Staff engagement: What’s ethics got to do with it?

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Engagement of staff members and physicians is a significant priority in many hospitals, and for good reason.  At a high level, organizations with more engaged staff members and physicians perform better.  Getting more specific, the research suggests that engagement has a direct influence on a wide range of human resource factors, including recruitment and retention, job performance, absenteeism, and morale.  In the hospital context there is also a growing body of evidence linking engagement to important hospital outcomes, such as quality, patient safety, and patient satisfaction.  All of this evidence supports the old adage, “A happy employee is a productive employee.”  The challenge for hospitals is that there are a host of factors that contribute to a particular staff member’s or physician’s level of engagement, including wellness, education and training opportunities, effective teamwork, rewards and recognition, and so on.  So how does ethics fit into this picture?

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One way that ethics is directly relevant to staff and physician engagement relates to the culture of the organization, specifically whether the organization lives its core values.  There is extensive research in the business ethics literature showing that employees prefer to work for organizations that promote key ethical values and live those values on a day-to-day basis.  This is an important contributor to feeling proud to work for an organization, which is a component of engagement.

A recent article in Healthcare Quarterly reported on results from the first wave of the Ontario Hospital Association-NRC Picker Employee Experience Survey, which involved more than 10,000 employees in 16 Ontario hospitals.  The results provide us with some incredibly valuable insight into hospital staff engagement on a large scale across the Province.  One of the analyses conducted by the author was a regression analysis to identify which of the many factors contributing to engagement best explained the engagement scores.  Of the 36 factors measured, the number one factor identified as having the greatest influence on engagement scores was, I feel I can trust this organization.  Explaining the importance of this result the author notes that; “The key to unlocking higher levels of engagement is for managers at all levels to build trust with employees. Demonstrating basic respect, fairness and integrity in all dealings with staff is the basis for trust…A prerequisite in this regard is open communication.”

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The second way ethics is relevant to engagement is through the concept of moral distress, which I wrote about in a previous column.  Moral distress refers to the symptoms of stress related specifically to the experience of being unable to carry out what one thinks is morally right, or to being put in a position where one feels forced to do or go along with something one thinks is morally wrong.  There is extensive research on the prevalence of moral distress amongst nurses and other health care providers, showing not only that it is widely prevalent but also that it is directly linked to burnout, absenteeism, withdrawal, and turnover.  There is even some recent research demonstrating the prevalence of moral distress amongst health care managers.  The recommendations that have emerged from this large body of research emphasize the importance of creating an organizational culture in which there are effective mechanisms for openly raising, discussing, and resolving (when possible) ethical issues.

Although the link between ethics and engagement might not be obvious, for the reasons I’ve mentioned above hospital leaders are strongly encouraged to think about the ethical cultures in their organizations and what improvements can be made in that area to help their staff and physicians feel more engaged.

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