Jennifer Bolster, Maria Cirstea, Shauna Speers, Melissa Vose
As paramedicine in Canada continues to evolve and professionalise, so does the expectation that the paramedic will treat their patients with respect and dignity, but what about how paramedics treat each other? Do we practice the same moral and ethical behaviours with each other that we demonstrate in our practice with patients? The history of paramilitary internal discrimination, bullying, and harassment is deep-rooted. Only in recent years have the voices of those silenced by toxic workplace culture and systematic failures come to light. The discussion, largely generated by the on-going controversies within the military and RCMP, is one of critical importance. The positive downstream effect of this attention in recent years has been the empowering of others to speak up against these behaviors in their respective workplaces.
Paramedics have extremely high degrees of mental and emotional strength, and resilience. What this means is that combating the issue of workplace harassment, discrimination, and bullying requires a specialized approach. From an organisational perspective, the goal needs to focus on being proactive. Many paramedics will read the stories from the final AV report and recognize similarities to their own experiences in Canada. The parallel nature of paramedic culture will ring true for any paramedic who has conversed with paramedics from other organisations. The purpose of sharing this synopsis is that it may serve as an awakening to Canadian paramedic leaders, and inspire organisations to utilize this investigation and its recommendations to be proactive about their own cultural tolerance, and make combating these issues a priority.
Ambulance Victoria (AV), operating in the southeastern state of Australia is a large organisation employing roughly 7,550 paramedics in varying roles, including emergency prehospital response, air ambulance, patient transport, adult retrieval, and emergency management. These paramedics provide valuable prehospital medical care and inter-hospital transfers for over 5.8 million people in Australia in both urban health centres and rural communities.
October of 2020 was a turning point for AV when individuals’ stories of discrimination, sexual harassment, bullying, and victimisation were brought to light. The allegations centred on unlawful conduct, predominantly against women, who spoke of an ongoing and pervasive workplace culture that demeaned, discriminated against, and excluded women. Joining these individuals in sounding the alarm regarding working conditions for AV paramedics were the paramedic professional organisation’s Ambulance Employees Australia Victoria and Professionals Australia and the Victorian Ambulance Union; and the paramedic professional college, Australasian College of Paramedics.
Within days of these allegations, the Chair of Ambulance Victoria asked the Victorian Equal Opportunity and Human Rights Commission to conduct an independent review of the current state of AV that would include a publication of their findings and recommendations for AV moving forward. This review was conducted between January and October of 2021 and consisted of 2,163 AV paramedic responses to a service wide survey, 255 individual interviews, 32 focus groups, and 143 written submissions. The Commission also conducted 15 on site visits and attended 3 observation shifts (source).
Phase 1 of the Commission’s Review findings was published in Oct 2021. (here) This publication focused on concerns related to safety, respect, and trust and the results were sobering. Of the participants, 47.2% reported experiencing discrimination at work. 17.4% reported experiencing sexual harassment. 52.4% reported experiencing bullying, and 34.5% reported experiencing victimisation. In addition, people widely reported bearing witness to discrimination, sexual harassment, and bullying, indicating that these behaviours are happening in plain sight. Women were also less likely than men to say they felt safe at Ambulance Victoria, with almost a quarter of participants saying they did not feel safe at all. The Commission found that women were at heightened risk of experiencing sexual harassment and sex/gender discrimination, as well as related forms of discrimination, including pregnancy and parental status discrimination. Feeling unsafe was compounded among participants who identify as LGBTIQ, have a disability and/or are from a racial minority. The most common types of discriminatory behaviour reported involved verbal, physical, or written abuse; and limiting access to training, promotion and progression. Sexual harassment most often involved sexually suggestive comments, jokes, and unwelcome touching, while bullying commonly took the form of hostile behaviour and verbal abuse. These findings all suggest that discrimination, harassment, bullying, and victimisation are frequent occurrences between coworkers at Ambulance Victoria, embedded in the work subculture, and tolerated by those in leadership.
Being subject to these types of discrimination and harassment, Ambulance Victoria paramedics incured a significant amount of stress and mental ill-health. Over one-third of participants stated they felt little to no respect at work. Some described feelings of dread about going to work, while others felt an undermining of their confidence in themselves and their ability to do their jobs. A small number of participants expressed significant depression leading to suicidal ideation, which led several participants to attempt suicide. For those who were witnesses to but not the direct recipients of such unlawful behaviour, seeing this behaviour tolerated negatively impacted workforce morale, diminishing their trust and confidence in the workforce of Ambulance Victoria.
While Ambulance Victoria in recent years has adopted measures to improve their reporting processes, embody a more victim-centred approach, and better utilise data to guide their response to allegations, there are still barriers that prevent staff from feeling safe to come forward with complaints. Some of the gaps noted include lack of multiple reporting avenues, flexible options for responses, and a lack of consistency in support available for victims. The Commission found that only 15% of participants who were subject to discrimination and bullying made formal comlaints, with the number dropping to less than 10% for those experiencing sexual harassment. More than three quarters of participants that reported discrimination and bullying reported feeling not at all satisfied with way their formal complaint was handled. Of the participants who filed formal complaints, the majority expressed feeling unsafe in the process, stating they were often left without any support and in some cases felt further traumatised by the process. While most participants understood how to make a formal report, nearly three quarters stated that they did not come forward with complaints for fear that nothing would be done and there would be no change. There was also a reported “culture of silence” where it was evident that coming forward would result in social isolation or imposed limitation in career advancement. These sentiments of not feeling safe to report were echoed by both participants who personally experienced events and those who witnessed them. Other concerns with the reporting process included: the impression that complaints took too long to resolve; a lack of clear, timely communication; a lack of clarity around what the process would entail; and further victimisation or retaliation following a complaint, all of which caused additional stress and negatively impacted mental health.
Taking this into account, the Commision report laid out 24 recommendations (here) for Ambulance Victoria to improve safety and their reporting and investigation culture. These recommendations include: internal reflection and adoption of new organisational values that encourage a ‘speak up’ culture; working with external bodies, including relevant unions and professional associations, to support, drive, and oversee evidence-based reform; developing fair, accessible, victim-centred reporting processes and procedures with a focus on restorative justice for victims; regular, transparent communication around prevention and learning tools around standards of behaviour; and creating and maintaining records and data that adhere to a measured benchmark for performance.
Phase 2 of the final report was published March 21, 2022. The focus was on creating culture, systems, policies, and practices that embody safety, fairness, and equity to all employees throughout their careers with Ambulance Victoria. While Ambulance Victoria has adopted a number of measures to increase fairness and inclusivity, more work needs to be done to increase representation of women in senior and specialist roles as well as to increase diversity across the entire workforce. Additionally, there are still systemic barriers that need to be overcome in regards to flexible work options and adjustments for workers with disabilities or older workers transitioning to retirement. On top of the 24 recommendations laid out in the Phase 1 report, Phase 2 includes 19 further recommendations to address systemic barriers, gaps in policies and procedures, and organizational capacity to increase, measure, and monitor safety and equality goals in the workplace.
Overall, this report highlights a workplace environment that is almost certainly reflective of every major ambulance service in the world and is a stark reminder of the ongoing issues female paramedics continue to face on a global scale. Female-led groups such as the Australasian College of Paramedics and our local BC Women in Paramedicine Special Interest Groups are engaging with their respective ambulance organisations in an effort to assess, understand, and tackle gender-based discrimination, sexual harassment, bullying, and victimisation. This shift in paradigm gives hope for a workplace where women can attain careers that provide the culture and balance they need to succeed and thrive.
2. Victorian Equal Opportunity & Human Rights Commission. Independent Review into Workplace Equality in Ambulance Victoria. Victorian Equal Opportunity & Human Rights Commission; 2021. Volume 1 Victoria AU. 502 p.
3. Victorian Equal Opportunity & Human Rights Commission. Independent Review into Workplace Equality in Ambulance Victoria. Victorian Equal Opportunity & Human Rights Commission; 2022. Volume 2 Victoria AU. 248 p