce during the drafting phase as part of a process of
obtaining the engagement of staff in this document.

6. TRAINING
Provide mandatory training to all staff on BHS policies and procedures (once revised).
Additional budgetary resources should be allocated to enable the provision of such training.
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Executive Summary: Ballarat Health Services Workplace Review Confidential Report

7. FURTHER BOARD ACTIONS

Establish a Committee to support the Executive with implementing the changes

recommended in this report
Carry out exit interviews with departing members of the executive team
Comply with the immediate actions in 2016 as detailed in the DHHS strategy paper,
Our pathway to change: eliminating bullying and harassment in healthcare
Consider for a fixed period (2 years), the establishment of an independent
ombudsman-type role. This position would report to the CEO in relation to
complaints that she/he may be requested to resolve and would be available to staff
as an independent person who can provide assistance and advice. Where consent
is provided by both parties, the ombudsman could put in place a conciliation process
to resolve complaints/grievances.

It is essential that the Board demonstrates a commitment to a new approach to handling

bullying, harassment and other inappropriate behaviours at BHS. In order to demonstrate
this commitment, we recommend that the Board release a statement which expresses a
resolve for change and accountability and outlines initial practical steps to be implemented
by BHS through its Board and the CEO. We recommend that this statement be released as
soon as possible.

_________________
Justitia Lawyers and Consultants
5 July 2016

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