Hospital: when caregivers invent their own solutions to their discomfort

Nurse suicides, mass resignations of exhausted emergency doctors, strikes to protest against the state of working conditions for hospital carers have regularly made the headlines in recent years.

Emmanuel Abord de Chatillon, Grenoble Alpes University and Nathalie Commeiras, University of Montpellier

Discussions within the healthcare team are an effective way of combating suffering at work. Shutterstock

According to theAgence Technique de L'Information sur l'Hospitalisation, absenteeism is on the rise, at 27 days.

"Fatigue and exhaustion are the order of the day in hospitals today," worries Frédéric Valletoux, President of the French Hospital Federation (FHF). Hospitals are in a bad way, and the health of their staff is not much better.

And 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 on the ward are often the most effective.

Work intensification, more absenteeism

Over the past 30 years, hospitals have undergone a succession of reforms and changes in the way they are financed. They have profoundly altered the way staff work. This has not happened without putting pressure on departments already affected by work intensification, which was even greater between 2003 and 2013 than in the previous decade(Algava et al., 2014).

In addition to these factors, there are the very real constraints of numerous absences. There is a shortage of staff, and in order to provide care in spite of this, staff have to be called back on their time off. What's more, hospital jobs are subject to extreme emotional stress. This all adds up to a loss of meaning, in an activity where this is more than necessary.

In the face of these difficulties, managers are not standing idly by. The results of research carried out by our team in public hospitals and private clinics in 2016 attest to the fact that these establishments are implementing actions to prevent psychosocial risks, although it is not possible to assess their effectiveness.

These include comprehensive surveys of working conditions, more or less exhaustive diagnoses carried out in collaboration with public or private players, a wide variety of training courses (mindfulness meditation, psychosocial risk awareness, stress management, etc.) and even charters of good practice. Some structures offer the possibility of relaxing during breaks, with gyms or massage chairs...

Weariness, weariness, loss of meaning

Nevertheless, the situation doesn't seem to be changing on the ground. In all the institutions studied in the course of our research, caregivers continue to be subjected to the same constraints, with the same consequences: absenteeism, fatigue, burn-out, wear and tear, loss of meaning, a feeling of not doing their job properly.

Today, psychosocial risk prevention initiatives are primarily part of communication plans. The aim is to "show what we're doing", to restore a battered image. The perverse effect is that this discourages "good will", particularly that of employee representatives, who do not wish to be perceived as "management's accomplices".

It has to be said, too, that hospitals increasingly resemble monsters. Hospitals are grouped together into departments and professions that are all different "worlds". Top-down prevention initiatives come up against this complexity. Actions are poorly adapted to the particularities of each profession and care unit. This makes it difficult for management to ensure follow-up. For staff, these actions appear totally artificial. They are disconnected from the field, and "slide" into the organization, without changing day-to-day operations.

Tinkering with solutions within departments

In an effort to survive, it is within the departments themselves that solutions are emerging to limit suffering in the workplace. Some healthcare managers are trying to improve their staff's working conditions themselves. It's as if, faced with the constraints of the hospital and the ineffectiveness of institutional preventive measures, local "do-it-yourself" solutions, spurred on by management, were becoming the ultimate way for caregivers to protect themselves from a deleterious system.

One example is a geriatric ward that has completely changed the way patients are groomed, combining tasks carried out by a single caregiver with those carried out in pairs, and rethinking grooming tools (towel size, soap packaging, etc.) and timetables to improve both the quality of care and the relationship with the patient.

In addition, many healthcare managers are trying to reintroduce time for discussion, and to reorganize transmission times between day and night teams to make them more effective. They are also creating new discussion forums where everyone can express themselves and share what is at the heart of their job today, and the difficulties they face.

Exchanges of services and reciprocal arrangements

This informal relationship is one of support and mutual understanding. Faced with the difficulties of managing schedules and absenteeism, the aim is to find solutions that suit all parties. This often involves exchanging services around each other's schedules. However, these solutions are highly dependent on the managers who implement them, and therefore fragile.

Mutual aid mechanisms also extend to relations between healthcare managers within the same establishment, and more particularly within the same department. Equipment or personnel can be loaned between departments, and patients can be accommodated temporarily in a friendly department. These phenomena depend above all on good relations between the managers concerned.

Last but not least, caregivers also take the initiative, outside any hierarchical intervention, to find their own solutions. Sometimes, they create new rules to ensure that care is carried out in the best possible conditions (e.g., using two people to carry out care that should a priori have been carried out alone, or vice versa). They can also forge new communication spaces, such as a team Facebook group for transmitting instructions and exchanging schedules.

Replicating a successful department

We believe that based on these experiences, there is still room for concrete action on the part of managers. It's up to them to take stock of local initiatives, in their own establishments, and to try to replicate what has worked in one department in others.

The ConversationManagers can also help rebuild work collectives. From this point of view, the development of work discussion forums seems to be an essential course of action, as shown in two studies published in 2013 and 2017. However, to be fully effective, discussions need to be rooted in daily work practices and give rise to real debates. Hospitals therefore need to provide managers with sufficient resources to facilitate such meetings.

Emmanuel Abord de Chatillon, Professor, Chair 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.