11. Advocacy and reform

 The goal of SafeDr is to summarise complex WHS laws, standards and resources to help improve the WHS literacy of the medical profession. Topic 10 includes popular articles published in MJA Insight+ on these topics. Topic 11 highlights one of these articles - an open letter to the boards of our public hospitals and medical organisations on government legislated WHS standards. The following article has been widely distributed to health-related boards and is included here to assist employers understand their duties. The link to the original article is https://insightplus.mja.com.au/2025/40/an-open-letter-to-the-medical-boards-on-government-legislated-whs-standards/

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. 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. 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); whistle blower victimisation; wage theft; and industrial manslaughter (here). Under new whistle blower 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 whistle blower      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 ground breaking new laws reforms is not optional – it is urgent. Australia's Work Health and Safety (WHS) system, governed by the WHS Act 2011 and supporting regulations, ensures workplace safety through a clear set of duties for both employers and workers. Employers must ensure the health and safety of workers, consult on risks, and manage hazards, while workers are responsible for their own safety and cooperation in safety measures.