Patient safety at Hobart's main hospital is being severely and routinely compromised, an audit has found.
A scathing auditor-general's report says Tasmania's four major hospitals are not working effectively to meet increasing emergency department demand.
The report released on Tuesday blamed poor culture, coordination and leadership for preventing long-standing problems from being fixed.
"Patients are now less likely to receive the treatment they need at the right time and place compared to almost a decade ago," Auditor-General Rod Whitehead wrote.
The report scrutinised emergency departments at the Royal Hobart Hospital (RHH), Launceston General Hospital, North West Regional Hospital and Mersey Community Hospital in the state's northwest from 2009 to 2018.
Ambulance ramping, where vehicles with patients inside are forced to wait outside hospitals, increased by 149 per cent between 2012/13 and 2017/18.
This far exceeded a 20 per cent growth in ambulance presentations over the same period.
Among the findings, RHH suffered bed shortages 93 per cent of the time between June 2018 and January, with patient safety "severely and routinely compromised" almost once every four days on average.
Mr Whitehead said reviews by state and federal governments found major drivers of hospital inefficiencies were dysfunctional organisational structures, behaviours and resistance to change from some clinicians and administrators.
"These issues mainly lie outside of the EDs but are within the control of hospital leadership teams and have yet to be addressed," Mr Whitehead wrote.
He acknowledged 2018 government reforms to improve emergency department bed shortages, but said it was too early to be assessed reliably.
Mr Whitehead called for urgent action to strengthen "whole-of-hospital and system-wide leadership, coordination and accountability".
The report's recommendations included clarifying staff roles and improving performance monitoring and reporting processes.
Health Minister Michael Ferguson conceded there was no "silver bullet" to fix the issues raised in the report.
He said the government would consider the recommendations and raise them at a meeting with health representatives next month.
The report also found emergency department presentations in Tasmania are increasing faster than population growth, partly because the state's population has become older and more ill.
Australian Associated Press