Is your hospital healthy? Organizational commitment promotes staff well-being: CrossCurrents Summer 2003
CrossCurrents
Rosemary is holding down a heavy caseload in her mental health clinic and is doing a remarkable job. But there are signs that
the stress is getting to her. It's early summer, and Rosemary has already phoned in sick seven times this year.
As her employer, do you a) hire your EAP firm to conduct a session on stress management for Rosemary and her equally stressed
colleagues? b) survey staff on root causes of stress and interest in wellness initiatives? or c) invite Rosemary and other
staff to take part in a joint labour/management committee focusing on workplace health?
The answer to this fictional scenario, according to those considering the thorny question of why health care workers are not
always themselves models of health, is all of the above.
Research conducted by the Canadian Policy Research Networks found that health care professionals are the least likely of all
occupations to rate their work environment as healthy. Only 16 per cent of health care workers strongly agreed that their
job allowed them to balance work and family or personal life.
Traditional measures of health problems include the frequency of time lost to illness and to incidents causing injury, says
Dr. Annalee Yassi, director of the Institute for Health Promotion Research at the University of British Columbia. In the case
of Rosemary, her employer has noted a pattern of 10 to 12 sick days each year. This isn't far off the mark for health care
workers in Canada generally, whose absenteeism rates are almost double the national average of six or seven days.
According to the World Health Organization's Task Force on Health Promoting Psychiatric Services, it is also clear that intangible factors such as workplace culture are important determinants of health. These include perceptions
about fairness of workload, personal control and input into work and management's support and vision.
Workplaces with a strong, positive organizational culture work like magnets, attracting health care workers. By the same metaphor,
other workplaces repel. Management commitment combined with worker participation can have a concrete payoff. For example,
Yassi and colleagues studied the effect of a joint labour/management program at a hospital in Winnipeg, Manitoba. The program
paid close attention to injured staff immediately following their injuries and was flexible in accommodating their return
to work. The results were dramatic - a 29 per cent decrease in time lost per 100,000 paid hours.
The Ontario Hospital Association's (OHA's) Healthy Hospital Initiative takes a similarly broad-based approach to employee health. Nineteen sites are taking part in a wellness program pilot test,
and an employee survey will be rolled out this year.
OHA wellness consultant Melissa Barton points out that, traditionally, wellness initiatives such as nutrition or stress management
have targeted the individual only. "These are important, but may not get lasting results," says Barton. The individual's control
of his or her job, and whether individual and workplace goals are aligned, must also be considered. Finally, there is the
societal arena, including the politics of health care.
The OHA recommends seven steps to implementing an effective program: getting commitment for a comprehensive approach; organizing
a committee to implement the initiative; surveying staff; planning programs and policies; implementing the program; measuring
the impact of changes and refining the program.
Barton points to innovative work at Credit Valley Hospital in Mississauga, Ontario, where the issue of personal control is
high on the agenda. "What we're really supporting is a process through which staff can control and enhance their environment,
bring up issues and deal with conflict," says vice-president Margaret Bachle, responsible for more than 1,200 nursing staff
at the hospital. Initiatives such as those outlined below are welcome, considering that nurses, the largest group of health
care workers, suffer from some of the highest rates of burnout and on-the-job injuries in the health care sector.
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Nursing "unit councils" have been established to manage issues including scheduling, intra-unit co-operation and daily challenges.
Council leaders attend conflict management and leadership workshops and meet regularly with senior staff.
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The "Our People Care" initiative empowers staff teams to take control of their work environments. A fundamental principle
is that caring for staff improves job satisfaction and, as a result, client satisfaction.
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Protocols for recognizing and de-escalating client violence have been reinforced.
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A modern facility has been equipped with a staff fitness center.
"As a leader, I must listen to what people say and be prepared to act on their ideas," says Bachle. The hospital is proud
of its track record as a healthy workplace, noting its annual sick day rate of 8.3 days, well below health sector averages.
In the mental health community, the Centre for Addiction and Mental Health (CAMH) in Toronto has begun to take a more formal
look at health promotion efforts directed at staff. A 2001 staff satisfaction survey revealed several key themes that need
addressing in terms of workplace stress, with the predominant issues being poor communication and conflict between individuals
or different levels in the organization.
"At CAMH, being a health promoting hospital means that health promotion is focused toward clients and their families, as well
as staff and the community we serve," says Peter Coleridge, vice-president of Communication, Education and Community Health
at CAMH. "Although still evolving, our employee initiatives include activities that are focused on improving physical health,
but most importantly include organizational change activities focused on enhancing autonomy and control over work conditions,
which are important determinants of health."
"Health care providers can be the ultimate models of healthy workplaces," says Barton. And workplaces that address the tangible
and intangible factors in well-being through a formal process are taking a big step toward that goal.
For more information about health promoting hospitals around the world, see the WHO Collaborating Centre for Health Promotion in Hospitals and Health Care.
Ian Kinross
Centre for Addiction
