Creating and Sustaining an Engaged Workforce in Healthcare

The workforce shortage in healthcare, and specifically, hospitals today, is a burning issue on the minds of many healthcare leaders. Currently, many people are not entering into a career in healthcare or are leaving the healthcare industry. The most frequently cited reasons people give for leaving healthcare are: the work is too demanding, feeling undervalued, and issues with compensation. Nursing retention surveys show that only 36% of nurses who are planning to leave their job are planning to look for their next position in another hospital. While there are many approaches to retention strategies, I would like to focus on the expansion of technology and communication as tools for reducing employee stress and potential medical error. Technology has the ability to make healthcare occupations less physically demanding as well as reducing procedural steps and tedious paperwork. These advances are still in the early stages of adoption in most healthcare organizations. A study commissioned by the American Hospital Association in 2001 found that for every hour of patient care, 30 to 60 minutes of additional paperwork was generated for nurses. This paperwork takes away from the time that the nurse has to provide care to patients. Nursing retention surveys have shown the importance and correlation of patient contact to job satisfaction. Medical informatics, or technology in the healthcare field, is quickly becoming more widely used in order to avoid human errors, increase efficiency, and ease the unnecessary burden of multiple steps in processes and paperwork. In addition, the increased use of technology and resulting efficiencies helps to mitigate the demand for healthcare workers. The adoption of technology in the healthcare industry has been a slow process. In 1999, other non-healthcare industries which are equally dependent on utilizing and storing information allocated 10-15% of their capital and operating budgets to improving and expanding technology. Yet the healthcare industry has devoted only 2-3%.¹ This is beginning to change, as demonstrated by the Hospitals and Health Networks Magazine "Most Wired" survey in 2003. The surveyed healthcare organizations reported that 18% of their total capital budget was allocated to technology advances, which was up from 16% in 2001. ² The adoption of technology that has improved efficiency and reduced redundant steps has been in the areas of staff scheduling, mobile communication, patient education, patient information, messaging functionality, medication administration, and nursing documentation. While technology will enable workflow and efficiency, and have the ability to assist in mitigating error, we still need to focus on the teamwork and communication skills of our healthcare workforce. Successful organizations still have to also address patient safety and incorporate factors related to the culture of medicine, the systems supporting care, and the human factor - how highly trained clinical personnel work in a highly complex environment. The basic tenet of medical culture is that well-trained individuals will deliver error-free performance if they are paying attention and trying hard. This belief is that clinicians link their sense of clinical competence and personal self-image with the absence of error. Yet we know that even in highly trained individuals, inherent human limitations and the complicated nature of healthcare make mistakes inevitable. The limitations of human performance include limited memory capacity, the negative effects of stress, fatigue, distraction and interruptions, and a limited ability to multi-task. In addition to technology, there are also some practical skills and tools that can be used to enhance communication, teamwork and reduce the potential for error. Communication errors are the most common cause of patient harm and detract from the quality of the work environment. There are several practical skills and tools that can be easily adapted and applied in the clinical environment. These include the following: (Susan: Can you provide examples of each skill or tool as it might be used in the cath lab, after the definition?) Briefings. A structured, efficient conversation for effective communication. Assertion. A model where junior team members can and will speak up if they see something going wrong. Situational Awareness. Keeping everyone on the same page. Expert-novice decision-making. Experts rapidly problem-solve by pattern matching against a large library of experience, while novices use a slow and error-prone problem-solving approach. ³ Debriefing. An opportunity for individual, team, and organizational learning after delivering care. Creating an environment that is conducive to retaining employees in healthcare is a complex task. A systematic approach to the implementation of technology and tools, as well as developing skills that increase communication and reduce redundant work, will engage your staff and encourage retention.

1. Masys, Daniel R., Effects of Current and Future Information Technologies on the Health Care Workforce, Health Care Workforce Information Technologies, September/October 2002

2. Landro, Laura. Most Wired Hospitals Enhance Patient Care through Technology. The Wall Street Journal Online. July 14, 2003. www.wsj.com

3. Klein G. Sources of Power. MIT Press, Cabridge, Mass;1998