45% of departing Health P.E.I. staff surveyed say 'toxic workplace' main reason for leaving

Nearly half of departing Health P.E.I. employees who took part in exit surveys as part of an effort to improve staff retention cited a "toxic workplace" as one of their main reasons for leaving the provincial health authority.

That information comes from an internal report on retention that consultant Garth Waite prepared for Health P.E.I. 

CBC News obtained the report through a freedom of information request.

Health P.E.I. gave Waite the names of 55 employees who left jobs with the health authority between March 2020 and January 2021. Of those people, 31 completed exit surveys that became the basis of his report.

Read the report:

• Pages 1 to 35 of Final Report: Findings and Recommendations for an Integrated Health P.E.I. Retention Strategy
• Pages 36 to 47 of Final Report: Findings and Recommendations for an Integrated Health P.E.I. Retention Strategy

"It became clear that staff resignations were a symptom of deeper system challenges and that deeper system changes would be required to address staff retention challenges," Waite concluded in his report, which was delivered to Health P.E.I. in May.

"Respondents frequently mentioned excessive workload, high levels of workplace stress, and work-life balance issues, including the ability to get time off for vacation or [to] attend family emergencies."

According to its most recent annual report, Health P.E.I. has more than 4,000 full-time equivalent staff positions. Waite's report does not give the total number of employees who left in 2020, but notes the agency experienced "a high number of staff resignations" over the time period studied.

Only some staff surveyed

The 55 departing employees identified by the agency for exit interviews were chosen from "key areas of the health system," including mental health and addictions, as well as the emergency and surgery departments and intensive-care units at the Queen Elizabeth and Prince County hospitals.

Stresses placed on the health-care system by COVID-19 exacerbated retention issues that had existed before the pandemic, the report found.

At the province's two main hospitals, red flags were raised around overcrowding, high patient volumes, worrisome staff-to-patient ratios and an overall shortage of staff.

"The ER was constantly short-staffed," according to notes included in the report from one of the exit interviews.

"The acuity of mental health patients, often aggressive or violent, without adequate security, meant that staff often faced terrifying situations without appropriate protection."

Staff shortages caused stress

Meanwhile, a lack of available beds in other hospital units to accept patients transferred from the emergency departments "led to daily frustration, feelings of inability to provide safe/quality care," according to another interview subject.

Opportunities to recharge and recover from work stress through leave or temporary changes are limited due to staffing shortages.— Consultant Garth Waite's report

Staff had difficulties obtaining leave and were often called in on their days off to fill in for colleagues who had called in sick. 

"Opportunities to recharge and recover from work stress through leave or temporary changes are limited due to staffing shortages," the report said. 

The scheduling issues were particularly hard on young families who faced challenges finding child care as the pandemic wore on.

'Little input into the changes'

Overall, 14 out of 31 respondents cited a toxic workplace as a primary motivator for leaving their jobs. But in the area of mental health and addictions, five out of six outgoing employees cited that reason.

Many respondents who had worked at Hillsborough Hospital and the provincial addictions treatment facility left during a time of significant upheaval. Some mental health units were vacated to make way for a potential influx of COVID-19 patients — an influx that never arrived in this province.

"Many staff reported that they had little input into the changes, and when they did, it was often ignored," the report states.

Employees who had left Hillsborough Hospital said they felt unsafe in the facility, citing low staff ratios in high-risk units, a lack of security on the night shift, and a lack of written policies for dealing with violent patients.

Staff also described a "low-trust environment" where staff and management did not trust one another.

Agency says report 'concerning'

CBC News asked for an interview with Health P.E.I. but no one was made available.

But acting CEO Dr. Michael Gardam has acknowledged in the past that staff retention is one of the agency's "biggest concerns."

We recognize that health care is a challenging place to work and the pandemic has put even more stress on our staff.— Health P.E.I.

In a written statement, Health P.E.I. said some issues identified in the report "are particularly concerning, including the high number of respondents who indicated they left due to a toxic organizational culture, concerns over physical and psychological safety, excessive workload and unsupportive leadership."

The agency said it's using information from the report to develop a new human resources strategic plan.

"We recognize that health care is a challenging place to work and the pandemic has put even more stress on our staff," the statement said. 

"Health P.E.I. takes the physical and psychological health and safety of our people and employee engagement very seriously and these will be significant areas of focus for our organization moving forward."

Issues compounded: Green MLA

Opposition health critic Michele Beaton said the issues raised in the report echo what health-care workers have been telling members of her Green Party caucus.

And she said the challenges for the health-care system are being compounded because the exit surveys show senior staff are leaving, with nearly half of those surveyed having worked for the agency for a decade or more.

"When you have senior people leaving, there seems to be an increasing issue that's not being resolved, a root issue there that is not being addressed," said Beaton.

"When we lose people that have seniority that puts even more stress and strain on the remaining nurses."

Former minister cites 'unsafe protocols'

Liberal MLA Robert Henderson, who served as health minister under the previous Liberal administration, acknowledged that retention was also a problem for the government he was involved in, but said he now worries the situation has worsened to the point where the system may lack the "critical mass" of staff required to operate.

Henderson expressed concerns about how often facilities are being forced to operate with less than their full complement of staff.

 "When you're in a lot of those unsafe protocols over a period of time ... it puts extra duress on staff," said Henderson.  

"What happens if something goes wrong? What happens if a fire breaks out? What happens if somebody dies, passes away through the night? How do we deal with that and how do we provide support to the remaining people in the building?"

Advice to government blacked out

The report appears to contain more than 70 recommendations for how Health P.E.I. might improve staff retention, but every one of those was blacked out in the copy of the report provided to CBC News.

Health P.E.I. cited section 22(1)(g) of the Freedom of Information and Protection of Privacy Act, which allows a public body to exclude recommendations made to government. But that exclusion is discretionary, meaning it's up to the public body in question to decide whether to release such information in response to an access request.

Beaton said the public deserves to know what advice Health P.E.I. has received on how it can improve retention.

"These are public documents and they should be shared with the public so the public understands and can hold the government accountable," Beaton said.

"This is impacting every single Islander. This is our health-care system… If we don't fix it, it's going to impact Islanders' health. And it already is."

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