Released Thursday, the 111-page document spells out how staff cuts and poor management have hurt patient care, as well as morale and trust among staff.

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OLYMPIA — A new report details many of Western State Hospital’s widely known troubles — and also documents management problems that have plagued Washington’s largest psychiatric facility for years.

Released Thursday, the 111-page document spells out how staff cuts and poor management have hurt patient care, as well as morale and trust among staff.

The analysis comes as the Department of Social and Health Services (DSHS), which oversees the hospital, is working with the federal government on a 13-month improvement agreement. The hospital in May quietly withdrew from a national accreditation program to focus on its improvement plan.

The report reveals problems with the quality of care, including “a number of patients [who] stated they rarely saw their doctor or ‘my doctor doesn’t know who I am,’ ” according to the report.

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Just over half of the 462 hospital staff who completed a survey for the report said they felt safe at the hospital — down 9 percent from a previous survey.

Anecdotes provided snapshots of the assaults experienced by staff and other patients.

“One was an RN with three surgeries over the years as a result of assaults (wrist and knees),” according to report. In another instance, a “female patient reported 14 assaults, a dozen by the same female peer over the course of just beyond one year.”

The report also documents how layoffs and attrition over the years caused the approximately 800-bed Lakewood facility to lose much of its middle management.

“This constant turnover of leaders throughout all levels of the organization often required managers and supervisory staff to take on a broader scope of responsibility,” according to report, which later adds: “Over time, the quality and consistency of services degraded.”

After two dangerous patients escaped in April, Gov. Jay Inslee fired the hospital’s CEO and appointed Cheryl Strange as the new top executive.

Strange said Thursday that she had moved to streamline and improve Western State’s management structure. And hospital managers are trying to work more closely and directly with hospital staff, said DSHS Assistant Secretary Carla Reyes.

DSHS also intends to ask the state Legislature to fund positions to oversee patient wards.

But, “it’s going to a lot of effort to rebuild that trust, because it has been eroded over time,” said Reyes.

The hospital, which has faced a steep worker shortage to fill its approximately 2,000 staff positions, has also been hiring aggressively. Between July and September, the facility saw a net increase of 100 care staff — workers like nurses, psychologists, psychiatrists and social workers.

Assembled by a firm called Clinical Services Management, the analysis is designed to help DSHS meet its improvement agreement with the Centers for Medicare & Medicaid Services and secure the hospital’s certification and federal funding.

Western State must essentially have its improvements in place by April, according to Reyes.