Australian hospital staff set up anonymous blog to voice concerns about cutbacks

BMJ 2009; 339 doi: (Published 18 November 2009) Cite this as: BMJ 2009;339:b4919
  1. Melissa Sweet
  1. 1Sydney

    Staff at an Australian public hospital have taken the unusual step of establishing an anonymous blog, called Who Will Speak for Us ( to draw public attention to their concerns about cutbacks to service.

    The bloggers, from the Blue Mountains District Australian and New Zealand Army Corps Memorial Hospital, also known as Katoomba Hospital, west of Sydney, have taken elaborate steps to protect their anonymity, including using some of the techniques of Iranian bloggers.

    They fear being sacked or victimised if their identities become known, and they state on the blog that staff at other hospitals are reportedly being threatened for engaging with the blog.

    The website says, “It has to be anonymous because all staff of Sydney West Area Health Service are required not to speak to the media as part of their employment contract. Where is the accountability of the system if staff are gagged?”

    In a telephone interview, in which they did not disclose their identities, two staff members said that the blog, which was initially established by nurses, was the work of a group of nurses, doctors, and allied health professionals.

    The website had been established as a “last resort” after their concerns had not been resolved through internal processes.

    “We really felt we’d exhausted all the other options that are usually put forward as the correct procedures for addressing issues of concern,” said one staff member. “We saw huge problems in our area health service that were being covered up.”

    In one article the bloggers highlight the closure of eight paediatric beds in one hospital in Sydney, which means children are left for days in the emergency department. The bed closures followed the voluntary redundancy of two experienced ward nurses “despite assurances by the state government that no frontline staff would be affected” by proposed cuts, says the report.

    The case of the bloggers follows recent revelations reported in the BMJ (2009;339:b3202, doi:10.1136/bmj.b3202) detailing how, almost a decade after the UK Public Interest Disclosure Act was passed, a foundation trust went to remarkable lengths to ensure that a senior consultant did not go public with his concerns about management and patient safety.

    Prue Power, executive director of the Australian Healthcare and Hospitals Association, which represents public hospitals, said that the blog was unprecedented and raised challenges for health service managers and policy makers. The importance of freedom of speech needs to be balanced against employees’ contractual obligations, she said.

    “We all have much to gain from engaging the community in transparent debates about some of the complexities involved in health service management and resource allocation,” she added.

    Kevin Gillies, acting executive director of workforce development for the Sydney West Area Health Service, said that he was sure that the blog breached the code of conduct for New South Wales Health employees. Employees’ use of blogs and other social media generally would be covered by a policy now being developed in consultation with New South Wales Health, he said.

    Steven Boyages, chief executive of the service, said that the bloggers’ action was counterproductive because it risked damaging the hospital’s reputation and making it more difficult to attract staff.

    However, others defended the right of staff to raise concerns in public, especially after many inquiries, ministerial reshuffles, and restructures in the New South Wales hospital system. One inquiry known as the Garling report found that bullying was endemic and cited the case of a doctor subjected to “unreasonable, repeated, unwelcome, unsolicited, offensive, intimidating, humiliating and threatening” treatment after raising concerns about patient care.

    Kerry Goulston, emeritus professor of medicine at the University of Sydney and a member of the New South Wales Hospital Reform Group, said, “I believe in open government and transparency and letting people have their say.”

    Professor Goulston said that the Greater Metropolitan Clinical Taskforce, which he previously chaired, had recommended that a senior executive from New South Wales Health should attend open meetings at hospitals annually but this had not been implemented.

    “The problem is that workers at the coalface do not feel they are listened to,” he said.

    Brian Morton, New South Wales president of the Australian Medical Association, said that doctors had an obligation to speak out when they thought that quality of patient care was compromised.

    He said that the bloggers’ concerns that they would be scapegoated if identified were realistic and that there need to be systemic efforts to tackle the bullying culture in New South Wales Health that affects “everyone right from medical students to chief executives.”

    Clare Skinner, an emergency medicine doctor from Sydney who established a now defunct blog, Clinicians Speak Out, to encourage greater public understanding of the realities of the health system, welcomed the Katoomba blog but said that it would have more credibility if it was not anonymous.

    “I think it’s good because it shows they care enough to engage,” she said. “There’s a whole syndrome in health, with many so despairing that they don’t engage.”


    Cite this as: BMJ 2009;339:b4919

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