Senior Doctor Pulse Check

The results of the 2021 Senior Doctor Pulse Check reveal a workforce that is passionate about providing high quality patient care, but risks burn-out and feels unsupported by key decision-makers.

INTRODUCTION

The 2021 Senior Doctor Pulse Check surveyed 1023 senior public hospital doctors across NSW over a five-week period closing in June.

The survey was established to measure senior doctor engagement with management at hospitals and local health districts. The Pulse Check looked at leadership and alignment, culture and recognition, resourcing, wellbeing and satisfaction.

BACKGROUND

Following the Special Commission of Inquiry, headed by Mr Peter Garling (the “Garling Inquiry”) senior clinician engagement has been the focus of improving patient care and hospital efficiency.

The Garling Inquiry found, “During the course of this inquiry, I have identified one impediment to good, safe care which infects the whole public hospital system. I liken it to the Great Schism of 1054. It is the breakdown of good working relations between clinicians and management which is very detrimental to patients. It is alienating the most skilled in the medical workforce from service in the public system. If it continues, NSW will risk losing one of the crown jewels of its public hospital system: the engagement of the best and brightest from the professions who are able to provide world-class care in public hospitals free of charge to the patient.”

Since the Garling Inquiry, surveys were conducted in 2015 and 2018 to gain a better understanding of clinician engagement within the NSW public health system, identify trends and compare results between hospitals and LHDs.

The Senior Doctor Pulse Check is the latest survey to advance this work. It is noted that the COVID-19 pandemic has put unique stressors on the system and the timing of the 2021 survey occurred shortly before the Sydney outbreak that is contributing to current resourcing and management challenge.

OVERVIEW

Senior clinicians continue to play a critical role in steering hospitals through the COVID-19 pandemic. Whilst the pandemic is presenting significant challenges for the health system, AMA (NSW) was interested in gaining a more in-depth understanding of the other issues senior doctors are facing. Central to the Senior Doctor Pulse Check was the question – do you feel valued?

The survey revealed senior doctors across the state feel valued by patients and supported by their colleagues as they put their patients’ wellbeing ahead of their own.

It also affirmed that most senior doctors go above and beyond, taking on excessive workloads and navigating a lack of resources to deliver to patient needs.

Comments from respondents made clear that many senior doctors feel that the support they receive from most of their colleagues doesn’t extend to decision-makers within the hospitals, their LHD or the Ministry of Health.

While this is a perennial issue, senior doctors have called out a lack of supportive leadership, transparency, and trust as key inhibitors to a cohesive workplace culture.

With three in four senior doctors saying they don’t feel supported by their hospital or LHD in their efforts to secure funding, the survey again raises the issue of inadequate resourcing. Senior doctors are particularly concerned with a lack of medical staff and beds/services required to keep up with patient demand.

Unsurprisingly, results indicate that under-resourcing is the top driver of workplace stress.

The Senior Doctor Pulse Check is a barometer of clinician engagement and provides a strong platform from which AMA (NSW) can advocate for improvements at individual hospitals and within local health districts.

PERSPECTIVES ON ADMINISTRATION AND CULTURE

In line with previous surveys on senior clinician engagement, the Senior Doctor Pulse Check survey asked respondents questions around opportunities for medical leadership and decision-making, consultation, communication, and trust. Overall, the results reveal a distinct lack of trust and poor communication.

63% – About 63% of senior doctors disagree that their LHD/network enables strong medical leadership and cross-organisation participation in decision-making, while 16% agree, with 21% remaining neutral.

34% – One in three senior doctors agree (34%) that they can openly and honestly discuss workplace problems or issues with their hospital/LHD. Almost half (47%) disagree.

52% – Half of senior doctors (52%) do not believe senior management at their hospital LHD consults doctors on issues that concern medical staff.

66% – Two in three senior doctors (66%) do not believe senior management at their hospital/LHD can be trusted to tell things the way they are. Just 14% believe they can.

PERCEPTIONS OF VALUE AND WORK

The Senior Doctor Pulse Check looked at whether respondents felt valued by their hospital, as well as different groups they interact with, including patients, colleagues and the Ministry of Health. Results revealed that the vast majority of senior doctors feel valued by patients, doctors in their department and other departments, and to a moderately lesser extent, other health professionals in their department and other departments. However, most senior doctors don’t feel valued by their Hospital, LHD/network or the Ministry of Health.

The results and comments also revealed respondents are feeling pressure from administration to perform, but there is not a corresponding acknowledgment of the hard work senior doctors do. Many note responsibilities to patients as driving them to go above and beyond, with little support from administration.

69% – Two-thirds of repondents (69%) do not feel valued by their hospital, and 31% do.

87% – Most doctors indicated they felt valued or highly valued by patients.

45% – Almost one in two senior doctors feel motivated to go above and beyond what is required of them at work (45%), whereas 38% do not.

90% – Senior doctors found clinical work the most fulfilling (90%), followed by teaching and mentoring (both 78%). Senior doctors are more likely to be neutral, or find research, quality assurance activities and medical leadership less fulfilling.

FUNDING AND RESOURCES

An important area of focus in this survey was support and resourcing. Respondents indicated there was little support by their hospital/LHD for funding to develop new services or improve existing services. Comments indicated promises for funding were “not being kept” and there was a “lack of urgency” to follow up on requests for resourcing.

Understaffing was also noted across a number of areas and only 1 in 10 respondents indicated the number of beds and services to meet demand are adequate.

75% – Three in four senior doctors (75%) believe they are unsupported by their hospital/LHD in securing funding to develop new services or improve existing ones. Just over one in 10 say they are supported.

62% – Most senior doctors feel the number of medical staff is inadequate (~62%) compared to ~24% who find it adequate.

54% – About 54% of senior doctors find the number of medical staff to teach and supervise junior staff/medical students inadequate compared to ~27% who find it adequate.

40% – About 40% of senior doctors find the ratio of permanent medical staff to locum/casual staff adequate compared to 34% who say it’s inadequate.

57% – More than half say the number of nursing staff is inadequate compared to ~20% who say it’s adequate.

55% – Half of all respondents say the number of allied health is inadequate compared to 16% who say adequate.

44% – Just less than half say equipment is adequate compared to 40% who say adequate.

72% – While 40% say the number of beds/services to meet demand are highly inadequate, and a further 32% say inadequate (72% inadequate) compared to 11% saying adequate.

SENIOR DOCTOR WELLBEING

It is clear that the majority of senior clinicians are facing workplace stress, with many responses focussed on a lack of support from the Ministry.

When asked to specify, 69.03% said they are stressed due to lack of resources followed closely by 60.38% who are stressed because of excessive workload.

Despite workplace stressors and other concerns highlighted throughout the survey, one-third of respondents would recommend, or highly recommend their workplace as a good place to work. One in three would neither ‘encourage or discourage’ and another third would discourage or ‘strongly discourage’ others from joining their workplace.

80% – Eight in 10 senior doctors are experiencing workplace stress, with the majority citing excessive workloads (~60%) and lack of resources (~69%). This far outpaces conflict with colleagues and patient expectations as stressors in the workplace.

32% – Senior doctors are divided on whether they would recommend their hospital. Almost one in three would recommend their workplace (32%), and the same proportion would discourage others.

NB: Where the phrase ‘agree’ or ‘disagree’ is used, it implies ‘agree + strongly agree’ and ‘disagree + strongly disagree’

INDIVIDUAL HOSPITAL RESULTS

Respondents from 32 hospitals in 18 Local Health Districts are represented in the 2021 Senior Doctor Pulse Check. While individual results are included in overall NSW stats, the number of respondents from Armidale, Royal Hospital for Women, Shoalhaven and Wyong was less than 10 and therefore not reported in individual hospital results (outside of the heatmap below).

DO YOU FEEL VALUED BY YOUR HOSPITAL?

The NSW average of doctors who indicated ‘yes’ they feel valued by their hospital is 31%.

SUMMARY OF HOSPITAL RESULTS

The following summaries provide a brief snapshot of the hospitals reported in the Senior Doctor Pulse Check.

RECOMMENDATIONS

Apart from Wagga Wagga Hospital, which had very positive results in almost all domains, most clinicians from other hospitals are experiencing similar challenges around clinician leadership and support, as well as resourcing. AMA (NSW) is preparing a detailed report of results for NSW Health, which will provide a platform from which to advocate change to improve senior clinician engagement. AMA (NSW) will be discuss opportunities to improve leadership opportunities for clinicians, with a focus on growing the role and scope of medical leaders in organisational activities.

Bankstown Hospital

Senior doctors at Bankstown Hospital are far more likely to feel valued by their hospital than the state average and moderately less likely (62.5%) to be experiencing workplace stress. The majority believe they are consulted by hospital/LHD management about medical issues but are divided on whether senior management can be trusted to tell things the way they are.

Blacktown Hospital

The vast majority of senior doctors at Blacktown Hospital do not feel valued by their hospital, with negative perceptions of trust in, and consultation with, senior management among the majority. An above average proportion (9 in 10 doctors) are feeling workplace stress principally because of workload.

Calvary Mater Newcastle

While a far higher than average proportion of senior doctors say they feel valued by their hospital and would recommend it to others, all respondents said they were experiencing workplace stress. Fewer than average said they are consulted about medical issues, but the majority were either positive or neutral (56%) when it came to trusting senior management to tell things the way they are.

Canterbury Hospital

A slightly above average proportion of senior doctors feel valued by the hospital and would recommend it to others as a place to work. However, sentiment around the level of consultation on medical issues and trust in senior management to communicate honestly was mixed. Only 1 in 10 agreed senior management could be trusted to tell things the way they are.

Campbelltown Hospital

Most senior doctors feel valued by the hospital and would recommend it as a place to work, which is supported by a perception of senior management regarding consultation about medical issues and honesty of communication that is significantly above average (45%).

Children’s Hospital at Westmead

The vast majority of senior doctors (83%) feel unsupported by their hospital with an above average proportion experiencing workplace stress. Most said that senior management couldn’t be trusted to tell things the way they are and that they felt unsupported in their efforts to secure funding.

Coffs Harbour Hospital

An above average number of senior doctors don’t feel valued by the hospital, with many also saying they don’t trust senior management to communicate honestly or consult with them about medical issues of concern. While the majority (69%) are experiencing workplace stress, the proportion is below the state average.

Concord Hospital

Senior doctors at Concord Hospital were among the most likely of all hospitals to say they feel valued. However, workplace stress was above average (88%), as was scepticism about being consulted on medical issues and perceptions of honest communication from senior management.

Dubbo Hospital

One in two senior doctors felt valued by the hospital and even more would recommend it as a place to work (60%). While the majority were experiencing workplace stress (70%), this was slightly below the average across the state.

Gosford Hospital

A below average number of senior doctors felt supported by the hospital. All respondents (100%) felt unsupported in their efforts to secure funding for new and improved services. That may be linked to the higher than average incidence of workplace stress, driven by a lack of resources as the top stressor.

Hornsby Hospital

The survey found that the number of senior doctors feeling valued by the hospital is above average when compared to other hospitals across the state. Pleasingly, the proportion of doctors experiencing some level of workplace stress is considerably lower than the state average (60%). Many, however, see room for improvement when it comes to open communication and consultation between senior management and senior doctors.

John Hunter Hospital

The survey found that the number of senior doctors feeling valued by the hospital is on par with the state average, while doctors experiencing some level of workplace stress is modestly greater. Similar to other hospitals, many see room for improvement when it comes to open communication and consultation between senior management and senior doctors.

Lismore Hospital

The survey found that just one in five senior doctors feel valued by the hospital – considerably lower than the average across NSW. The proportion of doctors experiencing some level of workplace stress is modestly above average (87%), and many see room for improvement when it comes to open communication and consultation between senior management and senior doctors.

Liverpool Hospital

One in four senior doctors feel valued by Liverpool hospital – lower than the average across NSW, and many see room for improvement when it comes to open communication and consultation between senior management and senior doctors. Pleasingly, the proportion of doctors experiencing workplace stress is marginally lower than average – 76% compared to 80% state average.

Nepean Hospital

The number of senior doctors feeling valued by Nepean Hospital is on par with the NSW average as is the proportion of doctors experiencing some level of workplace stress. However, 79% disagreed that senior management could be trusted to tell things the way they are compared to the state average of 66%.

Northern Beaches Hospital

Just 14% of respondents indicated they feel valued by the hospital – far lower than the average across NSW, and many see room for improvement when it comes to open communication and consultation between senior management and senior doctors. Pleasingly, the proportion of doctors experiencing some level of workplace stress is significantly lower than average at 40% compared to the state average of 80%.

Orange/Bloomfield Hospital

The survey found that the number of senior doctors feeling valued by the hospital is significantly lower than the average across NSW, and many see room for improvement when it comes to open communication and consultation between senior management and senior doctors. While the proportion of doctors experiencing some level of workplace stress is greater than average, advocacy for the hospital as a recommended place to work is on par with other NSW hospitals at 30%.

Port Macquarie Hospital

The survey found that the number of senior doctors feeling valued by the hospital (17%) is significantly lower than the NSW average, and many see room for improvement when it comes to consultation between senior management and senior doctors. Trust in senior management communication is comparative to other hospitals across NSW as is the proportion of doctors experiencing some level of workplace stress (83%).

Prince of Wales Hospital

The survey found that the number of senior doctors feeling valued by the hospital is above average (42%) and there were strong levels of trust in senior management (52%). However, many see room for improvement when it comes to open communication and consultation between senior management and senior doctors. Eight in 10 doctors are experiencing some level of workplace stress, which is comparative to the NSW average.

Royal North Shore Hospital

The survey found that most doctors felt valued by their hospital (62%), well above the state average, while under half agreed that senior management consult doctors about issues that concern medical staff. Just over one in two report they experience workplace related stress – well under the state average.

Royal Prince Alfred Hospital

The survey found that most did not feel valued at their hospital and 71% did not feel that senior management could be trusted to tell things the way they are. Almost half say senior management do not consult with doctors and anecdotal feedback suggests a lack of resources are a key issue and the top driver of workplace stress.

St George Hospital

The survey found most results were in line with state averages, despite anecdotal evidence being fairly negative. Seventy-two percent of doctors say they don’t feel valued by the hospital and 58% disagree that management consult senior doctors on issues concerning medical staff.

St Vincent’s Hospital

The survey found that the majority of doctors (72%) do not feel valued. The vast majority of doctors (65%)say they aren’t consulted about issues concerning medical staff and senior management can’t be trusted to tell things the way they are. However, advocacy for the hospital is moderately above average.

Sutherland Hospital

The survey found that results were broadly in line with state averages. Almost all (92%) are experiencing workplace stress, slightly above the average, while 3 out of 4 doctors say they do not feel valued at their hospital.

Sydney Children’s Hospital, Randwick

The survey found more than half of respondents would recommend the hospital as a place of work, considerably above the state average. While the incidence of workplace stress was also below average, the vast majority of respondents say they do not feel valued by the hospital. And 100% said senior management couldn’t be trusted to tell things the way they are.

Wagga Wagga Hospital

The survey found 2 out of 3 senior doctors would recommend the hospital as a place to work – well above average. Seventy-five percent feel consulted about medical issues, well above the average, and the number experiencing stress is below average.

Westmead Hospital

The survey found that most senior doctors disagreed that senior management consult them about issues concerning medical staff, while the same cohort disagreed that senior management could be trusted to tell things the way they are. The vast majority did not feel valued.

Wollongong Hospital

The survey found that few respondents felt valued by the hospital (12.5%). The vast majority disagreed that senior management consult doctors about issues concerning medical staff, and anecdotal feedback suggests this lack of communication to be a critical problem.