When safety science and systems thinking entered healthcare to address medical errors, our focus on the patient was challenged. The systems that delivered care had evolved to become more provider-centric than patient-centric.
We now understand the power of the patient voice, the importance of the patient perspective and the value of partnering with empowered and engaged patients. The Institute for Healthcare Improvement (IHI)’s Triple Aim embodies this as our collective goal for reform. But what about the people that form the workforce that makes this all happen? Where is the focus on them?
A workforce under pressure
To deliver healthcare, providers partner with patients and families, supported by a broader workforce making critical contributions to the process. For these partnerships to be effective, all parties involved must be able to contribute to the best of their abilities and feel engaged. Without this, the Triple Aim is unachievable. The healthcare workforce derivces its sense of purpose from serving others. People are drawn to the mission and the challenges of the job.
However, it has become ever more apparent that we cannot take meeting these expectations for granted. We must nurture and reinforce the qualities that attract people to healthcare and give them their passion for the job, ensuring that the work remains meaningful and the workforce remains inspired to serve. Too many healthcare workers do not have appropriate resources or adequate time and do not work in an environment where they can feel free from harm, safe or respected. Instead, we have too often allowed the system to exhaust and dispirit them.
This matter was taken up by the Lucian Leape Institute (LLI), a patient-safety think tank formed in 2007 by the National Patient Safety Foundation in the US. The LLI organized its initial work around five transformational concepts, one of which was ‘the joy and meaning of work’. At the time, there was growing concern that the healthcare workforce was showing signs of suffering from burdensome regulatory and administrative requirements, overwork, inefficiencies that take time away from purpose, and cultures that tolerate and reinforce a lack of respect. Relationships were breaking and workforce attrition was becoming an issue, with fewer people entering the field and discipline-specific shortages beginning to be felt.
In its follow-up paper in 2013, Through the Eyes of the Workforce: Creating Joy, Meaning, and Safer Healthcare, the LLI further explored the importance of a workforce focus on safety. It called for a workplace free of both physical and psychological harm, with a restoration of joy and meaning for staff. A follow-up article in 2015 called for the establishment of the Quadruple Aim, incorporating the concept of meaning in work into the original Triple Aim.
Workplace accidents and occupational illness in healthcare are also excessive in comparison to other industries, in some cases multiple times the industrial averages. The two papers validate the sense of discouragement within the workforce and set out paths for beginning to address the contributing factors.
Solutions for improvement
The best approaches to change come from the front lines. Healthcare organizations are now beginning to understand that workplace safety, both physical and psychological, is a precondition for patient safety and quality outcomes. Staff experience and patient experience should be inextricably linked in the culture and language of any organization.
Much has begun to happen on this front. Cultures of excellence are being further defined to include core values of mutual respect and civility. Hospital Corporation of America, which operates hundreds of hospitals and employs thousands of people, incorporates surveys, forums and advisory groups into its mission to have a happy and well-treated workforce. It also tracks staff productivity, turnover and engagement to help identify problems before they spiral.
Southeast Alabama Medical Center has adopted what it calls a ‘pay it forward’ scheme. Each month, the department with the highest patient satisfaction scores is recognized by the administrative team. It’s then asked to nominate the support department that helped it the most (for example, HR for helping them hire the right people) to ensure that non-clinical departments feel part of the hospital’s achievements.
Paul O’Neill, former chairman and CEO of Alcoa and a co-author of the original LLI paper on this topic, has a simple litmus test for organizations that speaks to workforce experience. He proposes that every member of the workforce should be able to answer ‘yes’ to these three questions every day:
- Am I treated with dignity and respect by everyone I encounter, everyday, without regard to race, ethnicity, nationality, gender, religious belief, sexual orientation, title, pay grade or number of degrees?
- Do I have the things I need: education, training, tools, financial support, encouragement, so I can make a contribution to this organization that gives meaning to my life?
- Am I recognized and thanked for what I do?
As we think about the need to ensure that healthcare workers are well taken care of so that they may best take care of our patients, it brings to mind the safety talk given at the beginning of every commercial flight – when passengers are told put on their own oxygen mask before helping others. The healthcare workforce needs its oxygen mask. We have to do better at providing it.