Agency Action: Removing Pebbles

Author(s):  
Stephen J. Swensen ◽  
Tait D. Shanafelt

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.

2002 ◽  
Vol 82 (7) ◽  
pp. 648-657 ◽  
Author(s):  
Rosemary Blau ◽  
Sarah Bolus ◽  
Terrence Carolan ◽  
Daniel Kramer ◽  
Elizabeth Mahoney ◽  
...  

Abstract Background and Purpose. The changes in the health care environment during the last decade have had an impact on the roles and responsibilities of all health care professionals. The purpose of this phenomenological study was to describe the experience of staff physical therapists during a time of systemic change within a large urban academic medical center. Subjects and Methods. Participants were 5 physical therapists working in various clinical settings within the medical center. The participants were interviewed and asked the question “Over the past 4 years, there have been major changes in your work environment. What has it been like for you working as a clinician during this time of change?” Interviews were recorded, transcribed, and analyzed to find thematic patterns of responses. Results. Four common themes emerged in which participants described experiencing loss of control, stress, discontent, and disheartenment. A fifth theme showed that despite these negative feelings, participants were able to “find the silver lining” in their daily work lives (ie, they were able to find positive aspects of their professional lives despite the perceived unpleasant changes with which they had to cope). Discussion and Conclusion. This study provides insight into the experiences of a group of staff physical therapists during a time of systemic change in their work environment. Although the themes reflect largely unsettling and negative experiences, there seems to be an underlying ability to find affirmative aspects of work.


Author(s):  
Stephen J. Swensen ◽  
Tait D. Shanafelt

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.


Author(s):  
Stephen J. Swensen ◽  
Tait D. Shanafelt

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.


2021 ◽  
Vol 12 ◽  
Author(s):  
Megan Woods ◽  
Mandy L. Matthewson

Each year thousands of workers experience a serious illness or injury that necessitates time off work and a subsequent re-engagement with the work environment. In Australia, workers’ compensation legislation mandates the return-to-work (RTW) process is formal, structured, and negotiated between the worker, their employer, health care professionals and their RTW coordinator. How this is executed by those parties directly influences whether the RTW process is supportive and successful, or exacerbates the suffering of returning workers by causing them to feel ostracised, exposed, and vulnerable in their workplace. In this article, we examine how the RTW process can cause physical, emotional, social, and existential suffering for returning workers. We then discuss how the suffering that workers experience can be mitigated by five key factors: clarity of roles in the RTW process, alignment of worker and employer expectations, the advocacy provided by the RTW coordinator, the support provided for the worker’s psychological wellbeing, and the RTW literacy of supervisors and colleagues.


Author(s):  
Stephen J. Swensen ◽  
Tait D. Shanafelt

Physical and psychological safety are important elements of the ideal work environment for health care professionals. Health care organizations should regularly assess both types of safety in their clinical work environments and mitigate factors that erode these qualities. Improving physical and psychological safety is central to creating Coherence and must be embedded into the leadership and organization infrastructure.


Author(s):  
Stephen J. Swensen ◽  
Tait D. Shanafelt

Health care professionals need to feel trusted by the leaders of their organization. Micromanagement and unnecessary adherence to process without justification are the antithesis of trust and respect. Without trust and the supportive, respectful environment it creates, health care professionals will be less likely to do their best or be invested in the organizational mission. Organizations build trust and respect by making every attempt to treat all staff fairly. All team members must work together to make sure an inclusive and respectful work environment is created and maintained.


Author(s):  
Stephen J. Swensen ◽  
Tait D. Shanafelt

The Blueprint is an evidence-based framework for cultivating esprit de corps in an organization. It is grounded on a moral imperative and a business case, which is necessary to gain the support of senior leadership. The framework is aligned with the best interests of patients, health care professionals, and mission-driven organizations. From a systems perspective, the goal is to increase structural and functional sources of positivity and decrease structural and functional sources of negativity in the work environment. The imperative to improve clinician esprit de corps is a shared responsibility. Achieving it requires individuals and leaders across the organization working together to create the ideal work environment.


Author(s):  
Enwereji Ezinne E. ◽  
Ezeama Martina C. ◽  
Enwereji Kelechi O.

Background: The need for nursing students to care and support patients especially those living positively with HIV and AIDS as well as those with terminal diseases should not be underestimated. By training, nursing students are expected to interact cordially with patients and other health care professionals but most times, the reverse is the case. Inter-professional and interpersonal education prepare nursing students on clinical posting to provide quality health care services to all patients irrespective of their ages and health conditions. Therefore, creating healthy work environment by encouraging team work, integrating treatment and prevention services to promote good health is imperative in ensuring patients’ safety, and enhanced inter-professional relationship.Methods: A two-day pre-clinical seminar which centered on professionalism, teamwork, interpersonal and inter-professional relationships, as well as effective communication to guarantee healthy work environments was carried out. The pre-clinical seminar was also used to prepare 186 nursing students on their expected roles during the twelve weeks’ clinical posting in health institutions. At the end of the students’ posting, two days post-clinical seminar aimed to harness students’ experiences, views and performances, as well as the teachers’ observations during the clinical posting was conducted. Thereafter, all comments on performances, observations, experiences and other remarks from the teachers and students were grouped together and analyzed qualitatively and quantitatively.Results: A good proportion of the students 142 (76.3%) established good interpersonal relationship with the patients who are HIV positive while 135 (72.6%) had effective inter-professional interaction with health care workers. Also 135 (72.6%) had good team work relationship with other health care professionals. There were better health care services to clients as evidenced by 95 (51.1%) of students who shared case managements with the health care workers and 122 (65.6%) of the students who used mobilization and advocacy to identify pressing challenges like inter-professional conflicts, poor uptake of messages about treatment and referrals as well as malnutrition among children. A respectable number of the students, 144 (77.4%) collaborated with colleagues to provide nutrition to malnourished children to improve their nutritional status, while 75 (40.3%) assisted in resolving some inter-professional conflicts.Conclusions: Students’ initiatives in management of cases, inter-professional and interpersonal learning experiences during clinical postings increased students’ understanding of teamwork and professionalism as well as promoted friendlier environments that guaranteed better health care services to patients.


2021 ◽  
Vol 9 (1) ◽  
pp. 11-25
Author(s):  
James Appleyard

Objectives: To reflect on the present international culture of professional burnout in health care systems and the need for a radical new approach with an increased understanding of a person- and people-centered attitudes in the promotion of training in wellbeing and the prevention and management of burnout among physicians and health care professionals Methods: A literature search worldwide was undertaken for significant research papers on professional education related to burnout with particular reference to both medical staff resilience and health care system factors. Findings: Burnout among doctors is a global phenomenon. The incidence of burnout reported in a selection of studies among pediatric residents and staff are 25% in Argentina, 37% in the United Kingdom, and 70% in Saudi Arabia. In a national survey in the United States where the overall rate was 59% burned out residents reported significantly increased stress, poorer mental health, and decreased empathy, mindfulness, resilience, self-compassion, and confidence in providing compassionate care Three levels of change that should be the focus of training in prevention, health promotion, and stress reduction awareness have been recommended to reduce the risk of burnout: (1) modifying the organizational structure and work processes; (2) improving the fit between the organization and the individual doctor through professional development programs so that better adaption to the work environment occurs; and (3) individual-level actions to reduce stress and poor health symptoms through effective coping and promoting healthy behavior. Discussion: The history of burnout shows important links with increased work complexity. Narrow training interventions such as debriefing after an adverse clinical event have not been found effective. A more comprehensive personcentered approach with a variety of measurable interventions has resulted in a reduction of 50% in the pediatric faculty in one study. A person- and people-centered cybernetic approach is needed with six standards are to establish and sustain a healthy work environment (1) authentic leadership (2) meaningful recognition, (3) skilled communication, (4) true collaboration, (5) effective decision making, and (6) appropriate staffing. Conclusion: With such high levels of burnout, health systems worldwide can be viewed as failing their populations on a grand scale. Only an organizational paradigm change to a person- and people cybernetic centered system that incorporates complexity is adaptive and integrative will a health system be effective in preventing and ameliorating the effects of burnout and reduce the increasingly unaffordable misuse of human resources.


2010 ◽  
Vol 29 (4) ◽  
pp. 293-304 ◽  
Author(s):  
Melanie Lavoie-Tremblay ◽  
Jean-Pierre Bonin ◽  
Alain D. Lesage ◽  
Arielle Bonneville-Roussy ◽  
Geneviève L. Lavigne ◽  
...  

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