A hospital trust that was plagued by a culture of fear and bullying has made progress, according to a report, but there is still "a mountain to climb.".
Following a BBC investigation, Prof. Mike Bewick has been investigating University Hospitals Birmingham (UHB).
In the second part of his report, he found additional evidence of misogyny and prejudice in addition to confirming earlier findings of a culture of bullying.
However, he saw progress, and the trust declared that it was "listening and learning.".
Although there is still a mountain to climb, Prof. Bewick said, "we see a trajectory of improvement.".
The trust, one of the largest of its kind in England with more than 22,000 employees, is in charge of the Queen Elizabeth (QE), Heartlands, Good Hope, and Solihull hospitals.
When Prof. Bewick released his first report in March, he found evidence of a "historical coercive bullying culture where fear and threats were used as a management tool," and in the second phase of the review, he noted that "these early themes have been confirmed by this more extensive inquiry.".
Allegations of sexual impropriety are among the other problems mentioned in his most recent report, which was released on Friday.
He claimed that two women had come forward with allegations of sexual harassment, and that future reviews would be expanded to look into this matter more thoroughly.
A team from Health Education England concluded that training was "unsatisfactory and patient safety may be compromised" in three key areas: obstetrics and gynecology, haematology, and acute and emergency medicine. These findings were among other "serious concerns" about training that were noted in the report.
However, it added that "active steps are now being taken to rectify these shortcomings".
When examining the trust's governance for phase two, the author found that the board's restructuring, which staff had criticized for its "whiteness," had made "significant progress.".
This was supported by a report from NHS England, which stated that only nine members of racial or ethnic minorities held positions in the highest bands, band nine and Very Senior Manager level, out of the thousands of employees employed by the trust.
"Some changes have been implemented but there is still much work to be done to move towards a modern board role in touch with the risks the organisation faces and how it mitigates them," Prof Bewick said, adding the trust's new chair, Dame Yve Buckland, was "committed" to change.
He said staff had similarly raised concerns there were "limited job opportunities" for women and ethnic and diverse communities, saying an environment of "medical patriarchy" was "a dominant cultural determinant".
As in March, Prof Bewick's latest report cited the death of Dr Vaish Kumar, 35, a junior doctor at the QE Hospital who left a suicide note blaming her death entirely on the place where she worked.
He wrote that UHB's response to her death was "one of the most significant concerns" but that the trust had now made a full apology to her family.
Elsewhere in the report, he examined a report by BBC Newsnight which found that none of more than 20 referrals to the General Medical Council (GMC) by the trust had resulted in any action.
Prof Bewick found that "most if not all had a basis for actual referral or at least merited consideration" but noted "striking similarities" in how some senior clinicians' cases were handled which "give rise to new concerns".
"One senior consultant surgeon has been excluded from work for over five years and a second for over six months, with so far no resolution to their case," he wrote.
"This is extremely serious, potentially harmful, and deprived the system of badly needed expertise. ".
Following the publication of his report, Prof Bewick said while it was "positive to note that good progress has been made" it was "vital UHB now further builds on lessons learned".
UHB said it had "taken the concerns raised to date incredibly seriously and have reflected, reviewed and reset".
"We will approach any new lines of enquiry that are raised within this second report in the same way," it said.
"Not wishing to wait solely for the findings and recommendations from the external reviews, a series of bold - but necessary and fundamental - changes have already been made to put us back on a positive path. ".
David Melbourne, Chief Executive at NHS Birmingham and Solihull Integrated Care Board said the report showed UHB had taken the recommendations of the initial review seriously.
"Their improvement journey will be a long one, and while we have seen the beginnings of change, much work is still to be done to create a lasting and different culture across all levels and disciplines, and across all hospital sites," he said.
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