Inspector calls for culture change at Mississauga’s Trillium Health Partners following complaints of intimidation, abuse of power by senior leadership
A provincial probe into allegations of harassment and abuse of power by senior leaders at one of Ontario’s largest community-based hospital systems has resulted in recommendations for a culture shift after an anonymous group of physicians came forward with claims of “inappropriate and unprofessional behaviour by hospital administration.” While the report did not find any impact on patient care and was unable to substantiate many of the serious allegations made against the organization, it acknowledges staff felt there was a “culture of harassment and intimidation.”
Trillium Health Partners (THP), which includes Credit Valley Hospital, Mississauga Hospital and the Queensway Health Centre, has been under the microscope over the last year after a series of allegations were levelled against the organization’s leadership. Between December 2021 and May 2022, the Ministry of Health received two letters from TTL Health Law — a firm representing an anonymous group of physicians from Trillium — which detailed allegations of inappropriate and unprofessional behaviour by hospital administration that raised questions about the quality of care being provided to patients. The letters requested the Minister of Health appoint a supervisor to investigate the allegations.
In the December 2021 letter, the anonymous group of physicians alleged hospital administration “had engaged in the abuse of power, harassment, and intimidation.” A second letter in May 2022 included an unknown number of additional physicians across six departments at Trillium indicating they have “essentially identical complaints” about hospital leadership as those previously brought forward and reiterated the call for an independent third-party investigation.
In June of 2022, the Ministry informed Trillium it would be engaging a third party to conduct a review of the concerns. A month later, Jeffrey Turnbull was appointed to undertake the probe of the organization. The review, released in February by the province following repeated requests from the media to make the document public, noted that not only were there claims of alleged abuse of administrative power, but it uncovered further concerns regarding alleged threats and conflicts of interest.
The independent investigation resulted in a series of recommendations for how administrators can improve the workplace.
The recommendations made to THP include: recruiting new physician leaders; conducting a review of the organization’s professional staff code of conduct, policies and procedures; “immediately” undertaking a formal process to “assess culture, morale, trust, safety, and engagement” for all professional staff. The review also recommended THP engage a third-party arbitrator to oversee staff complaints “to reduce the fear of retaliation” and appoint an independent facilitator to assist in the implementation of the recommendations.
THP spokesperson Keeley Rogers stated in an email its board of directors has asked the leadership team “to prepare an implementation plan” for all the recommendations.
“THP’s commitment to the provision of safe, high-quality patient care is at the core of what we do and we were pleased to see that Dr. Turnbull reported that the individuals he interviewed throughout felt that overall, the care provided at THP is excellent,” Rogers wrote. “At the same time, we share Dr. Turnbull’s concern and take very seriously the fact that members of our team felt unable to raise their concerns through THP’s existing channels and perceived a decline in morale.
“We note that Dr. Turnbull was unable to substantiate many of the claims against the hospital and its leadership and certain allegations were found to be incorrect.”
Throughout the investigation, THP’s top leadership has maintained the allegations made were false and felt Trillium “had undergone significant cultural and organizational change and that while difficult, these changes were considered necessary to ensure a respectful workplace and the consistent availability and competency of professional staff.”
THP has maintained throughout the third-party investigation into its hospital leadership and administration that the allegations made were false.
(Alexis Wright/The Pointer)
The investigation probed a number of damning allegations, including “several instances” where hospital administration interfered with investigations within the hospital. The physicians reported this led to “a toxic culture rooted in harassment, intimidation,” and hospital administration abused its authority by targeting physicians who questioned its decision-making and by threatening to revoke hospital privileges. They accused the administration of “threatening physicians with a suspension or revocation of privileges… of reporting physicians to the College of Physicians and Surgeons of Ontario [and] publicly shaming physicians.”
The alleged abuses by hospital administration have resulted in physicians being “prevented from advocating for improvements in the delivery of quality patient care for fear of retribution, thereby endangering the public,” and “an exodus of experienced and talented physicians, across departments, from the hospital,” the staff complaints stated. The letters also noted that nearly all physicians from an entire department left the hospital and many current physicians have less than five years of clinical experience. Turnbull was unable to substantiate these claims during his review.
The alleged abuse also led physicians to take leaves of absence because of “bullying, intimidation, and harassment,” while others were said to have been refused or prevented from taking medical leaves of absence, the concerned staff claimed.
The investigation found there has been significant physician staff and leadership turnover in several key areas. Overall staff resignation or retirement was between 6 and 7.9 percent annually from 2017 to 2021, approximately 2 to 3 times higher than a comparator hospital. Senior staff at THP maintained there have been no adverse impacts on the quality of patient care as a result of staff turnover.
Of the 19 physicians represented by TTL Health Law interviewed and the 25 other physicians who came forward during the review, Turnbull noted “almost all” of them insisted on anonymity for “fear of retaliation and in some cases, prior nondisclosure agreements were cited.” This limited his ability to investigate claims of abuse of power by hospital leaders, he said, specifically by the hospital’s chief of staff. Due to these limitations he was not allowed access to individual files involving any of the allegations of “illegal suspension” or “refusing or obstructing leaves.”
“I was not given sufficient information to properly investigate many of these allegations or to provide the Chief of Staff with an opportunity to know and respond to these allegations, to interview other relevant persons or to come to a fair and evidence-based conclusion on the strength or weakness of the allegations,” Turnbull wrote. “Due to the limitations resulting from the confidentiality requirements placed upon this review, I was not able to substantiate or refute many of the allegations raised.”
Despite the limitations of the investigation, a spokesperson for the Ministry of Health said the ministry has reviewed the report and remains “confident in THP and its leadership as they continue to deliver high-quality care.”
“The report recognized THP’s many successes over the last decade, particularly as it relates to the voluntary amalgamation of hospital sites and improvements to patient care,” said spokesperson Hannah Jensen. “In light of the report’s conclusions, the ministry will not be proceeding with any further action as it relates to this matter.”
Investigator Jeffrey Turnbull noted the findings of the report were limited as a result of staff’s request for anonymity.
(Alexis Wright/The Pointer)
The general findings in the investigation revealed management strategies over the last decade were consistently referred to as “top-down” or “autocratic” with little or no opportunity for dialogue. Physicians interviewed referred to management as adversarial, and disrespectful of physician staff who were to be “managed”. Professional staff reported they had become disengaged.
A 2021 Professional Staff Association survey, which saw a response rate of 15.2 percent of all members and 30 percent of active members, showed 60 percent of professional staff responded neutrally or negatively to whether they felt valued at THP. Seventy percent of respondents felt neutral or unsupported when experiencing challenges in their workplace and 49 percent responded neutrally or negatively on whether they would recommend THP to others. Notably, 79.3 percent of respondents expressed concerns of burnout.
“The complainants felt that when their concerns had been raised, their concerns had been disregarded and they had been targeted and punished for speaking up,” Turnbull explained, adding “there were few opportunities for the physicians’ voices in advocating for quality medical care and workplace health through medical leadership to the Board and to senior administration.” The report noted when they did speak up, staff felt their concerns were often discouraged and discounted — a claim Turnbull notes he was unable to support or deny.
However, the investigator concluded, “I have no doubt that subjectively, the complainants felt that there was a culture of harassment and intimidation.”
Turnbull also commended the organization’s success over the last several years in navigating through COVID-19, budgetary limitations and challenges of increased service requirements, noting THP has “successfully undergone remarkable change.” Investing in staff, he explained, “will position THP for success when faced with the inevitable challenges of the future.
“If the Board, with new administrative and medical leadership, continue to focus on assessing, and investing in strategies to improve the workplace, I am confident that they have the capability to continue the success of THP,” the report concluded.
Keeley Rogers, the THP spokesperson, said the organization was “disappointed to read that Dr. Turnbull was not given sufficient information by the concerned physicians to properly investigate many of the allegations, but acknowledged the “report provides us with a path forward in the form of recommendations, many of which are already underway.
“We are committed to learning from this report, and working with our front-line staff and front-line teams to strengthen our culture, processes and the outcomes we achieve for patients.”
In a February 9 letter addressed to the Minister of Health, Sylvia Jones, and made public by THP, board chair Christine Magee wrote, “THP’s Board and leadership take very seriously the report’s findings that some members of our team felt uncomfortable raising their concerns through our existing channels and perceived a decline in morale… We will take all steps necessary to ensure our staff and professional staff see THP as a good and fair environment to work in.”
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