Photo by Joshua Earle | Unsplash
Health systems around the globe have been under extra strain during the past few years, but at Mbingo Baptist Hospital in Cameroon, the challenges have been particularly acute. “For some time now, there [has been a] war ongoing in our region,” said Tumi Divine Bahtila, MD. “So, the pandemic came on top of the war.” Because of the danger their region was already experiencing, he and his staff waited for COVID-19 and feared the worst for their region. “Everyone was scared, including myself,” Bahtila recalled.
Elsewhere in the world, the pandemic and other factors have led to high staff turnover and staffing shortages. There has been a wave of retirements, and many employees have been leaving the health care profession. “We have a workforce crisis in the NHS,” said Gillian Long, Associate Director at the Newcastle Upon Tyne NHS Trust. “We had one before the pandemic, and the pandemic has exacerbated it.”
These conditions both highlighted the need for workforce well-being and posed barriers to achieving it. For support, the teams at Mbingo, Newcastle Upon Tyne, and other health systems turned to IHI’s Joy & Workforce Well-Being Results-Oriented Learning Network (ROLN).
The ROLN is a collaborative launched by the Institute for Healthcare Improvement (IHI) for health care organizations looking to boost joy in work, increase staff engagement and productivity, and improve the overall quality of care and experience for staff and patients. The network, which initially launched in March 2020, just completed its second wave.
Teams engaged in the network faced a variety of challenges. As Lisa Melink, Manager of Employee Well-Being Services at UC (University of Cincinnati) Health put it, “Although I am certain our employees want to feel more joy in work, it’s surprising how hard it is to help them get there.” She added, “Culture change, even toward something your employees are in great want of, is really challenging.”
This is the paradox of efforts to improve joy in work and workforce well-being: staff are often already stretched thin, and efforts to increase joy can add to their workload. “How do you frame this work in a way that it’s not just one other item on the to-do list?” asked Jennifer Molano, MD, Associate Professor at UC Health. Ebenezah Otoo, Continuous Quality Improvement Specialist at Dartford and Gravesham NHS Trust said, “No one’s not wanted to do it. The biggest thing is just the time.” The challenge, he added, is “trying to support people to be able to do it.”
Several teams faced bureaucratic hurdles to implementing certain tools. “We could not administer anything in the hospital without getting Institutional Review Board (IRB) approval,” said Bahtila of Mbingo. They had to write a protocol, which took some time to be reviewed and approved. Other teams also mentioned that they had been unable to do certain things without IRB approval, such as administer the Mini Z (a tool originally developed to measure physician burnout), which slowed their progress.
One important strategy the teams discovered was to change their mindset about the ebbs and flows of their work. As Melink of UC Health said, “Success is not a straight line.” She recalled a time when her team had paused their work because they did not have enough staff. They felt stuck and were trying to figure out what to do next. They attended a monthly ROLN session that happened to focus on meeting people where they are. IHI helped them realize, said Melink, that “just because we were stopped did not mean we were failing.” Her team also came to see roadblocks as opportunities to learn. “As we were struggling, our mentors at IHI modeled what we needed to do for our staff,” Melink recalled. Her advice: “Just be patient, acknowledge the obstacles, and don’t let them stop you.”
Another key to overcoming challenges was to ensure adequate time and resources for the work. Harold Mark Livingston, DDS, MS, Chairman of Hospital Dentistry and Advanced General Dentistry at the University of Mississippi Medical Center (UMMC), advised that the team lead needs to have “carved-out, protected time” to do their work. Otherwise, as the lead, “you get more stressed trying to help other people get unstressed.” If he had it to do over again, Livingston added, “We would have figured out a way to spread out [the work] a little more or pick someone to lead who could unplug from the day-to-day a couple half-days a week.”
Livingston also noted the importance of distinguishing between where you can make positive change and where you need to accept certain facts of life, such as bureaucracy. Eventually, he and his team learned not to “keep banging our heads against the wall about things that are just not going to change,” he said. “Fill out the forms you have to fill out. Don’t let it live rent-free in your head. Get over it and move on,” Livingston advised.
At UC Health, staff sometimes questioned whether joy in work was an appropriate goal. They wondered if it made sense to be joyful when working with very ill people. To address this thoughtful concern, UC Health leaders made it a priority to convey to the staff that workforce well-being is connected to patient outcomes. While Melink and Molano recently presented to the UC Health family and patient advisory council, Molano had a revelation. “It was a big aha moment for me that our patients care about [care provider well-being] because it directly affects them,” she recalled. Their team hopes to make a video of a patient on this advisory council explaining that they care about providers as people. “Our patients want our caregivers to have joy in work,” said Melink. “We need to make the connection that joy in work is something you do for yourself and for your patients. It’s win-win.”
At Mbingo Baptist Hospital, they put boxes in the ward where staff members are invited to drop color-coded pieces of paper indicating how their day was: yellow represents a good day, red represents a bad day. “At the beginning, the number of good days was far, far smaller than the number of bad days,” said Bahtila. Given the external circumstances, it would perhaps be unrealistic to expect a dramatic change, but after participating in the ROLN, that disparity has begun to diminish.
“It is a privilege for me and for my team to be part of this,” said Bahtila. “And we want to stay as part of the Network and keep learning.”
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