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Laying the foundation for a healthy staff culture

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Low staff morale. It’s the carbon monoxide of health care cultures.

Indeed, problems with employee morale can lead to a host of unpleasant side effects, including, but not limited to, burnout, increased employee absences, lower staff retention rates and, of course, deteriorating quality of patient care.

Healthy staff culture can help contribute to excellence in patient outcomes. Developing and maintaining a strong, healthy organizational culture is achievable. However, it requires a genuine, ongoing commitment from hospital leadership and vigilance to ensure the mechanisms are in place to help foster high staff morale, to monitor for potential warning signs and to address them in a timely manner.

Root causes

In my travels working with numerous health care organizations that have implemented changes to their nursing teams over the years, I’ve observed four common culprits responsible for eroding staff morale and, in turn, contributing to unhealthy cultures:

Perceived lack of empowerment: A nurse may be the most relevant care provider because of their close contact with a specific patient, but they’re often excluded from the decision-making process. They’re concerned the change may lead to poor patient outcomes but their knowledge isn’t considered. The result? Feelings of helplessness that lead to poor morale.

Feelings of insecurity regarding stability of employment: Leaders within many hospitals that are actually scrambling to fill nursing vacancies would be shocked to learn how many of their nurses struggle with chronic feelings of insecurity about the stability of their jobs.

Workload challenges: Dealing with unmanageable workloads for an extended period can also impact staff morale. There’s nothing as heartbreaking as a health care provider who wants to provide the best quality of care possible, but simply isn’t able to because of the growing pressures of today’s workloads.

Lack of trust in their employers and each other: Once an employee feels their trust has been violated, it’s extremely difficult to restore and morale problems can follow. Imagine a hospital that reduces staff numbers with a promise that they’ll add staff when the acuity level increases. For whatever reason, they’re unable to deliver on their promise. Despite good intentions, a promise is broken and morale suffers.

10 tips for fostering optimal employee morale

As with your health, poor morale and toxic cultures are much easier to prevent than they are to fix once the damage has been done. With that in mind, here are 10 tangible ways to lay the foundation for a healthy culture.

  • Remember the ‘why’: Ensure everyone understands the motivation behind the change. It’s easier to embrace change when we understand it’s based on sound reason and need.
  • Focus on the patient: Nurses and other members of the health care team are motivated by their ability to provide excellence in health care. Leading change through the lens of quality of care can keep care providers engaged and energized.
  • Monitor for misunderstandings: Sometimes, what leaders believe they said isn’t what employees believe they heard. Checking for mutual understanding can prevent issues down the road.
  • Ensure role clarity: Role clarity translates into a sense of purpose. Use strong role descriptions to avoid confusion and misunderstandings.
  • Empower staff: Involve staff in decision-making. Really involve them. Not just as a formality, but base decisions on staff input. Transparency and input greatly improves the chance of buy-in.
  • Be visible, be a resource: Nurses within strong teams have identified access to their manager as being significantly linked to job satisfaction. Carve out time to be accessible to staff. And senior management need to facilitate this by ensuring a manageable span of control.
  • Build trust: Keep your promises to staff. They’ll understand changes are needed if they know you’ll provide them with what they need to keep patients safe. Ensure consistency between your words and actions.
  • Watch for moral distress: Workplace stress is a reality. But when uncontrolled, care providers can feel ‘moral distress’ related to their inability to provide the quality of care that they want to, which can lead to burnout and disengagement. Regularly review nurses’ perceptions of the quality of care they’re able to provide.
  • Model humility, flexibility, respect and caring for others:  Assuming employees know how you feel about them is a recipe for disaster. When you’re proud of what you see, tell them. It will be a welcome surprise.  Recognize their expertise and follow their lead when possible. Seek feedback on what your staff most need from you each day. Be okay with being wrong.  And hold people accountable for the way they treat one another.
  • Socialize and encourage fun: Nurses and other care providers thrive in busy organizations in part because of the strong bonds they have with each other. Strengthening and celebrating that bond will go a long way to ensuring a strong team that can weather adversity.

Low staff morale comes at an incredibly high cost. And just as we tell patients that prevention is the best medicine, the same principle applies with fostering a healthy workplace culture. By implementing the proactive, strategic measures outlined above, health care leaders can help to prevent these problems and issues from taking hold in the first place.



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