It has been 3 years since the first volume of the report from Phase 1 of the Victorian Equal Opportunity and Human Rights Commission’s (the Commission’s) Independent Review into Workplace Equality in Ambulance Victoria (the Review) was published and just over 2.5 years since the second and final volume was published.
During this time Ambulance Victoria has faced a challenging operating environment, including the lingering effects of the COVID-19 pandemic, protracted periods of protected industrial action related to enterprise agreement negotiations and significant budgetary constraints. On a day-to-day level, members of the Ambulance Victoria workforce told the Commission they are trying to manage issues including ramping, rostering, dispatch and end-of-shift management, which are all significant sources of stress, frustration, mental and physical fatigue.
Within this context Ambulance Victoria has been working to implement the 43 recommendations made by the Commission in the Phase 1 report. Ambulance Victoria set an ambitious target of implementing all recommendations by 2027 (Safe Fair Inclusive: Your AV Roadmap 2022-2027, revised to YourAV Roadmap – Outcomes Focussed Model).
This Progress Evaluation Audit is the third and last phase of the Commission’s Review and work with Ambulance Victoria to help it to address workplace inequality and become compliant with the Equal Opportunity Act 2010 (Vic). This phase is a critical mechanism to provide Ambulance Victoria with an independent assessment of its workplace transformation progress and to aid it in taking stock at this half-way point of its program of work to create a ‘safe, fair and inclusive’ workplace.
In October 2020, individual members of the Ambulance Victoria workforce came forward with allegations of discrimination, sexual harassment, bullying and victimisation at Ambulance Victoria, primarily against women. These allegations highlighted a pervasive culture of exclusion and discrimination. In response, Ambulance Victoria requested the Commission to conduct an independent review (the Review) under section 151 of the Equal Opportunity Act 2010 (Vic).
The terms of reference established for the Review directed the Commission to:
· examine the nature, extent, drivers and impacts of unlawful conduct including discrimination, sexual harassment, bullying and victimisation
· consider the adequacy of Ambulance Victoria’s response to such unlawful conduct
· identify leading practice strategies to ensure a safe, equal and inclusive organisation that promotes equality and positive workplace systems, values and behaviours.
The Commission gathered extensive data, including 2,163 survey responses, 255 interviews, 32 focus group discussions and 143 written submissions. It also reviewed 1,213 documents and conducted literature reviews. The findings were informed by personal experiences shared by current and former employees and first responders, as well as insights from experts and critical partners.
Due to high workforce participation and the COVID-19 pandemic, the Phase 1 Report was split into two volumes. Volume I, released in November 2021, focused on building safety, respect and trust. Volume II, released in March 2022, addressed equality, fairness and inclusion. A total of 43 recommendations were made – providing Ambulance Victoria with a roadmap to prevent and respond effectively to unlawful and harmful workplace conduct, and embed organisation-wide equality.
Ambulance Victoria committed to implementing all 43 recommendations to become a leading, modern ambulance service where all members of the workforce feel safe and included.
During this phase the Commission provided expert guidance and support as Ambulance Victoria began work to implement the recommendations.
Ambulance Victoria and the Commission agreed to a set of guiding principles and parameters for how they would work together during this phase of the Review:
· ethical – acting with impartiality and integrity
· transparent – a 'no surprises' approach that applies rules of natural justice
· evidence-based and intersectional – advice is informed by evidence and the principles of intersectionality
· independent – maintaining the Commission’s relationship as a 'critical friend' that does not step into the shoes of Ambulance Victoria decision-makers.
Commission staff met regularly with Ambulance Victoria and provided advice, on request, across a range of recommendations.
From 1 June 2024 the Review transitioned into the final phase – the Progress Evaluation Audit. The Commission assessed the progress towards implementation of 25 priority recommendations to determine the extent to which Ambulance Victoria has moved towards compliance with the Equal Opportunity Act 2010 (Vic). The objectives of the Progress Evaluation Audit were to:
· assess the extent and adequacy of the steps taken to implement the priority recommendations, including whether those steps align with the intent of the Commission’s recommendations
· assess some early impacts arising from the implementation of relevant priority recommendations, including early impacts on the workforce and target audiences
· identify the barriers and enablers of successful implementation, any areas for further improvement and related further guidance to support implementation.
The timeline for Phase 3 was later than the originally scheduled timing of June 2023. This was agreed with Ambulance Victoria (in December 2022) in recognition of the significant scale of reforms recommended in Phase 1. For the Progress Evaluation Audit to meaningfully assess Ambulance Victoria’s recommendation implementation progress, it was vital that there was sufficient time for the reforms to effect meaningful change.
The Progress Evaluation Audit involved collection and analysis of data from:
· more than 1,900 written documents provided by Ambulance Victoria
· individual and group interviews with Ambulance Victoria senior leaders and key stakeholders including unions
· focus groups with regional directors, current and former members of Ambulance Victoria’s staff reference group and workforce members with roles or job functions related to diversity and inclusion
· observational shifts in the Gippsland and Metropolitan regions
· a workforce survey sent to all current employees and first responders
· sense-checking sessions with current and former staff reference groups and regional directors.
The Commission took both quantitative and qualitative approaches to collecting data from the above sources. Data was analysed using inductive and deductive approaches (see Methodology) to form an evidence-based and rigorous position for each recommendation on implementation extent and adequacy, early impacts, and barriers and enablers to implementation.
Ambulance Victoria has been reporting progress towards implementation on its website using a 5-point scale[1] ranging from ‘implemented’ to ‘implementation activities agreed’.
The Commission has made slight adjustments to Ambulance Victoria's assessment scale for evaluating the progress of implementing recommendations. While maintaining the framework used by Ambulance Victoria, the revised scale emphasises the importance of aligning activities with the intended goals of each recommendation. The circular representation also highlights the ongoing nature of the workplace reforms.
In some recommendations, the assessment scale is coupled with a flag. This is to signify recommendations where the Commission has concerns about the implementation approach taken to date, including where there is a need to urgently address issues or take significant actions. It is hoped this visual note will assist Ambulance Victoria to prioritise the next steps in workplace reform.
Key | Assessment |
Not yet commenced | This recommendation is acknowledged as an area where action is needed to implement the recommendation, but no steps have been taken to implement it. |
In planning and development | Work to implement this recommendation has begun and is in development. |
Implemented to a moderate extent | Some steps have been taken to implement this recommendation, but work is still needed to achieve the intent. |
Implemented to a significant extent | Significant steps have been taken to implement this recommendation, but minor work is still needed to achieve the intent. |
Implemented and embedding | This recommendation has been implemented in a way that achieves the intent of the recommendation. Practices are being embedded in business as usual and there are measures in place for continuous improvement. |
[1] Ambulance Victoria has an additional 6th status of ‘not available: status not reported as the recommendation is solely directed at external organisation’ which it assigned to Recommendation 5(b).
At the time of the Progress Evaluation Audit, of the 25 priority recommendations the Commission has assessed 5 recommendations as implemented and embedding; 5 recommendations as implemented to a significant extent; 9 recommendations as implemented to a moderate extent; 4 recommendations as in planning and development; and 2 recommendations as not yet commenced.
Five of the 25 priority recommendations have been assessed by the Commission as ‘implemented and embedding’ and 5 as ‘implemented to a significant extent’.
Many of the recommendations assessed at these levels have been achieved through the establishment of the Professional Standards and Behaviours Department (PSBD) as a new organisational response to complaints. These recommendations were made in response to the Commission’s findings in Phase 1 of the Review that there were several gaps in positive duty compliance across Ambulance Victoria’s reporting and complaints system. Gaps included lack of a person-centred approach, lack of up-to-date information for staff on reporting options and ineffective data collection and monitoring.
The PSBD (Recommendation 13: A victim-centred and fair report and complaint system and Recommendation 14: Enhancing perceptions of independence and supporting capability for the new organisational response to reports and complaints of unlawful conduct) and the anonymous report and complaint service Ambulance Victoria SpeakUp (Recommendation 15: Supporting staff to confidently report through anonymous pathways) are significant programs of work to address these gaps.
ParticipantIn terms of implementing some of the successes, I think the biggest one has to be the establishment of the Professional Standards Department.
Despite this work, the Commission found that workforce trust and confidence in the complaint processes are low. Rebuilding trust and confidence will take sustained effort and there is still much work for Ambulance Victoria to do to demonstrate to the workforce that complaints will be consistently managed in a person-centred and trauma-informed way, that perpetrators will be held accountable and that complainants will not be victimised. The PSBD is also experiencing a higher than expected workload and if Ambulance Victoria does not effectively respond to this demand, there is a risk that progress made so far on this element of positive duty compliance will be undermined.
ParticipantSo, at the end of the day, if we don't actually invest now, the money now, it's actually going to cost us a lot of money in the long term and it's going to do a lot of damage to people as well, I think. And that's everything, that's just not the PSBD stuff, that's across the board.
Nine of the priority recommendations have been assessed by the Commission as ‘implemented to a moderate extent’. The commonality among the assessment of these recommendations is that implementation activities may have been commenced or completed but the intent behind the recommendation is not being realised and meaningful change is not being experienced by the workforce.
Of the 9 recommendations in this category, the Commission draws attention to Recommendation 6 (Improving safety in isolated environments) as an example of where Ambulance Victoria has completed the recommendation’s activities but the intent of the recommendation has not been met. Although Ambulance Victoria did engage a consultant to audit safety in a representative sample of sites, the Commission did not find any evidence that Ambulance Victoria has acted on the recommendations made by the consultant.
The Commission found Ambulance Victoria does not have a program of work to systematically address safety in isolated environments across the organisation. This means that risks and behaviours identified in Phase 1 are still occurring and the organisation may be non-compliant with its workplace safety positive duty obligations.
Of the 25 priority recommendations, 4 have been assessed by the Commission as ‘in planning and development’. Many of these recommendations are related to workplace flexibility.
An example can be found in Recommendation 31: Implementing and tailoring the Think Flex First Framework. During the Progress Evaluation Audit, both operational and non-operational staff expressed a strong desire for improved workplace flexibility. The Commission consistently heard high levels of workforce dissatisfaction with Ambulance Victoria’s slow progress on improving workplace flexibility. The Commission was informed by Ambulance Victoria that funding has not been secured to fully support the implementation of workforce flexibility. Ambulance Victoria states implementation of this recommendation will be achieved by 2027.
The Commission found that work has not commenced on implementing Recommendation 8 (Encouraging a ‘speak up’ culture) and Recommendation 33 (Building knowledge, capability and accountability). The Commission understands both recommendations are scheduled to be commenced in the 2025 financial year (subject to resourcing).
Appendix C: Implementation status of priority recommendations provides an overview of the assessment of each priority recommendation.
Participants in the Progress Evaluation Audit were asked what positive impacts they had seen or experienced in the workplace as a result of the reforms to date. A consistent theme was that the Phase 1 Report of the Review was a kind of reckoning. It shone a light on the experiences of the workforce that were otherwise ‘brushed under the carpet’ and opened up an opportunity to talk together about these experiences and acknowledge the impacts they have had on people. This in turn has created an increased willingness to speak up and challenge behaviours that otherwise would not have been challenged.
ParticipantSo, I think having the Report, it's almost a line in the sand ... And I think we've been able to attract some people who want to help the organisation recover from that and help our people on the ground and in the corporate space to be the best they can be in that recovery phase.
Many participants spoke of the establishment of the PSBD as a positive, that this was a huge body of work and people were glad to see this department up and running.
Participants also spoke positively about Ambulance Victoria’s increased resourcing and focus on inclusion and diversity after the Review – that this shift has been able to increase the scope and impact of work to examine and improve the workplace experiences of diverse cohorts.
Participants in the Progress Evaluation Audit were also asked what negative impacts they had seen or experienced in the workplace as a result of the reforms to date. The most frequent negative experience reported was that the workforce is not seeing any tangible or meaningful changes to their day-to-day experiences at work, which is leading to people becoming disheartened and disengaged.
ParticipantA lot of paramedics have not seen any change, or little change other than values being rolled out, and a lot of them wouldn't even know AV’s strategic plan, a lot of paramedics on road, so it's not something that's relevant to them.
A related theme that came through was that the organisation often takes a ‘tick the box’ approach to reform implementation rather than considering the intent behind a recommendation and how to apply it in the context of Ambulance Victoria.
ParticipantThis is what the recommendation said, as opposed to this is what the recommendation is – what does this mean for AV and what is the most effective way for AV to see a change, a genuine, tangible, authentic change as opposed to just tick the box.
The other common negative theme was the lack of progress on flexible work, particularly for operational staff members. The lack of progress in this area is viewed as contributing to the reduction of trust in leadership and its ability to deliver these changes to the workforce.
Throughout the Progress Evaluation Audit, themes emerged that connected many of the priority recommendations. From these themes, the Commission identified 4 current Ambulance Victoria organisational practices that are barriers to workplace reform and 4 current organisational practices that enable workplace reform. Considering these barriers and enablers will support Ambulance Victoria to address the intent of the recommendations and achieve workplace equality reforms through the connected implementation of each of the recommendations.
The Commission observed the current change-management approach to be highly compliance focused. This approach is a barrier to realising the full intent of the recommendations as it fails to consider how each recommendation relates to rights and responsibilities under the Equal Opportunity Act 2010 (Vic).
Phase 1 of the Review identified that staff who reported feeling safe and secure at Ambulance Victoria tended to fit an identified paramedic archetype: a Caucasian, non-disabled man described as 'confident and stoic’. Through the Progress Evaluation Audit, the Commission found many systems, processes and attitudes are built around this understanding of the workforce. However, the diversity of Ambulance Victoria’s current workforce is not reflected in this archetype and the workforce is therefore disadvantaged by the systems and processes, which builds a culture of assimilation over inclusion.
A key finding during the Progress Evaluation Audit is that across Ambulance Victoria there are varying understandings of and attitudes towards flexible work matters – especially Ambulance Victoria’s responsibilities around flexible work arrangements and reasonable adjustments. This fails to acknowledge flexibility as an opportunity to be a benefit to the service through improving employee work–life balance, diversity, engagement, satisfaction and retention.
In addition to systems and process built with a typical paramedic archetype in mind, there are also elements in the structural environment that hamper recommendation implementation. Examples of these include processes around flexible work arrangements and reasonable adjustments, and the capacity of the current technology to allow for variety and local decision-making in roster reform.
The Commission acknowledges the context of this Progress Evaluation Audit within structures that include external factors such as hospital ramping, dispatch, end-of-shift management and protected industrial action which are having adverse effects on the confidence of the workforce.
Progress on reforms has been communicated with the workforce through a variety of channels. While the Commission heard this communication is valued, the volume of this type of communication appears to be overwhelming and it is therefore ineffective.
A review of the current communication strategy about the work of the reforms could be a positive contribution to the perception of disconnection between senior leadership and the workforce, and the operational and non-operational sides of the organisation. Through interviews and focus groups, the Commission heard there is an urgent need for a strategy to ‘communicate up’ to show the organisation is listening.
Ambulance Victoria has demonstrated a desire to build a culture of prevention, and the systemic process and strategies to do this are detailed all through the recommendations. There is a need to develop a collective understanding of the organisation’s knowledge of its obligations under the Equal Opportunity Act 2010 (Vic) and build in accountability for all staff (through performance development plans (PDPs) and KPIs) to hold prevention as a key objective.
Ambulance Victoria has voiced a commitment to distributed leadership, which would demonstrate trust in managers to address issues quickly and effectively. Survey responses and focus group discussions spoke of a loss of trust in senior management and a frustration felt by middle managers in wanting to be able to make localised decisions that are in the best interests of their teams. A focus on enabling distributed leadership will build on trust where it currently exists (in direct managers).
A consistent feature of interviews, focus groups and general discussions has been the strong sense of identity across the workforce directly connected to delivery of Ambulance Victoria’s functions in service of the community. This level of commitment is not found in all workplaces. Taking positive steps to recognise this (such as supporting physical and mental wellbeing, and improving flexibility, training, communication and meaningful engagement) will enable workforce confidence and commitment to the reforms.
This Independent Review into Workplace Equality in Ambulance Victoria has taken place because of courageous whistle blowers who spoke up about unlawful conduct. Their concerns were validated by the Commission during Phase 1 of the Review, which found concerningly high experiences of discrimination, sexual harassment, bullying and victimisation among Ambulance Victoria’s workforce. The experiences shared with the Commission showed that Ambulance Victoria’s efforts to prevent unlawful and harmful conduct were manifestly insufficient.
The Commission acknowledges that Ambulance Victoria has dedicated substantial time and resources to implementing the Phase 1 recommendations. It was very clear to the Commission over the course of the Progress Evaluation Audit that many people across the organisation have enthusiastically contributed to the planning, development and execution of the work required to implement the recommendations. They want to see change and have worked towards it over these last few years. As the Commission’s review role ends, this workforce enthusiasm and dedication to positive change will be critical parts of driving progress on reforms.
To the workforce members who shared with the Commission their concerns, experiences and perspectives over the time of the entire Review, thank you. We hear you and we believe you. You have a lawful right to be free from discrimination, sexual harassment, bullying and victimisation at work. With this right also comes the responsibility for every member of the workforce to not engage in unlawful conduct.
Lastly, but most importantly: leaders in any organisation are responsible for setting its culture and leading change. The Commission consistently heard during the Progress Evaluation Audit that Ambulance Victoria’s workforce feels let down by a lack of senior leader accountability on workplace reform. The Commission heard the workforce does not feel the organisation listens to them on reform issues. They do not agree that Ambulance Victoria is committed to a workplace free from unlawful conduct, do not trust that Ambulance Victoria will implement all the Commission’s recommendations and are fearful that their negative experiences in the workplace will not improve. The Commission acknowledges the desire of Ambulance Victoria’s leadership to understand why there is a disconnect between the work on reforms and the effect of these reforms on the workforce.
For the people in senior leadership roles who have been working to bring about positive change, this will be difficult feedback to hear, not least because having a leadership role does not make someone themselves immune from experiencing unlawful conduct. A person’s experience of discrimination, sexual harassment, bullying and/or victimisation is no less harmful because of their job title.
However, to say nothing or downplay this issue would be a disservice to everyone in the organisation. At this halfway point in Ambulance Victoria’s work to implement the Commission’s recommendations, senior leaders have a choice: continue as you have been, or critically reflect on how your words, actions or inactions have brought about these views and what you can do differently to regain the trust and confidence of the workforce so that Ambulance Victoria will be safe, fair and inclusive – and then be accountable for doing so.
'Write a new ending for yourself, for the people you're meant to serve and support, and for your culture.'
Dr Brene Brown[2]
[2] Brown, Brené, Dare to lead: Brave work. Tough conversations. Whole hearts (Penguin Random House, 2018) 272.
