Fighting a shortage of skilled staff? Increasing teamwork and respect is as important as increasing salaries

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The most difficult task — and by far the most important one — faced by a hospital executive team is building a satisfying work environment that keeps clinical staff engaged and loyal.

More than any other organization, a hospital depends on a large cadre of highly trained staff, many of whom are in professions facing serious shortages. That means your best doctors, nurses, therapists, technologists and technicians have choices. If they aren't happy working at your hospital, there are dozens of other hospitals happy to hire them, often with a competitive salary and, in some cases, a signing bonus. So poor morale among staff is a critical issue for any hospital.

Low morale and high turnover not only make life difficult for executives, they adversely affect patient safety and satisfaction. Several studies have documented this effect. A 2011 study by a group at the University of Pennsylvania School of Nursing found "patient satisfaction levels are lower in hospitals with more nurses who are dissatisfied or burned out — a finding that signals problems with quality of care." A 2009 meta-analysis on the relationship between worker engagement and organizational outcomes found the difference between healthcare units with employee satisfaction ratings in the top quartile and those in the bottom quartile resulted in a 41 percent difference in patient safety incidents. Numerous other studies have detailed how low staff morale results in poorer quality work for healthcare staff in a variety of disciplines, from laboratory to imaging and pharmacy, and how high turnover disrupts patient care and safety.

Keeping staff morale high and turnover low can save lives. It's a very, very big deal for hospitals. So in a competitive environment, how do you hang on to your best staff and ensure they are focused on high quality care?

Teamwork matters

Offering your staff a competitive wage and benefits package is important, because no one wants to feel they are undervalued. But there are other ways to show employees you value them. In many cases, the less tangible signs of how they are valued are far more important to employees than small differences in salary — or even not-so-small differences in salary.

This is one reason for the concerted movement toward team-based care. It creates an environment that respects the contributions of all staff, which is an important element in staff satisfaction. That is especially true in hospitals and other centers that provide care for people with complex illnesses and conditions. These are naturally high-stress environments, because mistakes can cost people their lives. Teamwork is an effective way to ensure coordinated care and good communication among caregivers, which improves patient safety, lowers stress levels and increases staff job satisfaction.

As physicians, we increasingly find ourselves either leading teams or working within a team led by others. For some of us, that's a natural way to work. But for others, it takes some adaptation. Too often, physicians in training were taught that we are supposed to be the ultimate authority, and medical education programs fostered confirmation bias in many of us. In some cases, that has caused physicians to discount the input of nurses and other staff. This leads to low morale among nurses and, in more extreme cases, medical errors that put patients in harm's way. Fortunately, that's changing as physicians find themselves working in situations that encourage listening to patients and other caregivers.

There is a movement afoot to dramatically change the way physicians are trained, and the American Medical Association has given grants to many innovative pilot projects with this goal in mind. Many of these pilot projects focus on teaching real-world skills needed to work as both members and leaders of a caregiving team, including leadership and listening skills. The next generation of physicians will be highly attuned to the need to listen to patients and other caregivers, and to see the patient as a whole person rather than a collection of symptoms. This will greatly humanize our profession and ameliorate the tendency of physicians to adopt confirmation bias. It will help us do a better job of working as effective team members.

A learning environment also matters

But working in teams is not a panacea for poor staff morale. You also need to create an organization that values organizational and system learning when mistakes occur opposed to an organization that simply punishes individuals. Most medical errors are the result of poor systems and workflows that create barriers to doing the right thing and make doing the wrong thing far too easy. By focusing on learning from mistakes, organizations get better over time and help their staff become more expert at delivering great care. And a learning environment is much better for staff morale than a "gotcha" environment, where people expend needless energy covering up the small mistakes. That doesn't mean you need to ignore obviously incompetent workers; but you also don't want to persecute well-meaning staff members working in a badly designed system.

A great example of how small changes to a system and creating a sense of teamwork can prevent errors and increase staff satisfaction comes from a surgeon at a hospital in Austin, Texas. He invited the materials management staff to observe surgery. He wanted to show them how he uses the instruments and supplies that they pack for him in surgery carts. This simple invitation greatly increased their understanding of the interplay between their work and that of the surgeon. Because the surgeon saw them as part of his team, and treated them as valued teammates, they felt valued and appreciated. The result: His surgery carts were arranged in a more efficient way, leading to less waste and fewer errors.

The more we look to helping each other, respecting each other and working in collaboration with each other, the higher morale we see across all aspects of healthcare. And that will pay off in fewer errors, better patient safety, happier loyal employees and a better healthcare system overall.


Nick van Terheyden, MD, is CMO of Dell Healthcare & Life Sciences. He previously served as CMIO of Nuance Communications. Dr. van Terheyden is a 25-year veteran of healthcare technology. He aided in the development of one of the first EMRs and served as a business leader in one of the first speech recognition Internet companies. He is a graduate of the Royal Free Hospital School of Medicine, University of London and has several professional memberships including HIMSS, mHealth Executive Committee, AMIA and AMDIS.


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