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Enabling Joy and Meaning – Contributing to Safety and Quality


There is another element of leadership that relates very poignantly to the concept of authenticity I raised in the January commentary.1
This is the relationship between hospital culture and the workforce experiencing joy and meaning in what they do. Everyone wants to experience joy, meaning and professional satisfaction. Commitment to a healthcare profession is particularly driven by this as it is both an honor and privilege to care for others. Frankly, if I did not experience a sense of joy and meaning in my work, I could never have remained engaged in clinical medicine for so many years. The responsibilities of clinicians are great, the workload is often demanding and stressful, and the impact on family life can be substantial. Joy and meaning is the payback that really counts, knowing that one’s efforts as a clinician have made a difference in improving someone’s well being.
The responsibility for developing and sustaining a hospital culture that nurtures joy and meaning resides with leadership. Where leadership is lacking, things can go wrong very quickly. Sadly, morale amongst healthcare professionals is at a low point, with many retiring early or leaving the profession for other opportunities. Though there are many reasons for this, the fact is that experiencing a lack of joy and meaning is a major contributor to this trend. If healthcare workers are unhappy, feel disregarded, undervalued, powerless and/or when bullying and unprofessional behavior is tolerated, then the stage for error and harm, both for patients and staff.2
Case Study:
A highly respected nurse omitted a dose of antibiotics for patient recovering from pneumonia. When she realized this she alerted the medical house officer that the dose had been omitted, apologized for this oversight, and explained that task saturation had affected her judgment and attention to detail. The patient was actually in the recovering phase of treatment, so the likely outcome of the missed dose was inconsequential.
Unfortunately, the house officer, who had a reputation for intolerance and condescension to nursing staff, openly chastised the nurse, calling her, “a fool and a disgrace to your profession.” This house officer had verbally abused the same nurse in the past, although she was a highly regarded professional held in great esteem by other nurses and doctors.
Though the house officer had been previously counseled, his behavior towards this nurse and others had continued to be abusive and no meaningful intervention was applied.
The nurse wanted to tell the patient about the missed dose but the resident ordered her not to do so. Still, the nurse felt badly about what had happened, shared this information with the patient and apologized. The patient suffered no ill effects from the missed dose and was discharged 48 hours later. She thanked the nurse profusely for her care and her honesty.
His advice was to “buck up, get smart, not be so sloppy next time.” The nurse became more despondent and anxious, finally sharing her concerns with the chief nurse of the hospital, who advised her to, “Straighten up and laugh it off.”
The nurse subsequently resigned.
The leadership of this hospital failed miserably in its efforts to create and sustain a culture that was supportive of staff, one that encouraged joy and meaning. The culture of the hospital did not encompass the concepts of respect, collegiality and teamwork. The behavior of the house officer was outrageous and he should have been appropriately disciplined. Furthermore, the senior physician and nursing leadership contributed to the dysfunctional attitude, resulting in further suffering of a respected professional.
When the culture of the hospital does not specifically address deficiencies that may degrade joy and meaning, then aberrant behavior, especially bullying by professionals and condescension by management, becomes pervasive. This deviant behavior becomes normalized feeding complacency and tolerance of such behavior in the workplace.
Improving healthcare and patient safety is all about professionals working together collaboratively to provide patients with the best care. Things will certainly go wrong from time to time, but there is never an excuse for bullying and unprofessional behavior. We all have an obligation to recognize the risks of unprofessionalism and the degrading impact this has on joy and meaning. Specific mechanisms must be put in place to counter this behavior when it occurs.
We can and must do much better!
References
  • 1. Swensen S, Pugh M, McMullan C, Kabcenell A. High-Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce Costs. Cambridge, MA: Institute for Healthcare Improvement; 2013. (available at www.ihi.org).
  • 2. Through the Eyes of the Workforce – Creating Joy, Meaning, and Safer Health Care. Boston, MA: Lucian Leape Institute and the National Patient Safety Foundation; 2013. (available at http://www.npsf.org/?page=throughtheeyes&hhSearchTerms=%22joy+and+meaning%22)
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