A confidential, internal report into a children's hospital in Dublin uncovered "bullying", "significant risk" and "serious issues of concern".
The review of Children’s Health Ireland (CHI) found that the unnamed hospital's workplace culture had "the potential to put patients at risk".
The report was compiled in 2021 and completed the following year.
It has been widely leaked in recent weeks.
A summary was published today with CHI saying they are legally constrained from releasing the entire document.
"The findings primarily focused on issues related to interpersonal relationships, training programmes, patient management, professional conduct and adherence to standards," the summary stated.
The summary noted that the report "was never intended to be made public", but the summary is being made available "to ensure that a wider audience" can examine it, while "balancing the needs of a confidential process".
"The report stated that a negative culture can impact service delivery, department dynamics and staff experience and has the potential to put patients at risk," it added.
NTPF issues identified
The culture "lacked governance and robust processes, and was influenced by strong and challenging personalities", which resulted in a "[high] attrition rate among support staff due to bullying issues".
"A significant risk was identified where only one employee managed the needs of a complex tertiary speciality", the summary reveals, noting that this "created a vulnerability in this specialty," it said.
The report also flagged "a number of issues in relation to a National Treatment Purchase Fund (NTPF) outpatient waiting list initiative".
"Certain NTPF-funded clinics did not adhere to NTPF standards of chronological scheduling (i.e. seeing the longest waiting patients first)," it siad.
The summary said that some patients "could have been seen...within the existing day-to-day service" had matters been handled in a "more proactive way".
It noted "the possibility that this could have led to any negative outcomes for patients".
'Inequitable' treatment of some patients
The report also found that concerns about hospital management had been consistently and persistently voiced.
The treatment of some patients was "inequitable", it stated.
It stated: "There was a substantial and persistent message of concern regarding the lack of strong site leadership and good governance, along with poor operational oversight and accountability.
"There was consistent feedback that the challenging behaviours of some staff were not adequately addressed by the site leadership team."
"The management of a particular cohort of patients was inequitable across CHI hospitals."
'Reputationally damaging for CHI'
For the report, interviews were conducted with "45 staff members from across CHI", and a variety of documents examined.
"Inconsistencies in managing staff contracts" were uncovered, with "[half] of medical trainees" revleaing that the environment was "not conducive to learning".
This resulted in the "training body" deciding "that there would be no intake of any new trainees or Specialist Registrars (SpRs) into the programme in 2022", something that was "reputationally damaging for CHI".
Following interventions, "[teamwork] has significantly improved", the summary says, and the "most recent training body assessment" was "positive".
The report also stated that: "No direct payments were received by CHI staff from the NTPF."
The summary says that "CHI now has a robust process for NTPF funded waiting list initiatives which requires multiple internal stakeholder approvals both clinical and financial".
"Capacity issues were addressed through the hiring of more personnel in certain areas and reconfiguration of access to facilities across CHI."
It says that "an identified cohort of patients" now have access to relevant specialist care as well as the development of appropriate transition pathways from paediatric to adult care.
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CHI to be 'open and transparent' - statement
In a statement, the CHI said today that it intends to "be open and transparent" and "takes accountability to the public and the families it serves extremely seriously".
It claimed that "the legal situation around releasing the full report is complex", but insisted that "the concerns raised in that report have been and continue to be addressed", adding that "improvements have been made".
The organisation accepted that "the culture at CHI has come under criticism, and we know there is more work to do", and said: "our immediate focus is on addressing the operational issues".
HSE board members to be appointed to CHI
Minister for Health Jennifer Carroll MacNeill said she has moved to strengthen governance and oversight structures at CHI.
In a statement, the minister said: "A succession of extant and pending reports have raised corporate and clinical governance concerns at CHI. In response to these, I have moved to strengthen governance and oversight structures at CHI by appointing two members of the HSE board to the board of CHI.
"The service level agreement between CHI and the HSE has been strengthened in relation to operational oversight. There has also been increased involvement and support from the HSE's Dublin Midlands regional executive officer and senior management.
"CHI's CEO is restructuring the Clinical Directors and the recruitment of clinical speciality leads and there is now centralised referral to all CHI surgical services."
