​New Brunswick Health Care Reform: it better be bold!

Recent headlines by other professional writers in Brunswick News have said:  Build Back with Private Health Care, and Fourth Wave Highlights Health System’s Fragility.  Both articles were superb in content and challenging thoughts.  It is nearly the end of October 2021 and those observing the scene are waiting anxiously for the reforms promised by Premier Higgs to be announced.  The public knows the system is broken, nurses and many physicians know it is broken.  Most with whom I speak have limited confidence that government can, in fact, rescue the system.

The pandemic has taken a toll on everyone who works in the health and long-term care system and has forced a level of change and disruption totally unheard of in modern times.  It has, in fact, robbed many great people of what once was the joy of going to work every day.  The distress felt within the system, particularly the hospital and long-term care sectors, is made so much worse by virtue of the place from which it all started in early 2020.  The pandemic has tested every health and long-term care organization; those with great workplace cultures at the beginning tend to fare well as they work through any crisis.  If the workplace culture has elements of toxicity, undue work stress, internal communication issues then working through any crisis, let alone one that is prolonged for two years, is a formula for disaster.

Long before the pandemic, signs and symptoms of workplace culture issues in health care were mixed.  We heard frequently about the high use of sick time, always a symptom of workplace culture issues.  We heard saber-rattling about unhappiness with levels of compensation and terms of engagement.  For years the media has had regular stories about overcrowding and the huge pressures of overflowing emergency departments.

At the heart of all this, and other issues, is one simple thing:  Workplace Culture!  Nowhere in the training of nurses, doctors, accountants, lab professionals, or the preparation of governing board members is there a course or training on how to develop and maintain a positive work environment in hospitals!  There is no university Workplace Culture 101!

In response to many of my previous columns I have had response from physicians and nurses alike, both current and retired, about elements of work environment and, for the most part, people would not use the term “culture” per se but that is what they spoke with me about.  Repeatedly the phrases they used were: “we have no voice”, “they don’t listen to us”, “too many desk jobs; don’t know what they do”, “I am burned out”, “can’t get decisions.” This is not the language of a healthy culture.  Admittedly there are people in every organization who represent the “out-lyers” but these themes have been far too common from people within the system as to suggest good organizational health.

There are many wonderful people functioning within the health authorities who give it their all every day and continue to learn, grow and give terrific service.  My family has been on the receiving end of some great care.  But in examining the overall picture and looking at the numbers, another story emerges.  So, if we can support those who deliver the everyday great service while correcting the sources of those other messages, these ships can be turned around!

But turnaround does not simply happen with a change of the guard!  Or by political announcements to hire more nurses and doctors.  It must be borne of strategy that enjoys enthusiastic support and investment by the highest authority, be it the board or the premier.  There are many tools for culture reform in the healthcare marketplace such as Planetree, Character First, and many more.

In the United States, in the early 1980’s, the American Nurses Association decided to stop talking and start acting and took the lead in establishing the Magnet Hospital Movement and Certification Process.  I checked this out in 1988 while working at the Kingston General Hospital in Kingston, Ontario.  At that time, all hospitals in Ontario were experiencing the same shortage of nurses with recruitment challenges…. except one!  Mt. Sinai Hospital had long been known for a strong and powerful workplace culture that attracted the best!  They then went on to become the first Canadian Hospital to become certified as a Magnet Hospital.

In continuing our research, we learned that already some of the great hospitals in the US had signed onto the Magnet Hospital Movement so we visited New York City Medical Centre in Manhattan. What we learned was transformative and sealed my fate for the rest of my career as a strong advocate for Workplace Culture reform.

Benedictine University in Illinois studied the Magnet Hospital phenomenon and identified 14 characteristics that set them apart from ordinary hospitals.  With these characteristics organizations cannot pick and choose but must be sold on and committed to each to be manifest in their daily operations.

1. Quality Leadership:  people with knowledge of and love for the hospital sector with serious training and demonstrated talent in leadership.  This starts with the CEO but extends to all who perform managerial functions.
2. Organizational Structure:  lean, flat, decentralized with decision-making close to the bedside or lab bench.
3. Management style:  leaders who delegate with authority, support, and empowerment; leaders who are visible and engage in being accessible to all in the organization.
4. Personnel Policies and Programs:  emphasis on flexible work hours, self-scheduling, policies that support employees and their well-being.
5. Professional Models of Care:  Nurses are expected to function as role models, demonstrating professionalism in all their work and interactions.
6. Quality of Care:  not only words but corporate insistence on care being delivered that prioritizes quality.
7. Quality improvement:  continuous quality improvement replacing the out-moded and conventional “medical audit” or Quality Assurance Committee”.
8. Consultation and Resources: the presence in the organization of persons with advanced knowledge and experience in various clinical fields who willingly and with skill share their insights to staff challenged each day with new issues of care.
9. Autonomy and Empowerment:  Functioning at full scope of practice, nurses are trained then enabled to function without needing to seek approval for steps for which they have been trained.
10. Community Presence:  great reputation in the community as a hospital with great care, workplace culture.
11. Nurse as a teacher:  roles are developed to the point that nurses are seen and respected for their ability to teach others, their patients, families.
12. Image of Nursing:  the image of nurses is developed to the point that nurses feel pride in themselves, in their profession in every way.
13. Interdisciplinary relationships:  a hallmark of great hospital culture is the vibrancy of the relationships that take place between and amongst professional staff.  Is there mutual respect, collaboration, programs that fully engage all professionals or is there a presence of defensiveness and “turf protection”?
14. Professional Development:  great hospitals invest significantly in continuing education and career development of staff.  Everyone wants to be recognized, appreciated, and have the respect of their employers manifest in the investment in employees’ career development.
    
    

These are the qualities of Magnet Hospitals as measured by the American Nurses Association Credentialling Centre and great hospitals such as the Cleveland Clinic, Mayo Clinic, Mt. Sinai Hospital and 563 more!  If government is serious about announcing strategies that work for recruitment and retention of staff, a laser-focus on culture is essential, learning from the best.  As the Costco founder, Jim Sinegal, says: “Culture is not the most important thing….it is the only thing.”
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Ken McGeorge,BS,DHA,CHE is a retired CEO in major teaching hospitals and long-term-care facilities. He was co-chair of the New Brunswick Council on Aging and is a columnist with Brunswick News and is the author of Health Care Reform in New Brunswick, available at www.kenmcgeorge.com;  His email address is [email protected].