Subcultures within the ACT's public health system make it hard to implement system-wide culture reforms, a review has found.
The review of culture in the health system found "significant percentages" of staff are actively disengaged across Canberra Health Services and Calvary Public Hospital Bruce.
But the review found there has been a decline in the rates of bullying and harassment.
The final review into the implementation of a landmark culture report into the territory's public health system was handed down on Thursday.
An extensive independent review into workplace culture in Canberra's public health system four years ago found troubling levels of mistrust and bullying and made 20 recommendations for improvement.
There are three groups within the public health system: ACT Health, Canberra Health Services and the Calvary Public Hospital Bruce.
The review released on Thursday was conducted by Glenys Beauchamp, a former Commonwealth departmental secretary, and said there had been a "steady improvement in cultural maturity and slight improvements in organisational trust".
But there were still "significant percentages of staff not feeling engaged or are activity engaged in CHS and [Calvary Public Hospital Bruce]".
Bullying rates within Canberra Health Services declined, the report said, from 44 per cent in 2019 to 27 per cent in 2021.
There was no data available for bullying rates within Calvary Public Hospital Bruce.
The review said there needed to be better data collection.
"There continue to be gaps in consistent data and reporting in other areas reflecting different staff surveys and methodologies of data capture, making system-wide assessments and trends difficult," the review said.
"It would not be difficult to have some consistent key questions for all staff in the ACT public health system."
The review said while the leaders of the three organisations had been more visible there needed to be more effort to support middle managers and supervisors to address poor behaviour.
"There remain areas of poor workplace behaviours and building the capability of leaders and managers at all levels is required to exemplify and facilitate appropriate behaviour," the review said.
"Ongoing awareness, training and development for managers and supervisors and clarity about performance expectations including behaviour should be consistently applied to individual performance agreements."
The report also noted the impact felt by health services over the COVID pandemic.
"There is no doubt momentum and variability in progress has been significantly impacted by the challenging operating environment faced by health services in the ACT since the original review of 2019," the review said.
ACT Health Minister Rachel Stephen-Smith on Thursday told the Legislative Assembly all 20 recommendations had been completed.
However, the review did note some members of an oversight group felt "some recommendations were not pursued as intended or were now not fit for purpose".
The review said there were only two examples of recommendations with "variable implementation".
Following the 2019 review, the ACT government formed an oversight group to focus on the cultural reform. An independent review of its implementation has taken place in the four years since it was delivered. This report will be the final one.
The group has members from ACT Health, Canberra Health Services, Calvary, the Australian Medical Association, the Australian Salaried Medical Officers' Federation and universities.
The Australian Nursing and Midwifery Federation ACT branch was previously a member but left in late-2021 expressing frustration with the rate of progress.
Ms Stephen-Smith said while the review program had been completed the government was still committed to driving positive cultural change across the health system.
"The findings of this review show substantial progress has been made to improve workplace culture over what has been an exceptional period of challenges and pressure for all health systems," she said.
"It also identifies areas for continued focus as all organisations embed cultural reform into their business-as-usual activities."
Opposition health spokeswoman Leanne Castley said this was another example of the Health Minister pretending everything was OK when it was not.
"The government are still not able to retain nursing staff to implement ratios, junior doctors are leaving and litigating the hospital and have failed to attract specialists and subspecialists in cardiology and the maternal and fetal medicine unit for months," she said.
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