Editor's Note: This is the first in a three-part series on leadership and operations that examines the power of front-line staff.
By Thomas H. Dahlborg
In a recent blog post, I implored healthcare leadership who make decisions that affect staff and patients to listen to those working on the front lines of healthcare.
Despite the dangers of not supporting front-line staff, many healthcare leaders continue to make decisions without their input.
For example, one community hospital in Portland, Maine, left front-line staff out of the equation as administration financially squeezed the hospital's obstetrics and gynecology department, to the point where nurse staffing levels on the maternity ward fell below national standards.
"Administration ignored staff when issues of quality of care were raised. Mothers did not get training on breastfeeding, bathing baby, what to do if baby doesn't sleep, what kind of rashes to look for, or what does baby look like when baby is sick," the interim chair of the department of obstetrics and gynecology told me.
Consider one component from this account--the impact on breastfeeding. Breastfeeding provides a range of benefits for the infant's growth, immunity and development. Studies show breastfeeding reduces the risk of obesity in childhood significantly. Yet, teaching and support for breastfeeding were not optimized, and the health of the mother and child were adversely affected.
Even if the main motivation is to improve care processes, leaders must involve front-line workers. One director of case management at a small community hospital in southern Maine told me a story of how leadership failed to support front-line staff during its efforts to improve protocols associated with congestive heart failure (CHF).
"You don't know how it is to call a code, take care of the patient and support the family. You don't know how it is when someone dies on your watch and no one is there afterwards to support the care team. You talk about initiatives and not about the people," a floor nurse had told leadership soon after a CHF patient had passed.
Hospital leaders showed no support for this individual as a nurse, as a professional or as a person, she said.
More and more, we read that hospital nurses suffer from depression at twice the average rate. If the earlier story is any indication of standard operating procedures in hospitals, we have much to do to better support front-line nurses.
The problem isn't confined to the United States. Amid government calls to reduce patient wait times for beds, a nurse in London was working in a closed hospital ward where the Pseudomembranous colitis (PMC) virus was running rampant.
After a death on the ward "opened up" a bed, hospital leadership ordered the bed be filled, this nurse told me. "The government has set a standard, and we are going to achieve it," leadership said.
The hospital leaders ignored the nurse's protests and admitted a sick elderly woman to the closed ward. "She contracted PMC and shortly thereafter died," the nurse said.
Each of these accounts highlights adverse affects on clinical quality, patient experience and safety, as well as staff satisfaction and retention. They show how hospital leadership focused on achieving a goal (whether it's cutting expenses or improving protocols) would benefit greatly by engaging their front-line staff. But most importantly, they underscore how not doing so impacts care.
Thomas H. Dahlborg, M.S.M., is vice president for strategy and project director for the National Initiative for Children's Healthcare Quality, where he focuses on improving child health and well-being.
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