Patients face significant safety risks at Canberra's women's and children's hospital and the obstetrics and gynaecology department has again failed to meet all its training accreditation standards.
A review of the department at the Centenary Hospital for Women and Children found serious workplace cultural issues, staffing issues, poor behaviour and unacceptable overtime hours are still present more than six months after training accreditation first became at risk.
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists said there were "significant risks to patient safety", especially as there were "repeated instances of consultant non-attendance" and a "reluctance to support registrars overnight".
Canberra Health Services have promised to act swiftly to address concerns, saying the review showed some concerning results. The hospital has been given provisional training accreditation.
"It is clearly concerning that broader issues surrounding team culture, behaviour and staff shortages continued to be evident," the spokesman said.
The review said consultants had not complied with on-call requirements.
"There must be clear consequences for those who do not comply with expectations regarding on-call attendance," the review said.
"The potential patient safety impact if this continues unchecked is highly concerning."
The review said there were "multiple instances" where trainees were asked to do procedures they were not credentialed to perform.
"The escalation of responsibilities was inappropriate (particularly with concerns around being clinically supported)," the review said.
There was also an excessive amount of overtime, with staff in some cases working more than 110 hours a fortnight.
"The hours worked are still extremely high, particularly in the last quarter of the year," the review said.
"Consistently working 110+ hours per fortnight is not feasible, nor does it contribute to training."
The college reviewed the department's training accreditation in June and the hospital was given provisional accreditation to deal with a number of issues but six months down the track they are still grappling with the same problems.
"While there are areas which the site has made significant progress in a short amount of time... some of the feedback received as part of this progress report and via ongoing mechanisms highlights significant risks to patient safety," the review said.
A Canberra Health Services spokesman said executives were working with consultants to address areas of concern.
"It is important to stress that as a group, these senior specialists have expressed an absolute commitment to ensuring CHS offers a safe and supportive environment for our trainees, and CHS leadership is working collaboratively with them to achieve this shared goal," the spokesman said.
Cultural issues remained significant in the department, with the review highlighting short staffing as a contributing factor alongside repeated poor behaviour.
"Continued instances of poor behaviour are unacceptable and must be addressed. This is a major contributor to culture within the department and presents potential risks to and impact on patient safety," the report said.
The review was scathing of the fact staff were expected to be resilient and were responsible for their own wellbeing.
"There is an over-reliance on staff to be resilient and to improve their own wellbeing when there are significant barriers at an organisational level which cannot be mitigated by a passive approach to wellbeing and culture," the review said.
The spokesman said the organisation would work on improving the broader working environment for junior doctors and the support available to them in the workplace.
He said there had been improvements for trainees in other areas and health authorities would work closely to ensure these flowed through to the women's and children's hospital.
"We will continue improving the broader working environment for junior medical officers in this challenging area, including through recruitment of additional doctors in training, senior medical officers and administrative support staff," the spokesman said.
"CHS has had success in recruiting additional specialists, despite the current national skills shortage."
Canberra Health Services has been urged to employ an external party to examine cultural issues.
"It is apparent from feedback throughout that there are cultural issues which would benefit from support by an external party experienced in addressing workplace cultural difficulties and enacting meaningful change," the review said.
