Agency Action: Introducing Control and Flexibility

There is a healthy tension between standard work, which is controlled, and flexible work. Standardization of processes that improve quality and safety is good for patients. Flexible work in other areas is good for employees’ mental and physical health. Executed properly, standard and flexible work can be complementary. In a collaborative environment, leaders and organizations create increased flexibility for health care professionals when they focus more on outcomes than on specific processes. How decisions are made at all levels of the organization substantially determines the degree of control and flexibility in the workplace.

Getting Senior Leadership on Board

Optimizing the organizational environment to promote esprit de corps can’t happen without senior leadership prioritizing the issues and dedicating time, attention, and other resources to address them. For meaningful and sustainable results, the commitment by leadership must be authentic. In other words, leaders must embrace this quest because they genuinely care, not just because they believe it is a good business strategy. There are four triggers for senior leaders to become committed to the well-being of the health care professionals in their organization: the moral/ethical case, the business case, the regulatory case, or the tragic case.

Introduction

Burned-out professionals are exhausted, jaded, demoralized, and isolated, and they have lost their sense of meaning and purpose. Frequently, these individuals are shamed and blamed by leaders who suggest they should sleep longer, meditate, and become more resilient even as they expect them to work harder, see more patients, embrace rapidly changing technology, stay abreast of new medical advances, and provide quality health care. We will show you how the current vicious cycle of cognitive dissonance, moral injury, and shame-and-blame can be transformed into a virtuous cycle: a cycle where one beneficial change in the health care workplace leads to another and, ultimately, to esprit de corps—a common spirit existing in members of a group that inspires enthusiasm, devotion, loyalty, camaraderie, engagement, and strong regard for the welfare of the team.

Coherence Ideal Work Element: Fairness and Equity

Fairness and equity are important elements of the ideal work environment. Health care professionals need transparency in all matters that make sense including the way pay, privileges, and work schedules are determined. This Ideal Work Element also requires fair and just accountability to provide support when clinicians experience a traumatic patient adverse care event.

Agency Action: Creating a Values Alignment Compact

Values alignment forms a powerful bond between individuals and an organization—one that cultivates meaning and purpose in work. Values alignment is central to well-being, mitigates burnout, and promotes esprit de corps. The Values Alignment Compact clarifies roles: what clinicians expect from their organization and what their organization expects in return. The process of developing a compact is a dialogue that nurtures the culture of “interdependency” of leadership (administration) and health care professionals.

Agency Action: Removing Pebbles

The identification and removal of sources of frustration and inefficiency requires a partnership of leaders and health care professionals. This participative management process treats health care professionals as trusted and respected colleagues. It results in a more friendly work environment and a cohesive team that is able to more readily navigate the occupational challenges that arise. The process of identifying and removing pebbles starts with an unrushed conversation with the health care professionals of a given work unit. The local challenges that often surface in these discussions frequently involve disorganization and processes that diminish meaning or that impede caring for patients.

Agency Ideal Work Element: Partnership

Partnerships are an inherent attribute of esprit de corps, and partnership is one of the three Ideal Work Elements fostered by Agency actions. Partners have a shared vision, invest discretionary effort, and look to accomplish a vision together. Health care professionals should be treated as partners, never as employees. In a partnership market arrangement, the culture is intentionally one of collaboration and cooperation; cultures have high levels of social capital because they function with higher levels of trust and interconnectedness. Physicians are hired, selected, and developed so that their behaviors and actions are aligned with the mission strategy and vision of the organization. Physicians are more likely to feel as though they are an important part of the organization, and they are dedicated and work together to promote the organization’s mission.

Agency Action Set: Introduction

The Agency Action Set has been designed to mitigate or eliminate specific drivers of professional burnout and to develop leaders and systems that foster the related Ideal Work Elements.

Assessment

The most important determinant of value in a health care organization is an intangible asset called social capital. Social capital comprises the talent, knowledge, goodwill, trust, skill, and interconnectedness of people. Social capital is a critical characteristic of organizations and the ingredient that allows people to work together for a common purpose. Organizations need objective data to understand the experience and well-being of their health care professionals. A baseline measurement is necessary to assess the current state and to evaluate progress toward an ideal future state. Objective measures of the efficiency of the practice environment can also serve as improvement targets and often provide continuous real time data on progress without burdening staff with repeated surveys.

Consequences of Professional Burnout

Work environments and interpersonal relationships often merge, eroding the passion and altruism of health care professionals and promoting burnout. Burnout of health care professionals negatively impacts safety, team effectiveness, staff turnover, professional productivity, organizational effectiveness, and organizational brand. Professionals also experience personal consequences from burnout including higher rates of relationship issues, alcohol and substance abuse, clinical depression, and suicide. Even more important, however, burnout has a profound, negative bearing on patient experience and outcomes.