Hospitals: When Healthcare Workers Come Up With Their Own Solutions to Their Own Struggles
Suicides among nurses, mass resignations by emergency room doctors at their wits’ end, and strikes protesting the poor working conditions of hospital staff have regularly made headlines in recent years.
Emmanuel Abord de Chatillon, Grenoble Alpes University and Nathalie Commeiras, University of Montpellier
Absenteeism, which is on the rise, now stands at 27 days, according tothe Technical Agency for Hospitalization Information.
“Fatigue and exhaustion are the norm in hospitals today,” says Frédéric Valletoux, president of the French Hospital Federation (FHF), with concern. Hospitals are struggling, and the health of their staff isn’t much better.
What if the people best positioned to find solutions to this problem were the healthcare workers themselves? Our recent research in hospitals and clinics shows that initiatives launched within patient care units are often the most effective.
An increase in workloads, higher absenteeism
Hospital and healthcare financing reforms have been implemented one after another over the past 30 years. They have profoundly altered the way staff organize their work. Indeed, this has not been achieved without placing pressure on departments already affected by an intensification of workloads that was even more pronounced between 2003 and 2013 than during the previous decade (Algava et al., 2014).
Added to these challenges are significant constraints stemming from frequent absences. There is a shortage of staff; to ensure care is provided despite this, employees must be called back from their time off. Hospital staff also face significant emotional strain. All of this leads to a loss of purpose in a field where it is more crucial than ever.
Faced with these challenges, managers are not sitting idly by. The results of research conducted by our team in public hospitals and private clinics in 2016 show that these institutions are implementing measures to prevent psychosocial risks, although it is not yet possible to assess their effectiveness.
These include comprehensive surveys of working conditions, more or less detailed assessments conducted in collaboration with public or private stakeholders, a wide range of training programs (mindfulness meditation, awareness of psychosocial risks, stress management, etc.), and codes of conduct. Some organizations provide opportunities for employees to relax during breaks, such as gyms or massage chairs…
Burnout, weariness, loss of meaning
Nevertheless, the situation on the ground does not seem to be changing. In all the institutions we examined during our research, healthcare workers continue to face the same pressures, with the same consequences: absenteeism, weariness, burnout, burnout, a sense of loss of purpose, and a feeling that they are not doing their jobs properly.
Today, initiatives to prevent psychosocial risks are primarily incorporated into communication plans. The aim is to “show that we’re taking action” in order to restore a tarnished image. The unintended consequence is that this discourages those with “good intentions,” particularly employee representatives who do not want to be perceived as “accomplices of management.”
It must also be said that hospitals are increasingly beginning to resemble a monster. Hospital facilities are grouped into clusters and departments that are like so many different “worlds.” Prevention initiatives imposed from above come up against this complexity. These initiatives are poorly adapted to the specific characteristics of each department and each care unit. Management then faces difficulties in ensuring their implementation. To staff, these initiatives seem completely artificial. These approaches, disconnected from the front lines, simply “slide” over the organization without changing day-to-day operations.
The "patchwork" of solutions within departments
In a desperate bid to survive, it is within the departments themselves that solutions emerge that manage to alleviate suffering in the workplace. Some healthcare managers are attempting to improve their staff’s working conditions on their own. It is as if, faced with hospital constraints and the ineffectiveness of institutional prevention measures, local “make-do” solutions—driven by management—have become the ultimate means for caregivers to protect themselves from a harmful system.
One example is this geriatric ward, which completely overhauled the patient bathing process by combining tasks performed by a single caregiver with those performed in pairs, and by rethinking bathing supplies (towel size, soap packaging, etc.) and the schedule to improve both the quality of care and the relationship with the patient.
In addition, many healthcare managers are working to reintroduce dedicated discussion times and reorganize handoffs between day and night shifts to make them more efficient. They are also creating new opportunities for dialogue where everyone can speak up and share what is currently at the heart of their work and the challenges they face.
Trade in services and reciprocal arrangements
This informal relationship is built on mutual support and reciprocal arrangements. When faced with challenges such as managing schedules and absenteeism, the goal is to find solutions that work for everyone involved. It is common to see people exchanging favors to accommodate each other’s schedules. However, these solutions are highly dependent on the managers who implement them and are therefore fragile.
Mechanisms for mutual assistance also extend to relationships among healthcare managers within the same facility, and more specifically within the same division. Equipment or staff may be shared between departments, and patients may be temporarily accommodated in a partner department. These practices rely above all on good relationships among the managers involved.
Finally, caregivers also take the initiative, without any input from higher-ups, to find solutions on their own. They sometimes create new rules to provide care under better conditions (such as having two people perform tasks that are supposed to be done alone or vice versa). They can also create new communication channels, such as a Facebook group for their team to share instructions and discuss schedules.
Replicate what works in a department
We believe that, based on these experiences, there is still room for concrete action on the part of managers. It is up to them to take stock of local initiatives within their organization and to try to replicate successful practices from one department to others.
Managers can also help rebuild work teams. From this perspective, creating spaces for discussion about work appears to be a key course of action, as demonstrated in two studies published in 2013 and 2017. However, to be fully effective, these discussions must be embedded in daily work practices and lead to genuine debates. Hospitals must therefore provide managers with sufficient resources to fully facilitate such meetings.
Emmanuel Abord de Chatillon, Professor of Management and Occupational Health, Grenoble Alpes University and Nathalie Commeiras, University Professor of Human Resource Management, University of Montpellier
The original version of this article was published on The Conversation.