Feature. Managing Workforce Health and Wellness

Transcription

1 Feature Managing Workforce Health and Wellness Karen S. Ward, PhD, RN, COI, Leigh Ann McInnis, PhD, FNP-BC (School of Nursing, Middle Tennessee State University, Murfreesboro, TN) DOI: /UQP7HTR8EATFQHVM labmedicine.com Downloaded from June 2008 j Volume 39 Number 6 j LABMEDICINE 325

2 Many factors are putting the health and wellness of today s health care workforce at risk. A number of these factors are related to the shortage of health care professionals. This shortage is a concern for all stakeholders, including the public served by it. Issues such as workplace violence, substance abuse, and medical errors are making headlines. It is a critical time for administrators and practitioners to explore ways to create and maintain a healthy workforce. Factors that health care professionals should consider when choosing employment are presented here, and suggestions are made for making a difference in creating a healthy environment and quality patient care. Managing Workforce Health and Wellness A breakdown in the health care workforce can have a direct impact on patient outcomes. Thus, it is essential to create and maintain a thriving, healthy workforce. Researchers agree that a healthy workforce reduces the risk of work-related injuries, diminishes sick-time use, and improves employee morale. 1 In the health care field, health and wellness are defined similarly. Health and wellness are much more than the absence of disease or dysfunction. These terms refer to the capacity to efficiently respond to challenges and successfully restore and maintain balance. Currently, there are many factors intersecting to create a crisis for the health care workforce. We will provide a review of the challenges as well as methods that may be used to restore and maintain health and wellness in the group. Laboratory personnel face many issues in today s workplace. Many of them are related to rapid changes in technology and an insufficient number of laboratory professionals. Recent discoveries in science and medicine increase the number and sophistication of laboratory diagnostics. Continual changes in technology are driving the shift toward automation and cost-effectiveness. During this period of rapid change, the laboratory profession is experiencing a significant personnel shortage with high rates of vacancy in clinical laboratories. According to a laboratory professional from a small facility, extraneous frustrations of billing and insurance and staffing laboratories from a small pool of employees are significant problems in small offices and labs. Clearly, many factors are intensifying the shortage 2 including the coming retirement of individuals from the baby boom generation, the diminished number of individuals entering the profession, and the difficulty retaining qualified and experienced personnel. 2-4 Although recent efforts to correct this problem have lessened the shortage, additional strategies will need to be initiated in order to resolve the situation. 4 It is imperative that an adequate number of appropriately educated and trained laboratory professionals be prepared to meet the growing and changing needs of the medical environment. 3,5 Without some resolution to the problem, those individuals planning their lives post-retirement must question the quality of their health care in later years. I worry that when it s time for me to be on the receiving end of health care, there won t be anyone there to take care of me! laments one worker close to retirement. Job satisfaction and employee retention are having a significant impact on the shortage of health care workers. There are many components to job satisfaction. The job satisfaction of health care workers is related to participation in decisions, a safe and clean work environment, satisfaction with the job, high-quality management, fair salary and benefits, 6 and reasonable workload. 7 Dissatisfaction is associated with limited upward mobility and low pay. Laboratory professionals want better salaries, increased opportunities for career advancement, a variety of duties, and control over their own work methods and pace. 6 One professional, who has moved out of the laboratory to pursue other interests, cited concern with personal safety from contamination as a key issue. Workforce Challenges Retirement Changes in the demographics of laboratory professionals and the aging of Americans in general are exacerbating the impending shortage of laboratory professionals. The baby boom generation is approaching retirement age. This will affect the shortage of health care professionals in three ways: by increasing the demand for health care, by causing a substantial loss of experienced personnel, and by decreasing the number of workers in the health care profession. 7 A shortage of providers increases workload. Double shifts, overtime, and demands for faster turnaround lead to burnout, exhaustion, and potential medical errors. 7 Cross-training, temporary staff, float pools, and financial incentives are a few strategies that can be attempted; however, as health care becomes more complex, these approachs may be less practical and they also bring their own sets of challenges. Lemons 8 proposes that the projected retirement of the baby boomers may not be as bad as predicted. In part, this is because many individuals do not have sufficient financial security for retirement. In addition, individuals want to stay active and are working beyond retirement. Since the baby boomers have a high level of skill, knowledge, and a strong work ethic, keeping this generation in the health care profession should be a priority. Retaining boomer talent and experience will require flexibility and creativity. Reduced hours, job sharing, float pools, and temporary staffing are potential strategies that can be used to entice workers to stay with their organizations. 8 Recruitment The Bureau of Labor Statistics (BLS) projects that by the year 2012 we will need 137,000 more laboratory workers than we had in the year The ability to correct shortages is directly linked to the perceived desirability of the careers in the health care arena. Salaries are a major cause of attrition in health care professionals, and earnings of laboratory professionals have not kept up with other medical professions (Table 1). For the shortage of laboratory professionals to improve, salaries must increase. The current workforce is driven more by salary and Table 1_Laboratory Professional Earnings ($/hr) Hospital Physician Office Private Clinic Laboratory Cytotechnologist Histotechnologist Medical laboratory technologist Histotechnician Medical laboratory technician Phlebotomist American Society for Clinical Pathology, 2003 Downloaded 326 from LABMEDICINE j Volume Number 6 j June 2008 labmedicine.com

3 economics than those in years past. 7 Additional economic strategies include sign-on bonuses, retention or referral bonuses, student scholarships, and relocation assistance. 7,9 Attention to salary alone, however, is insufficient to address job satisfaction and the current shortage. Those thinking money is the big answer have missed the boat, says one consultant. We must attract a greater number of individuals into the profession by modeling a respectful, supportive, and challenging work environment. A vice president for patient care suggests that few things are more important than respect between colleagues. We will need to increase awareness of the many options available for laboratory professionals. In addition to hospitals, there are many other settings available, including off-site laboratories, outpatient facilities, rehabilitation centers, and home health agencies. Once individuals have entered the profession, practitioners and administrators must work together to provide work environments that nurture and strengthen the profession. Summer camps and health fairs that provide opportunities to interact with laboratory professionals would be excellent ways to model the profession. As retirement of the Silent Generation is nearly complete and the baby boomer generation retires, we must identify ways to attract individuals from Generation X and Generation Y, also called Millennials (Table 2). 10,11 The Millennials and Generation Xers are not as fond of the hierarchical management structure as were previous generations. The Xers, in particular, expect leadership based on competence. They want to be mentored and given lots of feedback. These individuals prefer limited bureaucracy and enjoy working independently. They multitask well, balancing work, home, and recreation. 10,11 Offering this generation of employees the opportunity to schedule their extra shifts and earn rewards and benefits provides incentive to stick with their career choice. Millennials are self-confident and goal-oriented. They are used to instant communication and want flexibility in the workplace. This is a digital generation that takes technology for granted, an expectation in a work environment. Generation Y employees are a great resource for employers. In order to attract and retain these individuals, employers can provide challenging projects. For example, employers can ask this generation of laboratory professionals to find technological solutions to daily problems in the workplace such as the scheduling system. 12 Table 2_Progression of Generations Name of Generation Birth Years Silent Generation Baby Boomers Generation X Generation Y (Millennials) Generation 9/ present Retention Retention is an immediate challenge with many benefits to retaining staff. Retaining staff decreases training time, improves the quality of work, and increases productivity. If employees are retained, costs for the employer decrease through lower recruiting and training costs; however, most importantly, retention improves recruiting because potential employees recognize an exceptional and healthy work environment. 6 As noted previously, job satisfaction is a key component to recruitment and retention. Although benefits and salary may keep employees from leaving their jobs, it is career advancement opportunities and challenging and interesting work that prompt employees commitment to an organization. 6,13 According to researchers, laboratory employees who responded that they made a good salary, had autonomy in their positions, and felt respected and valued were happier with their positions and were less likely to leave them. The ability to control work schedules and tasks can improve job satisfaction. Recognition from those outside the immediate work environment is an essential element in creating high morale. A former administrator agrees: Open communication is a huge factor in keeping a healthy workforce. Allowing staff to do their jobs and showing employees the respect they deserve creates a sense of loyalty and pride that makes people want to stay. Organizations should strive to provide an environment that supports and nurtures current employees. This endeavor will improve retention and recruitment. Potential employees will network with current and past employees to explore their current job opportunities, and satisfied employees have a positive influence on job seekers. Improving retention decreases costs for the organization and minimizes lost productivity, administrative time, and training. 15 It is a win-win situation for all stakeholders. As with recruitment and retirement, generational differences are a factor in retention. In a study of attrition and retention of laboratory professionals, 4 a greater number of employees are lost in the first 5 years of employment. It is theorized that this may be a reflection of the differences between the existing work environment and the needs and desires of the younger generations. These generations require flexibility and are motivated more by money than previous generations. When staff have a voice in decision making, Downloaded labmedicine.com from June 2008 j Volume 39 Number 6 j LABMEDICINE 327

4 and shorter. They range from 2 to 6 hours with variable start times that are attractive to parents or individuals with other commitments. This allows managers to bring in extra health care providers during busy periods. 9 In addition, certain perks, such as fitness centers or health-club memberships and on-site daycare facilities, are not only attractive in themselves, but they foster wellness and demonstrate an interest in the employees peace of mind. One of the more innovative projects that may appeal to the younger generation is shift bidding. Shift bidding technology lets managers post vacant shifts online. Qualified staff can then bid for these positions. In this way, staff can choose their own overtime. Percent bidding has been useful in retention of personnel. Percent bidding begins with the employee s base pay, allowing employees to bid the percentage down in increments. Because this is based on the employee s base pay rate, it is easy to understand and rewards staff that remain with the organization. The longer you are employed, the larger the base rate. they feel part of a team that is working together for the betterment of the patient, offers a senior executive in health care. I agree, says one employee. Administration underestimates the importance of relationships with all of the staff personnel want input into decision making, want to be treated courteously, and want acknowledgement for doing way too much with way too little. There are many possible approaches to improving flexibility for employees and meeting the needs of the organization. For new employees and those from younger generations, flexibility is critical. Letting them create their own schedules and involving them in the process will help keep them engaged with work and the organization. 15 In order to allow this flexibility, it may be wise to keep a pool of potential employees, thus limiting the loss of experienced workers and alleviating the increased workload that can accompany a shortage. 15 There are many innovative approaches being used across the country in response to the shortage of laboratory personnel. At one institution, employees are encouraged to take on extra shifts and thereby accumulate points for incentives in return. Points can be traded for cash, massages, gift cards, continuing education, and other similar items. This opportunity is offered to all employees. Another employer offers seasonal contracts, including 4-, 8-, 12-, or 16-week contracts with higher pay, but no benefits. At the Cleveland Clinic, an innovative approach is used to address the shortage of health care professionals. Parent shifts are used to retain employees with responsibilities limiting their ability to work long hours. These shifts are flexible Healthier Workplaces It is the responsibility of leaders and managers to ensure a safe work environment and to adequately train and educate their employees. One health care professional claims that concern with injury and violence in the workplace is perhaps the number one issue detracting from healthy work environments. Employers must educate employees on potential dangers facing them in their jobs. Plans must be in place so everyone knows how to deal with things when they arise. One long-time laboratory professional contributed, Supervisors must be knowledgeable about current research regarding safety precautions for their workers. While following through with all rules and required behaviors, it is the leadership who sets the practices. The current shortages certainly contribute to the possibility of hazardous workplaces. Inadequate staffing tempts workers to take shortcuts in order to get the increasing volume of work accomplished due to decreasing numbers of personnel. Laboratories are not the only area experiencing shortages. The other health care disciplines (nursing, medicine, pharmacy, occupational and physical therapy) are also experiencing a decrease in the number of qualified applicants and workers. In response to multiple concerns regarding the shortage of health care professionals, job dissatisfaction, and medical errors, the American Association of Critical-Care Nurses (AACN) spearheaded a movement to address patient safety and healthy work environments. 16 Focus groups and extensive discussions across the country validated the information gathered in a review of the literature on healthy work environments. In health care professions, the practice environment greatly influences recruitment and retention. Work environments based on silence, defensive behaviors, and inappropriate deference to authority are mentally unhealthy and put patient safety in jeopardy. 17 The same health care professional quoted above observed that substance abuse can be one of the issues ignored and kept silent. When the workplace does not openly address an issue like substance abuse, both colleagues and patients are in danger. We have a responsibility to speak out when we see abuse occurring. Failing to communicate with colleagues regarding concerns about competence indicates a lack of trust and safety in the work environment. 16 The AACN published AACN Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Downloaded 328 from LABMEDICINE j Volume Number 6 j June 2008 labmedicine.com

5 Table 3_The Standards for Establishing and Sustaining Healthy Work Environments Skilled communication True collaboration Effective decision making Appropriate staffing Meaningful recognition Authentic leadership Laboratory professionals must be as proficient in communication skills as they are in clinical skills. Laboratory professionals must be relentless in pursuing and fostering true collaboration. Laboratory professionals must be valued and committed partners in making policy, directing and evaluating clinical care, and leading organizational operations. Staffing must ensure the effective match between patient needs and laboratory professional competencies. Laboratory professionals must be recognized and must recognize others for the value each brings to the work of the organization. Laboratory leaders and laboratory managers must fully embrace the imperative of a healthy work environment, authentically live it, and engage others in its achievement. Excellence (Table 3), 18 and these standards address many of the issues facing the health care environment today. Although developed in response to the nursing shortage, these standards encompass the difficulties facing all health care professions, in particular laboratory professionals. The standards address communication, collaboration, decision making, staffing, recognition, and leadership. Skilled Communication Laboratory professionals must be as proficient in communication skills as they are in clinical skills. 18 Quality patient outcomes require the exchange of knowledge and information. Modeling good communication from the top administrative levels through all tiers of the institution is conducive to employee satisfaction. It also provides a basis for individuals to understand the value of meaningful interactions. In today s litigious society, everyone involved in dealing with the public must be aware of the importance of customer-friendly verbal communication, appropriate and collegial interactions with coworkers, and accurate and succinct written documentation. Such communication eliminates one cause of stress in an already stressful environment. Healthy workplaces often provide opportunities for dialogue within and among work groups to alleviate tension before it becomes significant. It is important to schedule these dialogues on a regular basis so that all employees know there will be a time for discussion of concerns and conflicts. Effective Decision Making Laboratory professionals must be valued and committed partners in making policy, directing and evaluating clinical care, and leading organizational operations. 18 Laboratory professionals carry significant accountability in the patient-care arena; however, participation in decision making is often restricted. Laboratory professionals often feel powerless to make changes in their work environment. 18 Employers should look for ways to give employees more control over their time and work. 6 Something as simple as allowing employees to self-schedule allows them to act together to cover the work and provides a way for them to keep balance in their lives. As the director of one school points out, Helping those who work for you maintain an appropriate balance in their lives is good for everyone. This might mean honoring special requests for time off or scheduling a holiday party, whatever contributes to morale. True Collaboration Laboratory professionals must be relentless in pursuing and fostering true collaboration. Collaboration is a process. In today s health care system, the continuous collaborative interaction of health care professionals is essential. 18 Respect for each discipline and what it contributes to the care of patients is essential. Knowing you are part of a team that values your particular expertise goes a long way in making the stress that laboratory professionals face tolerable. An atmosphere of mutual respect is important in creating and maintaining a healthy workforce. It is incumbent on each team member to offer suggestions and opinions when appropriate. One method for encouraging employee involvement and collaboration is to provide each individual with an index card prior to scheduled meetings. Ask that all cards have something written on them, such as a suggestion, complaint, concern, or praise for a colleague. Appropriate Staffing Staffing must ensure the effective match between laboratory needs and professional competencies. 18 Individuals entering a career in the laboratory professions know that some time must be spent providing services during off hours. Most are ready to take on these less-than-desirable shifts if they know there is fair and equitable distribution of the load. In addition to patient safety, employee health and wellness are at risk when inadequate attention is given to staffing. Overtime, Downloaded labmedicine.com from June 2008 j Volume 39 Number 6 j LABMEDICINE 329

6 Feature double shifts, and insufficient staffing increase the likelihood of medical errors and employee burnout. Meaningful Recognition Laboratory professionals must be recognized and must recognize others for the value each brings to the work of the organization.18 As previously noted, recognition of the value and significance of one s work is a substantial factor in job satisfaction. A lack of recognition causes individuals to feel unappreciated and disrespected. Recognition from those outside the profession is also important. Leaders, managers, and colleagues should highlight, emphasize, and display the valuable work done by their coworkers. This display should be for laboratory staff and other health care providers.6 Authentic Leadership Health care leaders and laboratory managers must fully embrace the imperative of a healthy work environment, authentically live it, and engage others in its achievement.18 We must practice what we preach, says one administrator. Keeping a watch on our nutrition, exercise, and smoking habits are right in there with modeling compassion, caring, and safe work 330 LABMEDICINE j Volume 39 Number 6 j June 2008 Downloaded from habits. We can t forget that those we supervise notice what we do. Management styles and environmental characteristics influence job satisfaction and commitment to the organization.15 Organizational administrators should be counseled regarding the value and quality of the education and service of laboratory professionals; however, knowledge alone is insufficient. In addition, compassion is a key characteristic for authentic leadership. Employees must feel its presence.6 Conclusion A healthy workforce is essential to patient safety and improves the recruitment and retention of employees. The healthy workforce standards provide a framework that can be used to improve the current status quo in the health care work environment. We should strive to lead by example. By providing high quality care with a collaborative approach, we can model our values and have a powerful impact on the future of health care. LM 1. McAndrew KG. Principles of occupational and environmental health in primary care. In Buttaro TM, Trybulski J, Bailey PP, Sandberg-Cook J, eds. Primary Care: A Collaborative Approach. 3rd ed. St. Louis, MA: Elsevier; 2008: labmedicine.com

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