Dr. Bonnie Clipper, DNP, MA, MBA, RN, CENP, FACHE
Once again, the alarms have sounded regarding the impact that burnout is having on our clinicians. This is incredibly important to our health care system. There has been much agreement about how we define burnout, the effects of burnout and even recommendations on how to reduce burnout. It has been stated multiple times that burnout decreases a clinician’s quality of life, their performance, and even the likelihood that they will stay in their job. While burnout continues to be a top challenge among clinical professionals, there is a shortage of evidence regarding the tactics to change our cultures in order to make scalable and sustainable changes. In a study of more than 400 nurses across 11 hospitals in Jordan, the nurses showed evidence of burnout and the researchers worked to identify ways to mitigate its effects (Mudallal, Othman & Al Hassan, 2017).
While this study was not unique, it demonstrated that an increased level of trust by staff, of their leaders, and an increase in empowerment can improve satisfaction, quality of care, and positively impact the effects of burnout. As we know, when leaders use behaviors that are more likely to empower their team, it creates a positive work environment. The authors describe leadership empowering behaviors that are perceived positively by employees. While the study describes the impact of an organization in Jordan, there are lessons that can be applied universally. There are some great takeaways that can be introduced into the workplace that will make it more positive. These are easier said than done, however well worth a try.
- Enhancing the meaningfulness of work: leader behaviors that infuse employees’ work with purpose and give meaning to their contributions, thereby increasing employees’ sense of worth and motivating them.
- Fostering opportunity to participate in decision-making: leader behaviors that allow employees to express their opinions and share in decisions related to their work.
- Expressing confidence in high performance: leader behaviors that demonstrate confidence in employees’ abilities to fulfill expectations of high performance and that recognize employees’ accomplishments.
- Facilitating the attainment of organizational goals: leader behaviors that improve employees’ skills and knowledge and provide required resources for effective performance.
- Providing autonomy and freedom from bureaucratic restrictions: leader behaviors that minimize the constraints of rules, restrictions, and commands to allow efficiency and creativity.
(Mudallal, Othman & Al Hassan, 2017, para. 5)
Consider the impact on work environments when we, as leaders, find ways to make micro-changes to our own behaviors to allow our team to feel a more positive work environment as a result. Some of these changes are as simple as asking for more input or insight prior to making a decision, while some are more difficult behaviors to change. In order to reduce the unsustainable effects of burnout, we should determine which of these behaviors we are going to try first and begin testing the impact on us as leaders, on our work environments, and ultimately, in our organizational cultures. I too am a work in progress. As Mahatma Gandhi stated, let’s make the commitment to “Be the change that you wish to see…”.
Mudallal, R.H., Othman, W.M., & Al Hassan, N.F. (January 1, 2017). Nurses’ Burnout: The Influence of Leader Empowering Behaviors, Work Conditions, and Demographic Traits. Inquiry. 54. Accessed on November 22, 2019. Accessed at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5798741/.
Ashley Eddings, MBA, SSGB
What if all organizations involved the voice of patients in the human experience and care delivery? What if patients felt empowered to play a pivotal role in the progression of an organization by sharing feedback and insights that are heard? Is it important or not so much? Consider this through the lens of consumer loyalty, employee engagement, and patient satisfaction to determine the answer to these questions.
When looking at consumer loyalty, it is incumbent on organizations to know what drives loyalty. In healthcare, the consumers are patients. As consumers, patients choose who will provide/direct their care and where to receive their care. As patients become more savvy consumers, it takes more than a prestigious name to earn their loyalty.
Consider Cheney’s (2018) thoughts around gaining consumer loyalty: “Give every patient a voice. Maximize the volume and timeliness of feedback…” (para. 8). Once patients have a voice, they feel empowered in their care and experience. Giving patients a voice to express their feedback, recognition, concerns, and the like, conveys to them that the organization and its employees simply care. This undoubtedly sets a part the organizations who listen from the ones who do not. Continually hearing from patients allows organizations to pivot in the right direction in hopes of gaining loyalty as a result of this feedback.
What is the impact of the patients’ voice being heard at the bedside? Don’t underestimate the power of patient feedback on the care providers. In the face of burnout, staggering turnover rates, heavy workloads, and demanding work environments, it is necessary that nurses, physicians and other members of the care team feel valued and recognized for their extraordinary efforts.
Payne (2017) found that when employee engagement scores increase, patient and physician satisfaction increases. The challenge is how to get employees engaged amid the known challenges. One way, which is often overlooked, is through meaningful, real-time recognition directly from patients. When patients can thoughtfully voice their gratitude for the care provided in the moment, it has a lasting impact on the care team. Reviewing recognition and feedback from patients about their care connects the care team back to what attracted them to a healthcare profession and reminds them of their motivation to continue to provide high-quality care and an exceptional experience. Payne (2017) affirms this by revealing that more than 80% of employees report a more positive employee experience when they receive recognition for doing good work and receive feedback on work performance. As soon as employees are engaged in their work, it translates into the care being delivered, ultimately leading to satisfied patients and a positive experience.
It is critical to note ways in which organizations can hear the voice of the patient. Kommers (2019) raises an important point when she states that organizations need to “Make it easier for patients to share narratives…” (para. 4). It is imperative for organizations to find various avenues where patients can share feedback in a timely and thoughtful manner. It should never be enough to wait for surveys to come in; there needs to be ongoing feedback being shared to open much-needed dialogue between the organization and its patients.
Furthermore, Kommers (2019) prompted us to “Remember that narratives are their own form of evidence, even if they are not driven by data” (para. 5). When a patient shares their input, stories, and experiences, while it might not be clear-cut numerical data, it is still real-life, personal accounts that are indicative of what is going well and where the areas of opportunities lie. We must be careful to take these stories and connect them with the data to get the true picture of what is going on in an organization.
So, is the patient’s voice and feedback necessary and value-added? If we consider the results of consumer loyalty, a rise in employee engagement, and an increase in patient satisfaction, there is too much to lose if we think otherwise. Thus, the answer is a resounding yes.
Cheney, C. (2018, December 28). Patient experience five times as likely to drive consumer loyalty as marketing. Retrieved from https://www.healthleadersmedia.com/clinical-care/patient-experience-five-times-likely-drive-consumer-loyalty-marketing.
Kommers, A. (2019, July 9). Viewpoint: Patient narratives should be part of medical education. Retrieved from https://www.beckershospitalreview.com/patient-engagement/viewpoint-patient-narratives-should-be-part-of-medical-education.html.
Payne, S. (2017, May 19). 10 tips for boosting retention and performance in healthcare. Retrieved from https://whc.workhuman.com/healthcare-performance-lp.html.
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Dr. Bonnie Clipper, DNP, MA, MBA, RN, CENP, FACHE
Fall is a time of many conferences and events for nurses, physicians, and other clinicians. After reflecting on the many keynote speakers, panel discussions, break-out sessions, and shared stories that I have recently experienced, a common theme has emerged that validates much of what we hear about clinician burnout. This theme is a trend among nearly all organizations, inpatient, outpatient, large or small, academic or community-based. It is a sense of a lack of value and respect shown to clinicians (and often by colleagues towards each other) for their work in providing care. In conjunction with the conference information, the recent study on clinical wellbeing (NAM, 2019) has grabbed my attention due to the staggering statistics, including the fact that “between 35% – 54% of U.S. nurses and physicians have substantial symptoms of burnout” (NAM Study Highlights, 2019, para. 2). How is this good for clinicians or for patients for that matter?
Factors such as meaning and purpose in work, as well as organizational culture, are contributors to burnout (NAM, 2019) yet not impossible to positively impact. Hard – yes, impossible – no. The good news is that with some work, these factors can be changed. Imagine the impact of sharing gratitude more regularly for the care that is provided and expressing thanks to team members for a job well done. Sounds soft, right? Not really. How do you feel when someone thanks you for doing your job? Warm, fuzzy, grateful? Consider the impact of how nurses, physicians and other members of the care team would feel if patients were able to directly recognize or thank them for their work in real-time. According to the recently released National Academies of Medicine study (NAM, October 2019) feeling appreciated and valued go hand-in-hand.
The significance of this is that it isn’t hard to express gratitude to clinicians to reinforce the importance of their contribution and provide validation for the meaningful nature of this work. If we know that sharing recognition and gratitude can reduce burnout, provide validation and demonstrate the value that clinicians bring to the patient care ecosystem, why don’t we do more of it? After all, we know that “Meaningful recognition has been acknowledged as a component of a healthy work environment” (AACN, 2017).
For some reason in healthcare, we have a hard time creating a culture built on the “positive” and an even more difficult time maintaining this kind of work environment. Using the tools that we have available will help us to build healthy cultures and positive work environments. According to the work done by the AACN (2017) “… meaningful recognition can influence a healthy work environment…” (pp. 443).
What if we are making this too hard? Working together and finding ways to recognize clinicians for their efforts will incrementally improve the work environment which is highly likely to reduce burnout and promote retention. This is the perfect time to incorporate technologic tools to help us build muscle memory and make it easier for expressing gratitude and demonstrating recognition to accomplish our shared goal of reducing burnout.
AACN Standards for Establishing and Sustaining Healthy Work Environments. (2018). AACN standards for establishing and sustaining healthy work environments. Accessed on September 30, 2019. Accessed from https://www.aacn.org/nursing-excellence/standards/aacn-standards-for-establishing-and-sustaining-healthy-work-environments.
Clinical Well Being Study. (2019). National Academies of Medicine Study. Accessed on November 5, 2019. Accessed from nam.edu/ClinicianWellBeingStudy.
NAM Consensus Study Report. (October, 2019). Accessed on November 8, 2019. Accessed at https://nam.edu/wp-content/uploads/2019/10/CR-report-highlights-brief-final.pdf.