Promoting High Quality Health Care Workplaces
Funded by Health Canada’s Health Policy Research Program and Saskatchewan Health
ENABLERS AND BARRIERS TO KNOWLEDGE TRANSFER TO CREATE HIGH QUALITY HEALTH CARE WORKPLACES IN SASKATCHEWAN Summary of working sessions Knowledge Transfer Conference December 7, 2005 Participants at the Knowledge Transfer Conference reviewed the major themes related to the use of knowledge transfer to create high quality health care workplaces in Saskatchewan that were uncovered during the research process, and identified key barriers and enablers for each of the themes. The summary of those discussions is presented. LEADERSHIP 1. Management style Restraints A Management style – controlling, telling Being over-managed and under- led Enablers Know when to switch roles from leader to follower, team member, supporter Lead by example Self-assessment of biases and skills Leadership and management development, e.g. Regina-Qu’Appelle Health Region has an intranet program for self-assessment as a leader, which guides improvement, that is available to all staff members. 2. Change management Restraints Change in mandate Crisis management not leadership Squeaky wheel gets the grease Enablers Facilitation of change Identifying strategic decisions, and doing long range planning Know areas where staff want or do not want change
Promoting High Quality Health Care Workplaces
Share information with everyone Compare to evidence Accept what cannot change and move on 3. Accountability Restraints Not knowing who makes the decisions Unclear chain of command If a Committee is responsible, who is that? Enablers Transparency of decision making processes Clarity of the level of manager needed for different types of decisions, e.g. conference attendance of a staff member. 4. Workload of managers Restraints Managers responsible for many sites which increases their travel and decreases their visibility Decreased accessibility of managers for staff Staff feel abandoned and isolated Enablers Have a regular visiting schedule for managers on each site (e.g. Monday and Wednesday, Site #1, Tuesday and Thursday, Site #2, Friday, alternate between Sites #3 & #4) Face to face meetings arranged the day the manager is on-site Teleconference when not possible to do face to face On call managers are identified, second in command is identified Empathy for the role of the manager 5. Hiring practices Restraints High turnover rates Poor match of qualifications, education, and job requirements Favoritism expressed
Promoting High Quality Health Care Workplaces
Enablers Transparent processes Following the guidelines and requirements Commitment to follow through and NOT hire if not qualified Orientation of new staff using same tools and checklists Appropriate skill utilization of staff Conducting exit interviews Ensuring there is a good match of employee to workplace e.g. Sherbrooke has a preemployment seminar where applicants can decide if their values and expectations match the workplace 6. Supervision Restraints Lack of goals or vision Unclear expectations Unwritten rules Enablers Set clear expectations Trust staff to do the work, no hovering Trust that people will rise to expectations Praise for a job well done 7. Division between staff and managers, especially senior management Enablers Don’t keep manager in the dark More dialogue opportunities, e.g. on walk-abouts by senior management, staff members turn up to talk with CEO Hold forums for senior management and staff to work for common ground 8. Staff leadership Restraints Staff member reluctance to get involved Fear of suggesting ideas Conviction that no one would listen anyway Enablers Regular staff meetings
Promoting High Quality Health Care Workplaces
Openness of staff and manager to try new ways Attend staff meetings to voice opinion
OUTSIDE INFLUENCES 1. Politicians Restraints Policies and priorities do not fit Enablers Educate politicians, e.g. individuals and groups meet with politicians like MP, MLA Tell them what we do Tell them what affects client outcomes Identify the issues Engage the public in the issues Create a coalition, a “very powerful force”, to advocate and lobby for cause 2. Regionalization Restraints Saskatchewan Health policies and priorities Enablers Big things are standardized Policy communication is well done Evaluate the policies for fit Advise on “what” but leave flexibility on “how” Use technology for meetings; train in how to use to reduce impact of distance 3. Decreased communication across regions Enablers Provincial forum to share and plan together Identify partners Network and collaborate with all stakeholders, departments, regional health authorities Share evidence based practice Reflect on the impacts of action – both individual and organizational
Promoting High Quality Health Care Workplaces
4. Quality and Evidence Based Practice Restraints Lack of standards Best (or promising) practices not known Enablers Use professional associations and ethical codes Improve access to literature and documents Dedicated resource to bring research into action 5. Poor union-management relations Enablers Build better collaboration Ensure the appropriate people are involved Create open communication 6. Media coverage Restraints Poor media coverage Misrepresentation Context is everything – often left out Less public awareness of complexity of issues Enablers Positive media coverage Media can champion a cause Appropriate communication with care, for patients, families and the public SYSTEMS AND STRUCTURES 1. Organizational chart Restraints Power imbalance Too many levels in hierarchy Most staff have no power
Promoting High Quality Health Care Workplaces
Enablers Create self-managed teams Build shared governance structures and processes to give staff more power Staff members must volunteer to participate Staff can take initiative, buy in to co-creating their future Present the idea to staff meeting, then management meeting Get involved in union or professional organization 2. Budget Restraints Lack of budget Allocations in dispute Departments fight for bigger share Enablers Provincially funded target areas create pilot projects Incentives for units (not the managers) Meeting the dollar targets means increased resources and programs Consult on priorities 3. Staff development Restraints Poor access of staff to education Little budget for staff development, especially non-professional staff No time, no money Short term gain if education budget cut, just decreases morale Enablers Staff members will go to education sessions, welcome opportunity to go Consider whether some sessions should be mandatory Some topics apply to everyone, such as conflict resolution Time and dollars make a difference Long term gain when you invest in people
Promoting High Quality Health Care Workplaces
4. Access to equipment and supplies Restraints Poor access to equipment and supplies Enablers Occupational health and safety guidelines followed Better access to supplies Money for equipment and supplies 5. Safety Restraints Issues not addressed Enablers Use existing mechanisms to address such as OH&S, TLR to support staff members
WORK CHARACTERISTICS 1. Scope of practice Restraints Scope of practice ignored Enablers All staff working to full scope of practice will decrease workloads Respect for each other’s scope Right person, right place, right time, right cost
2. Work arrangements Restraints Heavy workload
Promoting High Quality Health Care Workplaces
Enablers Job creation Flexible work arrangements Flexible scheduling Self-scheduling – staff members volunteer to work on schedule WORK RELATIONSHIPS 1. Organizational values and vision Restraints Priorities are money related No clear goal Budget more important than quality care Paper focus not people focus Enablers Everyone involved in regular review of vision and values and goals Process to include staff members in setting direction for organization Sharing all information so decisions are understood 2. Management communication Restraints Increased mystery leads to increased mastery or control Enablers Sharing processes are established Eg. Senior management meeting. Then all members have middle management meeting to report news. Then all those people have front line management meeting to tell information, then front line managers have meetings with staff to tell news. Recognition by staff members that managers have time pressure for some decisions Increased information (evidence) means more understanding of reasons for a decision. 3. Connection with leadership Restraints Lack of contact with immediate supervisor Few if any performance evaluations
Promoting High Quality Health Care Workplaces
Divide between management and staff Less work satisfaction Enablers Regular performance appraisals Perhaps streamline the process by doing self-evaluations first to make it easier for the manager Praise for a job well done Personal goals recognized, such as management by objectives Empathy for managers Personal attitude Obligation for staff to give input Accountability of everyone – board, managers, and staff All involved follow through with commitments Opportunities for staff and managers to be on same committees 4. Turf protection Restraints Professional associations Unions Different disciplines in silos Enablers Team work is interconnected Focus on the client as the centre Be open to collaboration Open dialogue Support from peers 5. One size fits all? Restraints Attempt to force fit practices to all sites in same way Enablers Recognize and listen to differences across sites Build in flexibility and autonomy to adapt rural versus urban and acute versus community settings Board and senior management need to consult staff and managers
Promoting High Quality Health Care Workplaces
6. Staff involvement Restraints Poor involvement of staff means uninformed staff Top down decisions do not fit practice settings Enablers Staff need to identify the issues in which they want involvement Staff need to volunteer for committees Management time lines must allow for consultation process Build consultation into regular processes 7. Morale Restraints Poor morale Focus on past failures, poor relationships, low trust Gossip, pessimism Unlabelled discontent, poor systems Enablers Provide recognition and support for peers Say ‘thanks ‘ and ‘good work’ more often Plan social events and unit practices to build community Eg. praise in the communication book, baby showers Create a “valuing environment” Use humour Provide a voice and an ear to listen Encourage everyone to be accountable for a more positive attitude Use the FISH! Philosophy (Play, Be There, Choose your Attitude, Make Their Day) Focus on the positive, hope, opportunities Commit to try a new approach Expect accountability Be champions individually Provide education about change theory Get to the root cause and fix it, not the symptoms Do upstream thinking Invest money to improve systems and morale Eg. Succession planning, mentoring
Promoting High Quality Health Care Workplaces
8. Trust Restraints Display mistrust, hypocrisy Say one thing and then do another Eg Paid too much retroactive pay so employee has to pay some back Enablers Demonstrate openness, honesty by saying issues out loud to the people involved Demonstrate moral courage Acknowledge that everyone is accountable 9. Recognition/ promotion Restraints Large regional recognitions have no meaning Enablers Create career laddering as promotion opportunities Provide balance between the site (local) and the regional recognition and celebrations. One size may not fit all. Access to technology can be one reward
HUMAN RESOURCE ISSUES 1. Effective management Enablers Properly trained in labour relations and performance management Fair and flexible Autonomous, empowered decision making at local level Accountability Restraints No money allocated to Human Resource development, training and education Decisions become precedent setting No ownership of decisions Lack of trust and respect
Promoting High Quality Health Care Workplaces
2. Staffing Enablers Full time jobs when desired, ensuring full scope-of practice Strategies to meet predictable staffing requirements Consultation among stakeholders Fairness and flexibility Autonomy Restraints Rigidity regarding jobs, dress codes, coffee breaks, schedules Poor retention strategies Equity does not necessarily mean being treated the same Low morale when decisions questioned/challenged
INFORMATION 1. Useage Enablers Regional and provincial statistics are useful for local comparison purposes Provide direction and guidance Appropriate evaluation of improvements Restrainers No time to keep current Lack of accessibility to research and other documents (i.e. no computers) Lack of financial resources to make use of and apply research information Large volume of information becomes overwhelming