How Care Settings Are Getting Healthier

By Martie Moore, RN, MAOM, CPHQ | February 28, 2019

This past week I moderated a panel at the Creating Healthy Work Environments (CHWE) conference in New Orleans. Preparing for the event got me thinking about how far we’ve come when it comes to workplace culture, and how far we still have to go. Research first emerged a little more than ten years ago that opened eyes throughout healthcare. Incivility, bullying, those hadn’t been topics of wide discussion up to that point, but once those conversations did start happening, it was like the scab had been pulled off. Many in the industry looked around and realized that their work environment wasn’t just unhealthy, it was toxic.

In 2008, the Critical Care Association (ACCN) came out with their Healthy Work Environment Standards. Many leaders, including myself, took those standards and began to put action plans together to advance their institutional culture. I will tell you this is without a doubt the hardest body of work a leader can do. When you try to call out harmful behavior, people will defend what they see as “the norm.” “Oh that’s just how that person is.” There will be a deeply engrained bias where behavior will be excused or tolerated because an individual is believed to be a “fantastic clinician.” But if people are afraid to work with them, afraid to approach them or point out their mistakes, they are by definition not a fantastic clinician. Their power persona creates safety issues that impact not only patient safety, but employee safety and the overall culture as well.

This paradigm shift around workplace culture dovetailed with conversations around safety and clinical errors spurred by “To Err is Human.” If you think about a healthy workplace environment, it’s one in which there are clear expectations around team work and mutual respect. Healthy work places are not fixated on power, control and hierarchy. I always say ‘Trust is an outcome.’ You strive for what I call a trustworthy organization. That’s not to say everyone gets to do whatever or say what they want. You create a culture that values listening, one that continually strives for empathy, observation and communication. When I said this is hard work, I wasn’t kidding.

The panel that I participated in has grown out of the research that demonstrates people are an organization’s greatest asset. Leaders have learned to buy in. There’s a huge financial incentive once you realize that culture affects recruitment, retention, burnout, clinical errors, litigation and safety measures. This isn’t just a nursing issue. The Joint Commission identified ways that provider behavior jeopardized patient safety, which led to their own disruptive behavior standards.

Certain people rely on power and control to manipulate their environment: a bully on the playground tends to be that person in adulthood. You’d hope that an industry based on care and compassion wouldn’t have room for that kind of behavior, but unfortunately that’s not the case. The CHWE panel’s research further deepens the body of knowledge around work cultures, the panel shared ways attendees could operationalize the latest strategies within in their organizations. To call efforts to create a healthy work environment a program is a misnomer. Programs start and end; this work requires a life-long commitment to safety. It may sound trivial, but as a leader if you slip once and demonstrate behavior that runs counterintuitive to your institutional values, you’ll lose trust. Leaders need to develop insight and be aware of their actions at all times. Creating and sustaining a healthy work environment takes what I call a fire in the belly. It takes that kind of passion to get everyone from the c-suite to the front line working together towards this vital common goal.

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Categories: Caregiver Readiness, Expert Views

Martie Moore, RN, MAOM, CPHQ

Chief Nursing Officer

Martie L. Moore, RN, MAOM, CPHQ, is the chief nursing officer at Medline. As CNO, Moore develops forward-thinking, solution-driven clinical programs, as well as new products and educational services. Prior to joining Medline, Martie was the chief nursing officer at Providence St. Vincent Medical Center in Portland, Ore. Under her leadership, Providence St. Vincent earned a third and fourth designation for Magnet.

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