Main­tain­ing morale

Hos­pi­tals tak­ing steps to counter ris­ing job dis­sat­is­fac­tion

Modern Healthcare - - THE WEEK IN HEALTHCARE - Ashok Sel­vam

Nurses at Mercy Hos­pi­tal & Med­i­cal Cen­ter in Chicago were frus­trated that they had to search through sup­ply clos­ets to find sup­plies and equip­ment such as cuffed blood pres­sure mon­i­tors and sy­ringes. Lack­ing an ef­fi­cient sys­tem to track in­ven­tory, they felt they were wast­ing time that could be bet­ter spent car­ing for pa­tients, they com­plained to hos­pi­tal lead­ers.

In re­sponse, Mercy ad­min­is­tra­tors im­ple­mented the Blue­Bin sys­tem, which cost about $700,000. The sys­tem uses com­puter soft­ware and scan­ners to im­prove track­ing of sup­ply lev­els. Nurses no longer need to hunt or beg for sup­plies. They’re also mak­ing fewer trips to the sup­ply clos­ets, as cab­i­nets or nurse servers stocked with the sup­plies they need most are lo­cated in the mid­dle of their hos­pi­tal floors. Hos­pi­tal of­fi­cials say it has cre­ated bet­ter or­ga­nized sup­ply rooms and boosted nurses’ morale.

“We’ve taken the bur­den off the nurses,” said Mercy Chief Op­er­at­ing Of­fi­cer Richard Cerceo. “They don’t have to ever or­der sup­plies, it does it au­to­mat­i­cally for them. It was de­signed around their needs.”

Main­tain­ing a happy and healthy work­force of nurses and other staff is be­com­ing more of a pri­or­ity as hos­pi­tals face bud­get cuts and staff re­duc­tions that can alien­ate tenured work­ers who have grown com­fort­able with the tra­di­tional ways of do­ing busi­ness and now face a more stress­ful, cost-con­scious health­care en­vi­ron­ment. There’s also a grow­ing aware­ness of the need to pro­vide per­sonal sup­port to treat­ment staff who some­times for­get to take care of them­selves in the rush of car­ing for pa­tients.

Staff in­put re­quested

Mercy’s ac­tion is just one ex­am­ple of the var­i­ous ways hos­pi­tal and med­i­cal group lead­ers across the coun­try are work­ing to im­prove morale, as frus­tra­tion lev­els among care­givers rise. Providers are re­quest­ing more staff in­put to make sure their needs are met. They’re us­ing new tools to mea­sure em­ployee sat­is­fac­tion, and also try­ing to en­sure bet­ter pa­tientto-staff ra­tios. Some are es­tab­lish­ing more train­ing pro­grams that could lead to pro­mo­tions, while some have even cre­ated in­cen­tive-driven well­ness pro­grams, which re­ward staff with prizes like ex­tra va­ca­tion days for healthy be­hav­ior. About 86% of hos­pi­tals have es­tab­lished work­place well­ness pro­grams, ac­cord­ing to the Amer­i­can Hos­pi­tal As­so­ci­a­tion.

Yet re­cent sur­veys show the ef­fec­tive­ness of th­ese morale-boost­ing mea­sures still have a long way to go. Though ca­reer sat­is­fac­tion among nurses re­mains high with 90% happy with their choice of pro­fes­sion, fully 35% say they feel like quit­ting their cur­rent po­si­tion, up from 33% in 2012, ac­cord­ing to a soon-to-be pub­lished sur­vey from the AMN Health­care con­sul­tancy. The num­ber ex­pect­ing to be at a dif­fer­ent job a year from now ticked up a per­cent­age point in the past year to 33%, which is sig­nif­i­cantly higher than the rest­less­ness reg­is­tered among nurses in 2010, the first year AMN did its nurse sur­vey. An­other trou­bling in­di­ca­tor: Fully half say they worry about their jobs af­fect­ing their health.

Among nurses, many voice frus­tra­tion that they are work­ing longer shifts with­out breaks or va­ca­tion time, said Zenei Cortez, a co-pres­i­dent of the Cal­i­for­nia Nurses As­so­ci­a­tion and a reg­is­tered nurse at a Kaiser Per­ma­nente med­i­cal of­fice in San Ma­teo, Calif. Low morale can make even ba­sic tasks such as re­spond­ing to a pa­tient call light dif­fi­cult. “Nurses’ morale is plum­met­ing be­cause they feel like they can’t do their jobs given what’s go­ing on,” she said.

Cal­i­for­nia is the only state with a law that man­dates spe­cific nurse-pa­tient ra­tios, and that law helps pre­serve morale, Cortez said. But the union still feels they don’t have enough nurses on duty and that re­sources are spread too thin.

En­sur­ing staff isn’t over­worked is just one key trait of a suc­cess­ful or­ga­ni­za­tion. Other signs of a pos­i­tive work­place en­vi­ron­ment in­clude job se­cu­rity, re­spect­ful treat­ment of em­ploy­ees, con­fi­dence in man­age­ment, and a cul­ture of high-qual­ity pa­tient care, Cortez added.

Re­search from Press Ganey also links morale and en­gage­ment with qual­ity of care, read­mis­sion rates and per­for­mance of hos­pi­tal core mea­sures, con­clud­ing that “em­ployee en­gage­ment has very real fi­nan­cial im­pli­ca­tions.”

“Pas­sion­ate and vis­i­ble” lead­er­ship is a com­mon thread for suc­cess­ful or­ga­ni­za­tions, said Deb­o­rah O’Brien, se­nior vice pres­i­dent, con­sult­ing and ed­u­ca­tion ser­vices for Press Ganey. Lead­ers need to plan out their de­part­men­tal rounds with goals. They need make their time see­ing staff count— whether that’s de­liv­er­ing a mes­sage or look­ing at a par­tic­u­lar con­cern. That also breeds

an en­vi­ron­ment of ac­count­abil­ity and trust.

“It’s not just walk­ing the halls, but it’s about ac­tu­ally bring­ing the in­for­ma­tion back and shar­ing it with the oth­ers out at the hos­pi­tal and then act­ing upon it,” O’Brien said.

Press Ganey’s data tied higher CMS Hos­pi­tal Con­sumer As­sess­ment of Health­care Providers and Sys­tems scores, which re­flect hos­pi­tal per­for­mance, to high em­ployee en­gage­ment. Hos­pi­tals with a high aver­age en­gage­ment rank­ing scored 16 points higher in over­all hos­pi­tal rat­ings, com­pared with fa­cil­i­ties with low en­gage­ment rank­ing.

Avoid­ing burnout

While Mercy’s re­design of the sys­tem for or­der­ing sup­plies may seem like a sim­ple task, its im­pact on morale and even qual­ity of care shouldn’t be un­der­es­ti­mated. Stress and low morale could lead to burnout, which leads to med­i­cal er­rors. Re­search con­ducted at the Univer­sity of Penn­syl­va­nia School of Nurs­ing pub­lished last year showed a link be­tween nurses suf­fer­ing from burnout and higher in­ci­dents of catheter-as­so­ci­ated uri­nary-tract in­fec­tions and sur­gi­cal site in­fec­tions.

“The reaction to short staffing or burnout is nurses aren’t go­ing be able to pay at­ten­tion to de­tails,” said Cheryl Wag­ner, the as­so­ciate dean of grad­u­ate nurs­ing pro­grams at Amer­i­can Sen­tinel Univer­sity in Birm­ing­ham, Ala. “You’re go­ing to see more er­rors. The er­ror can be a higher in­fec­tion rate on the floor, med­i­ca­tions er­rors—all kinds of th­ese things hap­pen when the nurses aren’t pay­ing at­ten­tion.”

Thanks to the new Blue­Bin sys­tem, the nurses at Mercy said they spend much less time sift­ing through sup­ply clos­ets to find what they need, which frees up more time to spend with pa­tients. Mercy es­ti­mates the sys­tem saves 18,000 staff hours an­nu­ally.

Nurses said they ap­pre­ci­ated ad­min­is­tra­tion lis­ten­ing to their in­put and ad­dress­ing their con­cerns. Other staffers are pleased that the new sys­tem has less­ened ten­sion and im­proved com­mu­ni­ca­tion be­tween de­part­ments.

“We tried to form a part­ner­ship at the be­gin­ning” with the nurs­ing staff, said Quincy Stan­ley, Mercy’s sup­ply chain man­ager. As a re­sult, he said, the nurses feel a sense of own­er­ship over the new sup­ply sys­tem be­cause they helped de­sign it.

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