‘Toxic’ AHPRA culture and complaints backlog in the spotlight

Burnout, shifting standards and management pressure have caused delays in dealing with complaints at the Australian Health Practitioner Regulation Agency (AHPRA) to worsen, according to a report published this week in Nine Newspapers.
 
In an investigative article based on leaked internal documents and interviews with current and former staff at the health regulator, the media group says an internal AHPRA project referred to as ‘Operation Reset’ was introduced to reduce the backlog.
 
‘Efforts to make the process more efficient have backfired, staff say, which has caused a backlog of complaints to build up,’ the report states.
 
‘Investigators working in the notifications team described the highest level of burnout, alleging senior managers pressure staff into working quickly within ever-changing standards for how to assess complaints.’
 
The report cites interviews carried out by Nine journalists with more than 30 existing and former AHPRA employees, and cites one internal document suggesting investigators spend less than one hour working on each case per week.
 
Bullying and harassment concerns among AHPRA staff also prompted a national review of the organisation’s culture, a document leaked to the media organisation has revealed.
 
The internal AHPRA briefing, which dates from 2020, suggests the results of a 2018 staff survey led to the engagement of four external consultants to assess the issues.
 
Dr Edwin Kruys, a member of the RACGP Expert Committee – Funding and Health System Reform, said it would be ‘very concerning’ if the allegations are true. 
 
‘You don’t want to be treated as a patient in a hospital or clinic with a toxic work culture because it affects the quality of work and safety at so many levels,’ he told newsGP.
 
‘The same is true for any organisation, but especially AHPRA.’
 
He said the quality of the work delivered by investigators would be called into question ‘if they themselves work in a culture of inappropriate civil behaviours, hierarchical issues, us versus them sub-cultures and high staff turnover’.
 
He also said the allegation that investigators spend less than an hour per week working on each case ‘should set off alarm bells’. 
 
‘We know the vast majority of notifications to AHPRA do not lead to action, so prolonged processing time due to internal issues leads to unnecessary stress on doctors,’ he said. 
 
‘High-risk cases should also be finalised swiftly. Much has been said already about delays in processing of notifications, and we really don’t want another confounding factor related to AHPRA’s internal workplace issues.’
 
In a response to a newsGP inquiry, an AHPRA spokesperson said they appreciated ‘a notification can be a stressful experience, which is why we work hard to shorten the process where we can, while ensuring due diligence to each concern’.
 
They also said the number of cases referred to tribunal almost doubled in 2021–22, which increased pressure on timeframes.
 
‘These serious matters require more resources and effort to manage than lower risk, lower complexity cases,’ they said.
 
‘We receive and manage more concerns about practitioners every year.
 
‘We are acutely aware that our activities are funded by registrant fees, so improving efficiency as well as the experience of those who are in contact with us is really important.’
 
A spokesperson also told Nine Newspapers that ‘COVID-19-related resource challenges’ had an impact on the regulator’s performance.
 
AHPRA also confirmed the existence of Operation Reset, which it said was delivered from late 2020 to early 2021.
 
Describing it as ‘a fundamental reshaping of thinking’, the spokesperson said it involved moving away from investigating if an event happened to ‘ensuring there are sufficient risk controls in place to support safe and professional practise in the future’.
 
The regulator said this was done to address a growing number of notifications and resulting delays.
 
‘Efforts need to be focused on resourcing matters where there are not sufficient risk controls in place to mitigate ongoing risk to the public from the health, performance, or conduct of a practitioner,’ the spokesperson said.
 
They also said AHPRA sought advice from staff and started training employees in new processes involving ‘more direct engagement with practitioners and employers’ from October 2020.
 
Meanwhile, the leaked internal document outlines the organisation’s response to bullying and harassment allegations raised in a 2018 staff survey.
 
It reports 317 staff contributed to focus groups, while there were 302 responses to online surveys, and 61 individual interviews conducted to delve into the issues being experienced by managers and staff.
 
The resulting report, entitled ‘Building a safe and inclusive culture within AHPRA’, outlines ‘inappropriate, uncivil behaviours … between leaders and staff, boards and staff and staff to staff’.
 
The behaviour, and ineffectual responses, were ‘contributing to a perception of bullying and harassing behaviours within the organisation that may increase the risk to psychological safety’, the report concludes.
 
Workload strain was also highlighted as a concern, with ‘inadequate resourcing, poor processes, poor induction, high turnover, poor performance management or inappropriate [Key Performance Indicators] leading to stress and strains on existing team members and helping to perpetuate uncivil behaviours’.
 
Hierarchy issues were also flagged, with the report stating there was ‘too much emphasis on status through positional power rather than inspiration and positive influence’. The report identifies this as an issue within AHPRA and its interactions with the medical boards.
 
Finally, the consultants reported siloed working arrangements were creating ‘a multitude of cultures with shared hallmarks of distrust, disconnection and disengagement’.
 
The report suggests leadership and manager capability as well as workplace systems and structures should be a focus ‘to drive positive changes to its organisational’ culture.
 
Creating fair and transparent processes, effective training, setting clear and achievable goals, as well as ensuring information from leaders is ‘open, clear and credible’ are among the improvements the consultants suggest.
 
However, Nine Newspapers indicates former and current staff say little has changed since the report was distributed within the organisation in 2020.
 
‘Staff painted a picture within AHPRA where workloads are unmanageable, women are mistreated, badmouthing colleagues occurs in the open and staff are put on stress leave, creating a “super toxic” and “stressful” workplace,’ the article states.
 
Interviewees said the culture caused the quality of work to deteriorate and heightened concerns that high-risk complaints could be missed.
 
The latest annual report from the National Health Practitioner Ombudsman stated it received 823 complaints about AHPRA in the past financial year, a 42% increase from the previous 12 months.
 
For Dr Kruys, the issues have to be addressed openly.

‘We now need to find out ASAP if the workplace culture issues AHPRA appears to have had in 2020 are still a problem and to what extent,’ he said.
 
‘If the allegations are true, transparency may be an issue here so a third-party intervention may need to be considered.’
 
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AHPRA Medical Board of Australia