The struggle to achieve cultural change on OHS

In 2008, a New South Wales Parliamentary Committee reported to the Government on problems with that State’s Ambulance Services.  The problems included bullying, harassment and a dysfunctional management.  A review into the Ambulance Services progress on the recommendations two years later has found :

“…the general feedback received from ambulance officers is that despite the new initiatives, little has changed, and significant management and cultural problems remain within the Service. While awareness of the Service’s new policies and initiatives appears to be high, adherence to and application of the policies – particularly by Ambulance managers – appears to be low, or at best, varied.”

Some of the recommendations from the Final Report, Review of the Inquiry into the management and operations of the Ambulance Service of NSW, have generated local media attention.  Some of the progress for change has led the NSW Ambulance Service and the Health Services Union to the Industrial Relations Commission.  The recommendations of this report are:

  • “That NSW Health publish the results of the Chief Executive’s and senior executive managers’ performance reviews on the Ambulance Service of NSW’s website and email system, within one month of each review being completed.
  • That NSW Health establish a Key Performance Indicator in which the Professional Standards and Conduct Unit reports the percentage of investigations completed within three months.  Performance against the indicator should be reported in the NSW Health Annual Report.
  • That the NSW Government fund NSW Health to introduce personal electronic access cards for drug safes in all ambulance stations across New South Wales, as a matter of priority, in the 2010-11 State Budget.
  • That the Ambulance Service of NSW ensure that on-duty crews, where appropriate, consist of two ambulance officers by 31 December 2010.
  • That the Ambulance Service of NSW replace all personal Satellite Navigation Units with one high-quality Satellite Navigation Unit, fixed in each ambulance.”

The recommendation for two-person ambiance crews continues to be a sticking point since it was first recommended in 2008.  The reality of an ambulance officer working alone and trying to render medical assistance is clearly indicated by the case of Rick Wallace.  According to a 4 May 2010 report in the Sydney Morning Herald (SMH):

“Fifteen years as a single-crew ambulance officer left Rick Wallace with post-traumatic stress disorder and a serious back injury – he would sometimes have to carry patients by piggyback to a stretcher because he was on his own…..

The final straw was when a woman jumped in front of an express train near Wollongong in late 2005.

A manager told him to ”cowboy up” when he attempted suicide in September 2006, and he was diagnosed with post-traumatic stress disorder.”

These excerpt also indicate the management attitude to exposure to psychosocial hazards in the workforce.  Wallace said operating a single-person crew was very stressful:

“‘You’re treating, you’re driving, you’re running communications and the fear of violence is always in the back of your mind…. You just did the best you could do and hoped that they would not die.”

Another SMH article outlines how not only is there a risk to the worker but that working alone can impeded the quality of emergency treatment that can be supplied.

An earlier media report said

“… that in nearly all of nine suicides of paramedics over the past 12 years their families, friends and colleagues believed work stress was a factor.”

The Ambulance Service says that reasons for suicides are very complex.  The SMH article points out that

“The suicide rate among paramedics is one in 3500 compared with one in 10,000 in the general community.” (No source quoted)

The challenge for OHS improvements in the emergency services is not only in New South Wales.  In January 2010, an article in Victoria’s Herald-Sun reported on the stress levels of ambulance officers and the rate of departures from the service.  The Victorian Government undertook a review in to the Rural Ambulance Service’s organisational culture and governance following earlier reports of bullying in the organisation.  The final report is available HERE.

Queensland’s ambulance commissioner commented on similar workplace hazard reports in August 2009.

Clearing changing the culture in a high-stress occupation is difficult and takes time.  One of the reasons, I believe, it takes time is that to make effective change one must confront flaws in the fundamental structure of organisations.  This is scary and threatening and there is no guarantee that the organisation one will receive after the (r)evolution will be the same one that you were so keen to join.

Some experts say that humans are “hard-wired” to resist the pain of change and this may be true, though a little mechanistic, but firstly organisations and individuals must have a willingness to change.  Sadly many organisations are not willing to change and choose to wait for government pressure, social outrage and, often, worker suicides before acting.

Kevin Jones

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