Hospitals: when caregivers come up with their own solutions to their discomfort
Suicides among nurses, mass resignations by emergency doctors at the end of their tether, and strikes to protest against working conditions for hospital staff have regularly made the headlines in recent years.
Emmanuel Abord de Chatillon, Grenoble Alpes University and Nathalie Commeiras, University of Montpellier
Absenteeism, which is becoming increasingly prevalent, now stands at 27 days according tothe Technical Agency for Information on Hospitalization.
"Fatigue and exhaustion are part of everyday life in hospitals today," says Frédéric Valletoux, president of the French Hospital Federation (FHF). Hospitals are struggling, and the health of their staff is not much better.
What if the people best placed to find solutions to this malaise were the caregivers themselves? Our recent work in hospitals and clinics shows that initiatives taken in care units are often the most effective.
Increased workload, higher absenteeism
Reforms of hospitals and their financing have been ongoing for 30 years. They have profoundly changed the way staff work is organized. This has inevitably put pressure on services already affected by an intensification of work, which was even greater between 2003 and 2013 than in the previous decade (Algava et al., 2014).
Added to these factors are significant constraints linked to high levels of absenteeism. There is a shortage of staff; in order to provide care despite this, employees must be called back to work during their time off. Hospital jobs are also subject to significant emotional stress. All of this leads to a loss of meaning in a profession where this is more than necessary.
Faced with these difficulties, 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 establishments are implementing measures to prevent psychosocial risks, although it is not possible to assess their effectiveness.
These include comprehensive surveys on working conditions, more or less exhaustive assessments carried out in collaboration with public or private stakeholders, a wide range of training courses (mindfulness meditation, awareness of psychosocial risks, stress management, etc.), and charters promoting good working practices. Some organizations offer opportunities to relax during breaks, with gyms or massage chairs available.
Wear and tear, weariness, loss of meaning
Nevertheless, the situation does not seem to be changing on the ground. In all the institutions studied during our research, caregivers continue to be subject to the same constraints, with the same consequences: absenteeism, weariness, exhaustion (or burnout), burnout, loss of meaning, and a feeling of not doing their job properly.
Today, measures to prevent psychosocial risks are primarily part of communication plans. The aim is to "show that something is being done" in order to restore a tarnished image. The perverse effect is that this discourages "goodwill," particularly among employee representatives who do not want to be perceived as "accomplices of management."
It must also be said that hospitals are increasingly resembling monsters. Hospital facilities are grouped into clusters and specialties that are like different "worlds." Prevention measures imposed from above come up against this complexity. The actions are poorly adapted to the specificities of each profession and each care unit. Management then encounters difficulties in monitoring them. For staff, these actions appear completely artificial. These approaches, disconnected from the reality on the ground, then "slip" through the organization without changing day-to-day activities.
The "DIY" approach to solutions within departments
In a bid to survive, solutions are emerging within departments that are managing to limit suffering at work. Some healthcare managers are attempting to improve their employees' working conditions themselves. It is as if, faced with the constraints of the hospital and the ineffectiveness of institutional prevention measures, local "DIY" solutions, spearheaded by management, have become the ultimate means for caregivers to protect themselves from a harmful system.
One example is the geriatric department, which completely changed the patient bathing process by combining tasks performed by a single caregiver with tasks performed in pairs, and by reviewing bathing tools (size of towels, soap packaging, etc.) and schedules to improve both the quality of care and the relationship with the patient.
In addition, many healthcare managers are attempting to reintroduce speaking times and reorganize handover times between day and night shifts to make them more efficient. They are also creating new opportunities for discussion where everyone can express themselves and share what they see as the core of their job and the difficulties they face today.
Exchanges of services and reciprocal arrangements
This informal relationship is based on mutual support and arrangements. Faced with difficulties in managing schedules and absenteeism, the aim is to find solutions that suit all parties. We often see exchanges of services based on each person's schedule. However, these solutions are highly dependent on the managers who support them, and are therefore fragile.
Mutual assistance mechanisms also extend to relations between healthcare managers within the same institution, and more specifically within the same department. Equipment or staff may be loaned between departments, and patients may be temporarily accommodated in a friendly department. These phenomena are based above all on good relations between the managers concerned.
Finally, caregivers also take the initiative, without any hierarchical intervention, to find solutions themselves. They sometimes create new rules to provide care in better conditions (e.g., having two people perform care tasks that are normally performed alone or vice versa). They can also forge new spaces for communication, such as a Facebook group for their team to share instructions and discuss schedules.
Replicate what works well 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 in their establishments and try to replicate what has been successful in one department in others.
Managers can also help rebuild work collectives. From this perspective, developing spaces for discussion about work seems to be an essential course of action, as shown in two studies published in 2013 and 2017. However, to be fully effective, discussion must be embedded in everyday work practices and give rise to genuine debate. Hospitals therefore need to provide managers with sufficient resources to enable them 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 Resources Management, University of Montpellier
The original version of this article was published on The Conversation.