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Australia’s public hospitals are under severe financial strain, with the current National Health Reform Agreement dispute highlighting the system’s non-viability. In a compromised environment of constrained resources, government legislated work health and safety reform in public hospitals is not optional — it is urgent for all patients and staff — including those in training.
Dear directors and officers,
As a fellow non-executive director, I recognise the harsh reality you face. The immediate financial non-viability and long-term non-sustainability of the health industry — alongside intense political and societal pressures — have never been sharper than in the current debate surrounding the National Health Reform Agreement (NHRA). Budget constraints, rising costs, quality concerns, access blocks, skeleton staffing levels, escalating community expectations and rolling crises dominate the board agendas of our public hospitals (here, here) and our medical organisations — particularly the Australian Medical Association (AMA) and Colleges.
Layered on top of these pressures are heightened responsibilities for all directors and officers to comply with transformational new government-legislated work health and safety (WHS) reforms (Box 1) (here). These reforms mandate that both physical and psychosocial safety must be embedded in governance under the July 2025 Model Code of Practice for the Healthcare and Social Assistance Industry. The intent is clear: prevent injury and reduce workers’ compensation claims.
Public hospitals are not exempt.
Failure to comply now risks multi-million-dollar penalties (here) and, in the most serious cases, imprisonment for directors and officers for gross negligence (here), as seen recently in the United Kingdom. To bring these changes into focus, offences now exposing Australian directors/officers to imprisonment include:
- WHS Category 1: Reckless conduct exposing workers to the risk of death or serious injury. (here).
- Industrial manslaughter: Up to 25 years’ imprisonment (individuals) and about $20 million for bodies corporate in NSW, with comparable regimes in other jurisdictions for work related deaths (here).
- Corporations Act: Criminal consequences for dishonest or reckless governance failures leading to harassment, dismissal or retaliation of whistle-blowers (here).
- Wage theft offences: Imprisonment in some jurisdictions.(here, here, here).
Significant financial penalties have already been imposed in Australian hospitals and other government-funded services (Box 2). The quantum of these penalties should focus boards on proactively preventing and managing injury and reducing the substantial personal and financial risks of non-compliance. As hospitals are inherently hazardous workplaces and sit among the highest-risk industries for serious work-related psychological and physical harm, hospital directors and officers carry a higher risk of personal vicarious liability (here).
In highlighting these complex issues, the goal of this open letter is to urge greater collaboration between the boards of public hospitals and medical organisations to achieve a better outcome in the current National Health Reform Agreement dispute (here). Without additional funding investment, it will be challenging for both public hospitals and medical organisations to comply with new WHS reforms.
How WHS has changed — and why it matters for hospital and medical boards
There is a strong business and safety case for greater investment in WHS to save lives and scarce resources. Creating a better culture is key to complying with recent changes in WHS laws.
To prevent harm, boards must ensure effective systems are in place to proactively address physical and psychosocial hazards (poor work conditions, hostile environments) and workplace abuses: sex discrimination and gender inequality (here), racial discrimination, sexual harassment, bullying (here) and any form of violence (here); whistleblower victimisation; wage theft; and industrial manslaughter (Box 1)(here). Under new whistleblower laws, protecting people who speak up is critical to reduce claims, fines and litigation.
The medical profession is well placed to advise on addressing these hazards, as well as preventing and managing physical and mental injury. Initiatives such as “A Better Culture” have demonstrated the value of collaborations between senior medical practitioners (such as chief medical officers, occupational physicians, psychiatrists, general practitioners) and other health professionals along with WHS regulators and hospitals. These sorts of effective national programs represent a positive opportunity to make public hospitals a leader, not a laggard, on WHS (here). And yet, the recent abrupt cessation of short-term project funding for “A Better Culture” is only one example of the severe lack of government investment into WHS in health care.
Why doctors in training are at heightened risk of WHS breaches
In these considerations, it is important to acknowledge that underreporting is masking the true scale of workplace mental and physical injuries in certain groups such as trainees for a number of reasons (here). For example, doctors in training are deterred from reporting incidents, making complaints or workers’ compensation claims due to:
- Low WHS literacy: WHS laws are complex, evolving, overseen by many different national and state regulators, and largely absent from the medical curriculum.
- Fear of retaliation: Trainees often avoid reporting occupational harm due to fear of career retribution, mental-health stigma and concerns about mandatory reporting.
- Hostile environments: Anonymous surveys (Medical Training Survey, Australian Salaried Medical Officers Federation, AMA) consistently reveal repetitive exposure trauma with high levels of discrimination, racism, sexual harassment, bullying and verbal and physical violence in public hospitals — often without dedicated trauma and recovery support in hospitals.
In this context, many doctors in training are not merely “a bit burnt out” post-pandemic. Many are suffering under-diagnosed, untreated work-related mental injuries (here) — major depression, anxiety disorders and post-traumatic stress disorder — arising from excessive demands and trauma exposure. Wellness and resilience programs alone are inadequate. These psychiatric conditions require evidence-based treatment by independent, experienced practitioners alongside workplace safety interventions (here).
Foreseeability and industrial manslaughter
As mentioned above, major penalties for breaching expanded industrial manslaughter laws in each State (here) have sharpened board focus on protecting health workers (including doctors) from psychological and physical harm. Although rare, consequences are catastrophic for families, staff and hospitals.
Industrial manslaughter is the unlawful killing of a worker due to gross negligence or recklessness by an employer, director or other responsible officer. Where foreseeable risks and evidence of unmanaged unsafe conditions lead to death — such as accidents due to fatigue, assaults, pregnancy loss due to occupational hazards, or suicide (here) linked to work-related mental injury — industrial manslaughter provisions are relevant.
WHS reform makes clear that safety is not a bureaucratic checklist; it saves lives and requires optimal resourcing.
The governance work to do
Transformational WHS laws demand a consistent approach across all hospitals and medical organisations (here). Practical actions (here, here) for directors and officers may include (but is not limited to):
- Lifting WHS literacy at all levels of hospitals and medical organisations, including directors and officers. Refer to the new SafeDr website for more information on preventing and managing workplace hazards.
- Measuring what you cannot see: Build robust data on psychosocial and physical hazards, track trends, hotspots and resolution times.
- Creating safe reporting with follow-through: Provide confidential and anonymous reporting mechanisms with genuine anti-retaliation protections for whistle blowers; close the loop with visible systems interventions.
- Engineering safer work: Embed psychosocial controls in rosters; adequately resource staffing levels, supervision, workload and pre-planned cover for breaks and leave (here, here); provide dedicated trauma and recovery support for health workers (including doctors) as first responders.
- Assuring – not assuming: Audit incident-management quality; test whistleblower protections; verify WHS training uptake; link leadership performance to WHS outcomes.
- Strengthening clinician-conduct pathways: Dual-track clinical care and proportionate management of clinicians who perpetrate workplace abuses such as bullying; protect patients and staff while ensuring early specialist management of perpetrators.
- Advocating and investing: Seek the funding and systems required by law; invest in technology and redesign that prevent physical and psychosocial harms.
Under the new requirements, regulators, accrediting bodies, specialist colleges and funders are likely to request evidence of such actions to test WHS compliance. Failure has potential consequences, including sanctions on accreditation and funding where hostile environments persist (here).
Conclusion
With updated WHS law literacy, courageous leadership and unity, the boards of public hospitals and medical organisations can turn the tide of workplace physical and mental injury in Australia. By embracing WHS reforms, hospitals can become Australia’s safest workplaces and deliver on their commitment to excellence and world-class care — for every patient and health worker including every doctor (here).
Through combined national and state advocacy, we must also secure optimal government funding – via the National Health Reform Agreement – to ensure compliance with government-legislated WHS standards.
Upholding groundbreaking new laws reforms is not optional – it is urgent.
In a few weeks, Leanne will publish another opinion piece to discuss the role of senior doctors in the adoption of new WHS laws in more detail.
Clinical Professor Leanne Rowe AM is an experienced GP with specialised clinical expertise in the comprehensive assessment and management of physical and mental injury. In the past, she chaired public and private hospital boards and gained medico-legal expertise in work health and safety. Among her many non-executive director roles, she has served as Chair of the RACGP, and Deputy Chancellor of Monash University.
She has recently developed the SafeDr website to empower every doctor to uphold human rights in health care through groundbreaking new WHS laws.
| Box 1: Selected recent reforms (non-exhaustive) |
| Model Code of Practice (Healthcare & Social Assistance, 2025): Psychosocial hazards (excessive demands, denial of leave, discrimination, racism, sexual harassment, bullying, violence) are explicitly unlawful and must be controlled. |
| Sex Discrimination Act – Positive Duty: Directors and officers have a positive duty to promote inclusive healthy workplace cultures and must eliminate any form of sex discrimination including pregnancy and parental discrimination (here). |
| Workplace Gender Equality Amendment (Targets): Organisations ≥500 employees must set and improve gender-equality targets, including toward equal remuneration. |
| Racial Discrimination & National Anti-Racism Framework: Prohibits overt/indirect racism and systemic bias across training, hiring and promotion (here). |
| Whistleblower laws: Retaliation against whistleblowers is unlawful; organisations must actively protect disclosures. |
| Fair Work Act: Protects against unfair dismissal or adverse action linked to safety or discrimination complaints (here). |
| Wage theft (state laws): Criminal in several jurisdictions, including systemic underpayment of overtime, on-call and leave (here, here). |
| Expanded industrial manslaughter laws are the ultimate sanction for egregious neglect leading to work-related death. Effective systems must be in place to prevent industrial manslaughter (eg, deaths due to assault, accidents related to exhaustion, entrenched bullying resulting in mental injury and suicide). |
| Box 2: Recent penalties and cases against government funded services (illustrative) |
| Peninsula Health (Frankston Hospital, VIC): $316 260 civil penalty for failing to pay a junior doctor’s overtime. |
| NSW Health (statewide, public system): $229.8 million settlement approved 20 September 2024 in the junior doctors’ class action. |
| Victorian public health services (multiple): $175 million in-principle settlement for junior doctors’ unpaid overtime. |
| Monash Health fine (2024): $160 000 for patient suicide inside hospital — unsafe environment risk. |
| Coroners Court of Victoria and Court Services Victoria: was convicted and fined $379,157 over a toxic workplace culture that contributed to the suicide of one worker and numerous others taking stress leave for a toxic workplace culture (bullying, intimidation, invasions of privacy, exposure to traumatic materials, excessive workloads). This was a separate process to the major review by the 2020 Attorney-General and the Chief Justice of Victoria in partnership with the Victorian Equal Opportunity and Human Rights Commission, which found widespread sexual harassment at Court Services Victoria and VCAT. |
| NSW Ambulance: fine reported at “almost $190,000”; guilty plea to a WHS breach after a paramedic died by suicide. |
| Services Australia: Proceedings listed following a Comcare investigation into a worker being stabbed at a Centrelink office; WHS charge alleges failure to ensure health and safety (potential maximum fine $1.5 million). |
Where to get help
Your trusted GP or psychologist. Your employer or college may have a wellness program or a confidential employee assistance program (EAP).
Doctors’ Health Alliance
Call the Doctors’ Health Line 24/7: 1800 006 888 to be directed to your local doctors’ health service. Doctors’ Health Services are free and available across Australia for doctors and medical students.
OR
NSW and ACT: 02 9437 6552
NT and SA: 08 8366 0250
Queensland: 07 3833 4352
Tasmania and ACT: 1300374 377
Victoria: 1300 330 543
WA: 08 9321 3098
New Zealand: 0800 471 2654
OR be connected to a counsellor through Drs4Drs: 1300 374 377
Lifeline: 13 11 14
SafeDr: safe doctors deliver safer patient care https://safedr.org/
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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If you would like to submit an article for consideration, send a Word version to mjainsight-editor@ampco.com.au.
Thank you so much Leanne for your ongoing advocacy. A Better Culture worked to raise the profile of these issues over some 30 months, but with surprisingly little traction with duty-holders. We can only hope that as the reality of their accountabilities and risks becomes more clear, that some of the proposed solutions get taken up. What is certain is that those health departments, employers and other duty-holders who have approached this with a “nothing to see here, we’ve got it under control” attitude are walking to a cliff. The impending release of the 2025 Medical Training survey results will be a barometer by which we can assess if the rhetoric about improving has actually been followed up with meaningful change.
Thank you for taking time to write these comments. They reflect what many others have said about the public hospital system after previous MJA insight + articles and in other forums. In this context, allegations about a potential $10 billion funding shortfall in the current NHRA dispute are alarming.
There has never been a more important time for our medical organisations to advocate on our behalf – particularly as many doctors are deterred from reporting incidents due to justified fears about career retaliation.
In this environment, we must develop a confidential national reporting mechanism in addition to the Medical Training Survey to fully comprehend the scale of the issues.
In the absence of this, MJA Insight + has become a safe place to raise concerns anonymously. Please continue to express your views – you are being heard.
Also – please protect yourself with your new WHS rights. For more information http://www.safedr.org
I will be addressing these topics as key note speaker at the Australasian Doctors’ Health Conference in Melbourne 27-29 Nov
https://doctorshealthalliance.org.au/event/2024-australasian-doctors-health-conference
Ignorance of the law has never been an excuse for lack of compliance; harsher penalties are enacted due to the ongoing lack of leadership in this area, this has long been the case in health, and we still hear that “it was an emergency”, as response to poor practice that arises from lack of human and other physical resources. HCW’s ignorance of law and best practice WHS is absolutely astounding, being educated as a medico/ nurse/ AHP does not make a WHS expert, so much of what is seen in health services is received practice from our fore-bears not best practice, we all need to do better
The LHD Boards in NSW are poorly governed with dereliction of duties of almost every clause in the Health Services Act.
The agenda for most Board meetings extend to pages and every report is a short summary of important issues at the coal face often summarised as “report read and no issues”
How can all the issues of a LHD be covered in a 2 hr monthly Board meeting? It simply cannot.
Most Board members are onlookers and contribute little.
Their inclusion serves the purposes of making up “obedient members” and the members have another large organisation on their CV.
Recent engagements with cherry picked “consumer groups” to fulfil community stakeholder engagement are media heavy fanfare events yet the consumers are paid between $42-60 per hour and receive NSW Health on their CVs. That’s one example of staged performance. They then ignore the core stakeholders which are clinicians- the people who actually engage daily with consumers and patients within the community.
The oversight of the LHD Chief Executive is a loosely governed clause.
If the Board’s job is to oversee the CE, then they will have to know everything that is important.
If there is an indiscretion from the CE, the Board has to accept responsibility or profess they were misled by the CE and dismiss them.
The proposed changes to the Workers Compensation legislation to raise the threshold of psychologic injury from 15% to 31%, thus eliminating virtually every psychologic injury case, is into its 3rd attempt by the Minns govt to pass.
The fact that SafeWork is now part of a “Troica” with iCare and SIRA, all who tend to merge into a single ineffective collective of failed policies and maladministration, is concerning.
NSW Health TMF will be overrun by injured workers inadequately supported by a new insurer under iCare and will face the consequences of suboptimal care and poorer return to work rates.
The Boards need to be on top of these issues. But they are asleep at the wheel.
Most Boards are executive silos, slogan proclaimers, Kangaroo Courts and Star Chambers for the purposes of CEs toeing the line of the MOH and the directives of the Health Secretary who control the narrative, rhetoric and can shuffle policies and procedures to implement that plan.
The only LHD Board that fulfils most of their duties under the HSA is the NSLHD as the Board Chair is the Chair of all the NSW LHD Chairs so he leads by example.
An excellent and insightful article on work health and safety (WHS) from an experienced professional expert in the field. It is also solution focussed.
Hospital administrators and staff can no longer ignore these warnings.
Professor Leanne Rowe – your courage, concern for the profession, well being of our hospitals and demand for positive change is commendable! Thank you 🙏
Thank you Leanne for the clarity encapsulated in the messaging of this open letter. Strong governance is key to enabling compliance with WHS legislation. Directors need to ensure they personally see the data being collected and interrogate it, not file it. Anonymous reporting can highlight what data are missing, especially if the data are too comfortable. Ultimately, a determined intent to embed a culture of compassion within the leadership of the organisation can ensure that compliance with legislative requirements of WHS is crafted as an opportunity for vision and innovation within the organisation, rather than simply a ‘chore’ to delegate.
The SafeDr website is an impressive resource for all doctors, including junior doctors, ensuring that we can all understand our rights and our responsibilities. Your illustrative list of penalties highlights how much better is it to focus on resourcing a positive health care environment. This is indeed a pivotal moment for leadership and collaboration. Enabling the safety (physical and psychological) of the medical workforce, indeed the whole health care team, is vital for the delivery of high quality safe care to our patients.
In terms of the ‘workplace’, I think that the crucial element missing in all of this debate is that hospitals are extraordinary workplaces with a uniqueness that is not found across all industry generally. And this is the problem. Those responsible for administering WHS laws in this country are not able to identify bullying, harassment, stress and fatigue in the same way as can hospital workers. They have no appreciation of the ‘unique’ workplace health and safety issues faced by hospital workers such as emergency staff threatened with knives or abused by drunken ‘street people’, junior doctors intimidated by their senior colleagues, staff who are owed salary, burnout, fatigue, stress, psychological and medical problems associated with rotational shift work, demanding patients, excess patients loads, ambulance ramping, et cetera. And, in recent times, enter psycho-social safety into the workplace health and safety arena. Entering the traditional workplace health and safety arena too are the issues encountered by doctors in our Australian hospitals. I believe the time has come for a ‘think tank’ to enable the custodians of the WHS legislation to come to grip with the health and safety realities in our public hospitals. This mania particular to hospitals is not repeated across industry generally. It is, however, repeated across hospitals.
It remains unsafe for junior or even senior doctors to raise complaints in healthcare until whistleblower reprisal penalties are actually taken seriously.
We need an external oversight body to ensure this is done as internal ( or even institutionally paid for, external) investigations have a conflict of interest when organisations have vicarious liability for reprisals taken by employees against disclosers.
The waiting rooms of Emergency Departments are the coalface of our public hospitals.
A reflection of the inefficiencies of community and hosiotal medicine, it bleeds of increased demands and blocked access to care.
The canaries of the coal mine are our public patients, the staff who attempt to assess and treat patients in an inadequate environment are working in unsafe conditions.
Unsafe staff to patient ratios, unsafe assessment areas, with increased abuse to staff from frustrated and unwell patients and also from inpatient specialist teams.
Highlighting these issues to the NSW Health and the NSW Government is met with empty pockets and a deaf ear.
Excellent article that succinctly summarises risks, legislation, and potential remedies. Necessary reading for all involved in health planning, medical education, and service delivery. Ditto for medical students and doctors. Know your right & obligations.
The dominant negative impact in health workers physical and mental health is obviously a consequence of rostering policies that are not compatible with health. Not bullying, not violence etc – which all happen, but are more isolated and individual issues. Rostering harm affects most of us, most of the time – and doesn’t get addressed at all. It is the mega-elephant in the room no administrator dates to mention.
Nobody can consistently perform under high cognitive load for 10+ hours, and yet 10+ hour shifts ate now the norm for many hospital based doctors (myself and teo out of three of my children who also are medical doctors).
The issue is compounded by disturbances of our circadian rhythms caused by on call and rapid cycling of day/night shifts.
This harm is measurable, accumulating over time, and does not get compensated. Plenty of evidence confirming this. It does not only affect us personally, but also our family and our patients. All professional mistakes I made in the 3 decades of my career (that I am aware of) were in a context of mental and physical exhaustion caused by unhealthy rostering policies.
I terminated my career in medicine in 2011. I concluded an article I wrote for InSight with the comment “And hardly a day goes by that I am not reminded by something in the media, of how glad I am to be out of the political dog’s breakfast that medicine has become.”
I rest my case
I welcome the thoughts of the authors to restore transparency, accountability, and fairness to those who govern the medical profession.
A profession is a group of people with skills so critical to society that the community allows the group to self regulate.
Medicine is the most regulated of all professions to the point where medicine is no longer a profession.
Non-medical government bureaucracies dictate to practitioners how to care for patients, on what is right and what is wrong.
Sadly, in contrast to the collegiate network encouraging reform through education, the non-medical government bureaucracies do so through fear of punishment.
It is time to return the care of patients to those who care for patients.
Dear Leanne, thank you for your articles on WHS in the health sector. Just a couple of observations from a recently retired anaesthetist. The dangers and frustrations you articulate are indeed real and a present danger. In my former specialty there have been too many untimely deaths of both trainees and consultants. In many ways I failed to comprehend the psychological pressures until my retirement last year. Since then I have had troubling dreams about work every single night. It was my local vet who exclaimed that I was suffering PTSD, much to my surprise. I have since learned from other former colleagues that my experience is not uncommon. As to the issue of wage theft, I think all hospital administrators and boards should be very concerned indeed. Maybe one or two custodial sentences would save a lot of time and effort in the future.