Insights (Essays) May 2013

Do We Honour The Contributions Made By Our Most Important Asset?

Hugh Macleod and Judith Shamian


Today I am joined on the balcony by Judith Shamian, a champion for Nursing Leadership. Only one-third of the healthcare’s service value comes from its capital assets: buildings, equipment, supplies and drugs. The balance, 65–70%, is in human capital. Seemingly then, the primary task of healthcare leadership is to develop its most critical assets: its dedicated, caring people. So it is important to ask: What kind of job have we done with this incredibly vital resource? Before we can attempt to answer, we are cut off by a now familiar and critical voice, that of the Ghost of Healthcare Despair:

“You refer to healthcare workers as crucial people assets. How ironic. Since your assets are 1.5 times more likely to be absent from work due to illness or disability than people in all other sectors. Now, let’s talk about the walking wounded—workers who are on the job, but physically, emotionally and cognitively impaired. Your talk of ‘assets’ is laughable. You should be embarrassed to call yourself experts in healthcare. Shame on you for having a system that makes your staff sicker than dozens of other categories of workers in this great country of ours.”

So there. We have just had our noses rubbed in a painful paradox. How can a healing system evolve and transform itself when its most valuable components are suffering? What must the system do to outgrow this paradox? It is about something much more fundamental than strategy. All effective strategies are deeply rooted in the intent to honour the contributions made by people – especially in healthcare. It is about communicating that the system respects people. It is about expressing gratitude for the essential intellectual, emotional and physical contributions of the workforce. 

Yes, both governments and employers invest significant funds to improve the health of the staff: investments in lifts to reduce back injury, flu campaigns to reduce the incidents of flu, policies of proper masks and many more examples. The real question is how come it did not change the statistics of the incidence and prevalence of sickness among healthcare workers? Let us share our opinion which is partially evidence informed and partially informed by years of experience in leadership positions, much of it in care settings and in the arena of labour relations. Let’s start with the basics: Many healthcare providers do not feel engaged. They do not feel they are able to make contributions that impact on how the system is managed day-to-day. The literature is clear: if employees are not satisfied, challenged and motivated in their jobs, the outcomes will be less than stellar. There are studies that clearly demonstrate that productivity drops significantly when people don’t feel engaged. If you are engaged 100% with your workplace you provide 120% productivity and the reverse is correct. If your engagement is only 80%, your presence, engagement and commitment drop significantly. So how do we manage our workplaces? Does our staff feel valued? Do they feel a sense of belonging? Do we include them in our decision-making processes? Do we give them the responsibility, ownership and accountability that will empower them? Do they walk the extra mile for the organization? 

These questions and opinions provide the platform for emphasizing the role that health plays in “optimizing the value” created by “human capital” – a value that can never be adequately measured on a balance sheet. Hope and confidence grow and spread like wildfire when people feel honoured and valued. The message of being valued and respected doesn’t come from memos that are being sent out to thank and praise the staff. While staff appreciate those notes, they truly watch to see if the organizational leadership walks the talk. Penmanship and lip service can only go so far; management can’t just say they value their workers. They have to show it in real terms. Every day we hear about workload issues. Often growing workload leads very quickly to ill health and lack of engagement.

We need to understand the sources of stress. Stress can come from many sources, such as work-related stress, either because there is too much demand and not enough time (i.e., quantitative overload) or because the job is too demanding and complicated and one does not have the skills to complete the job (qualitative overload). Another source of stress described well in the literature is role ambiguity and role conflict (i.e., when an employee does not know what is expected of them in their job and/or different people have a different understanding of role responsibilities and accountabilities). If there is too much stress on the worker, they will become ill, either physically or mentally, and too often we hear about burnout. Therefore, hospitals, like other sectors, need to understand what the root cause of the stress is and provide employees with working conditions that enable them to deal with these sources of stress.

Where do we start? First, make a commitment to go beyond lip service. Take a blank sheet of paper and begin to consider all possibilities. The best investment you can make is to divergently inquire into all the ways you can enrich employee health at all levels.  Show how this investment will almost immediately contribute to improving the health of Canadians. By posing the following questions, you may begin to find an underlying pattern suggesting a deeper attitudinal paradox:

  1. How much air time at senior management meetings or board meetings is devoted to human resources?
  2. How do you select leaders to sit on Occupational Health & Safety Committees?
  3. How many CEOs or Senior Vice-Presidents take an active role in promoting workplace safety?
  4. What do people in communities of practice believe we should be doing to improve the health of caregivers in our system? What are their issues, hopes and fears?

Has our monopoly on service delivery, coupled with an expectation and history of going to the Ministry for budget adjustments, created a mindset that workplace injury, sick-time and long-term disability are just costs of doing business? In the private sector, safety connects to quality, which connects to market share, which connects to bottom line, which connects to survival.

A strategy focused on the people side of healthcare recognizes the essential intellectual, emotional and physical contributions of the workforce; it emphasizes the role that health plays in optimizing human capital. The relationship between individual health and productivity, as well as organizational performance, provides the rationale for investing in employee and workplace health. The collateral benefits that accrue from making employee and workplace health a core value will increase employee satisfaction and morale, improve labour relations and enhance public perception. What is required is the organizational will to shift from the conventional, fragmented approach – one where employee health is seen as an ever increasing cost of doing business – to a new paradigm, where investing in total health management is considered an essential business strategy. The potential return on investment impacts positively on both financial and human resources. Even more importantly, good health contributes significantly to two things that we all value highly – quality of life and quality of patient care.

A strategic focus on health and caring could be a unifying, humanistic theme in an otherwise divisive and impersonal business environment. Creating a new future of employee and workplace health will require visionary leadership, competent and focused management, and a fully engaged workforce. It will also require a sound cultural change strategy, an effective management framework and sustained commitment to disciplined action, as well as accountability to deliver.

Improving our workplace health record will improve the resiliency, adaptability, creativity, satisfaction, moral and productivity of individual workers. At the organizational level, this translates into improved performance, decreased costs and increased quality.  In other words, employee and workplace health is inextricably linked to productivity, high performance and success. A strategic focus on health and caring for employees would be a unifying thesis in an otherwise divisive and impersonal environment. Simply stated, there is no status in the quo.

The answer is simple: if we engage employees and include them in decision-making and planning, they want to be at the workplace, yet, if they feel less engaged, they are less likely to walk the extra mile. Finally, the key question is: What do we manage? In our hurry to become “sophisticated” or to be more “like business”, do we forget the face of the people that provide the care and services that makes the health system what it is? 

Next Week’s Guest on the Balcony of Personal Reflection: G. Lowe in a conversation titled “Organizational Connectivity.” 

Click here to see the First Series of Ghost Busting essays.


Click here to see essays from the Second Series: The Ghost of Healthcare Consciousness.

About the Author

Hugh MacLeod is CEO of Canadian Patient Safety Institute. Judith Shamian is President and CEO of the Victoria Order of Nurses and Professor at the Lawrence S. Bloomberg Faculty of Nursing at the University of Toronto



Anton Hart wrote:

Posted 2013/07/05 at 02:14 PM EDT

Judith -- would like to see you write more on the welfare of the healthcare worker. Not as one big blob but as individuals; distinct providers of very different services. Once you sift and separate the staff (i.e. triage them) you might have the makings of a series. Doctors are different from nurses are different from administrators are different from cleaners are different from IT providers. All, however, play an important role in the care of patients. You might find out that the answer is NOT simple. Look forward to Graham Lowe's piece; maybe you can collaborate. . . . and see what the ghost of inner angst might be looking for.


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