What does healthcare need from its leaders in 2022?

March 7, 2022 Published by Sharee Johnson

During the pandemic crisis healthcare workers have pulled together to respond with military precision and peak effectiveness to meet the immediate need, to look after patients. But what of before and after the crisis? Burnout and workforce shortages already existed pre-COVID and healthcare worker wellbeing was rarely prioritised in terms of time and budget. Will it really be that different post pandemic?

Janet is a senior nurse in her department of a major hospital. When her boss is on leave she sometimes acts in the role of Nurse Unit Manager (NUM). She engages me privately to be her coach as do an increasing number of doctors. Janet tells me of various dilemmas at work and we discuss how she might choose to respond effectively to these situations in future, so that

• her patients receive the best possible care
• she maintains great relationships with her colleagues
• she can enjoy her work.

Sometimes there is an issue that needs to go higher up the organisation, or she meets a problem that is complex and needs several people’s involvement. Like when there is not enough staff for the roster and workforce have said they cannot approve a locum, or when an adverse event has occurred, and many people need follow up attention.

Janet has often struggled to describe a clear process or chain of management when she has recounted these kinds of events to me. She is not alone. Many of my doctor clients don’t know what to do, or who to tell when something needs to organisationally or systematically be managed either. In real terms no-one seems to be ‘managing’ the day to day in healthcare, meaning that many matters are left untended. Healthcare is reduced to being transactional.

Who are the managers in healthcare, particularly in hospitals?

Hospitals are full of protocol and process, there are standardised ways to do almost everything when it comes to patients. Most of these have arisen out of the worthy intention to keep patients safe.

Protocols and standard process are okay for a complicated system where the many parts follow a predictable pattern, but healthcare is a complex system, composed of multiple elements with many intricate interactions and relationships that are constantly changing. Protocol and standard process is an attempt to standardise human behaviour, which is an oxymoron!

Healthcare is made up of humans with unique circumstances who have the potential to create exceptions and new scenarios never seen before, in any given moment. A complex system like healthcare requires that those responsible for its delivery have the skills they need to respond to this ever present level of complexity. Managers need the capability to respond to the immediate situation, the people in front of them and to hold the bigger strategic and systemic perspective too.

In health there are people with titles that sound like they are managing … practice manager, general manager, chief medical officer, nurse unit manager. Well intentioned people, usually with a lot of frontline experience with patients, responsible often for training of junior staff and according to the stories my clients relate, little expertise in management.

Healthcare organisations have not invested time or money developing people who can provide effective management throughout the system. For example, Heads of Departments are sometimes not paid much more for the extra responsibility they take on. The new title recognises them as senior, giving them more power in the hierarchy, they attend a lot more meetings and usually become less available to guide junior staff. They are only sometimes offered leadership training and rarely mentoring that is specifically focused on managing people. If you have never been taught yourself how to take good care of people at work, you can hardly mentor anyone else.

When I first started coaching doctors I was struck how many doctors had sought out community leadership programs in their own time in order to gain some bearings to manage their teams. Why weren’t the organisations upskilling them for leading teams in the same way they required updated technical and clinical skills?

Doctors who take on a wellbeing officer role in their department are rarely given time or budget to achieve the stated goals of well healthcare staff and the result is too often that their enthusiasm for wellbeing programs is eroded. Then these doctors who can see the gap blame themselves for not managing effectively when nothing much changes. Let’s be absolutely clear zero resources equals zero priority and that signals – we don’t really care about your wellbeing.

Management skills in healthcare

The corporate world understands that management of people and systems is a big ask and has spent decades learning about what skills and support managers need in order to do well. Whilst they don’t have it all resolved they have learnt a great deal that could help us in healthcare.

Healthcare is accepted as complex no matter which country or model you review. In just about every healthcare system around the world there are issues of competition for resources, access equity, staff shortages and provider burnout.

The pandemic has served to increase the stress for all of the participants in healthcare, not least the frontline managers. High levels of organisational and individual stress and fatigue can create a hot bed for conflict, confusion, ambivalence and uncertainty, especially once the crisis is over. One of the risks is that burnt out, fed up, exhausted workers (including doctors) leave the system all together. A reality frequently reported in the American media in recent months with the so called Great Resignation seeing one in five healthcare workers resign in the US.

In January 2022 Jenifer Robinson, Senior Editor at Gallup wrote that worker wellbeing has “generally dipped during the pandemic” and that has “damaged organisations”. We have seen very high levels of stress and anxiety in healthcare during the pandemic and many experienced people have considered leaving their job. Such loss of workforce will be a critical hit for healthcare that we all should be concerned about, there is no healthcare without experienced doctors, nurses and allied health professionals to teach the next generation of caregivers.

So what can leaders do to help managers?

Robinson identified three things leaders in business should focus on in 2022:

• Communicate often and clearly
• Develop well-prepared managers
• Make wellbeing the business of your business.

In her article Robinson wrote that Gallup has found that “higher levels of organizational wellbeing track with lower levels of employee burnout, stress, worry, anxiety and depression — while boosting trust, innovation and resiliency. Even engaged employees who are not thriving in their wellbeing have a higher risk of burnout.”

In other words, wellbeing of the workforce is central to business – to delivering. Healthcare is a business that cannot deliver any of its stated goals without a well effective workforce. I consider it a silver lining of COVID that this is now squarely on the agenda. But you might have missed the last sentence, these are the critical words to my mind:

‘… even engaged employees can burnout if they are not well…’

Have you ever been engaged in your work and unwell at the same time?

What does it look and feel like?

Do you believe that you can deliver optimal care in this state?

Are you more at risk of error when you are unwell, even though you are keen and engaged in what you are doing?

Healthcare professionals around the world have shown us how engaged they are in patient care these past two years. For many their work is a vocation. Wearing PPE for 12 hours at a time without food or proper hydration, working too many shifts because colleagues are furloughed, feeling scared about bringing COVID home to their own family and still showing up, quarantining without pay however, has seen even the most devoted, engaged doctors, nurses, psychologists, chaplains, caterers and others burnout. Having sacrificed their own wellbeing for the greater good and for the next patient in front of them.

Most healthcare workers are incredibly committed to their work, they genuinely want to help the patient, many describe their work as a calling. These people are deeply engaged in their work. In the case of doctors and specialist nurses they have often spent ten or more years in difficult training programs building their expertise. AND, it is not enough to protect them from burning out. If you are unwell and no-one cares or manages the situation, even if you love your job, Robinson reminds us, it’s not sustainable.
Research has shown that fatigue affects our performance. In the case of healthcare workers they are more likely to make an error that has a negative impact on their patient’s health outcomes if they are fatigued or distracted as a result of stress or burnout. If they are not well – fatigued, stressed, sick – they are more likely to make an error and each error has the potential to increase their risk of overwhelm, anxiety, depression and burnout.

Robins concludes that “wellbeing is a leadership issue”.

As I read Robinson’s article extrapolating the Gallup findings to health I kept wondering how when managers are non-existent or without the necessary capability. Robinson encourages manager development because they are the people closest to the employees, they know them the best. The manager is the messenger, bringing wellbeing efforts to the people, she wrote.
I agreed with her conclusion that “development turns bosses into coaches.” And celebrated at this
“And highly effective coaches, Gallup data show, achieve better wellbeing, engagement and performance outcomes”.
Coaching is a booming industry, growing at 12-15% per year, largely because over the last three decades business has discovered how effective it is at developing people. Add to that a growing acceptance of meeting online, and coaching has well and truly arrived as a mainstream response to skill development, wellbeing, performance and self care. Chevron provides a corporate example employing a coach for all of their supervisors and managers and 94% of them saying it has provide high value. Imagine if every nurse, doctor and head of department in the hospital routinely attended leadership programs that included coaching… what difference do you think it would make?

As Josh Bersin noted in 2021 “Very few business people will tell their boss, peers or subordinates they’re having problems…. It’s almost impossible to ask a work associate for in-depth help when you’re struggling. This is what great coaches do.” Why would managers and leaders of teams or departments in healthcare be any different? They are working in a competitive environment and also deeply engaged in reputation management. Adults do not like asking for help or admitting mistakes, a coaching culture helps counter these barriers to learning. The coachee benefits and those they lead can too.

Healthcare is different to business in a myriad of ways, but not in the fact that both are coordinating and encouraging groups of people to work together to achieve a goal. Healthcare has not taken the time to develop its managers or in many cases to even identify what it means to be a manager. It’s high time it did, and it can start by providing coaching to every supervisor and manager. Now that would be systems change that would send a clear message that we really do care about you. As a healthcare manager how do you feel when your employer’s actions indicate – We want to help you build the skills you need to be fit for purpose, to manage effectively? Such a change of attitude and culture could truly transform healthcare.

Robinson’s advice for business is just as relevant to healthcare as it emerges from two years of crisis. Leaders need to:

Continue their more recent regular and clear communication demonstrated throughout the pandemic
Actively prioritise the development of well-prepared managers. Provide budget and systems to help managers understand their role, to take care of their teams. Use coaching throughout the organisation to upskill managers and lift capacity broadly
Make wellbeing the business of your business – take it seriously by taking visible action. An engaged workforce who is also well is sustainable. It’s up to leaders to provide the conditions for workforce wellness, it won’t happen by accident. Make healthcare worker wellbeing your first priority, the rest will follow.

[1]

https://morningconsult.com/2021/10/04/health-care-workers-series-part-2-workforce/

https://www.theguardian.com/business/2022/jan/04/great-resignation-quitting-us-unemployment-economy

https://hbr.org/2021/09/who-is-driving-the-great-resignation

https://www.9news.com.au/national/coronavirus-nurses-exhausted-healthcare-workers-quit-amid-major-staff-shortages-during-covid-19-pandemic/a9fece72-4948-4267-8423-3a9afe092dd0

[2]

https://www.gallup.com/workplace/389036/leaders-focus-2022.aspx?utm_source=linkedinbutton&utm_medium=linkedin&utm_campaign=sharing

[3]

https://joshbersin.com/2021/12/the-flourishing-surprising-badly-needed-market-for-online-coaching/

[4]

https://joshbersin.com/2022/01/online-coaching-is-so-hot-its-now-disrupting-leadership-development/

[5]