Make empowered front-line staff a healthcare reality

Imagine you are working on the front lines of a large healthcare system. You are a clinician (i.e., physician, nurse, medical assistant or other), your department is understaffed and you are obligated to achieve productivity quotas (see more and more patients to ensure revenue is generated for the system).

Then you learn your healthcare system is implementing a hiring freeze so the relief you were expecting (the opportunity to breathe and use the bathroom between patient visits) will not be realized.

Now imagine you are again a clinician on the front lines of a large healthcare system and you have recently learned the level of stress associated with trying to ensure patient safety, optimal outcomes and better patient experience while also meeting productivity quotas will worsen due to hiring freezes as well as the system offering early retirement incentives to hundreds of employees in an effort to improve the bottom line.


Let's continue imagining. You are again a clinician on the front lines of a large healthcare system, you are pressured by the system to ensure productivity, staffing levels are already below what is safe for patients, your stress level and that of your peers has reached critically high levels, you have peers suffering from depression and not seeking treatment, you have others considering leaving the healthcare workforce, and others are at their breaking point. You now learn the system is implementing layoffs to create "financial stability."

You reach out to your peers and find support within this cohort, you soul search and tap into your lifelong passion for healing and rededicate yourself to ensure patients are safe and you continue to do all you can to improve the health of your patients ... even at the expense of your own health.

And then you read that the same healthcare organization that has not positioned you to ensure the optimal health of your patients, your team, your peers, or yourself is continuing to compensate its executives and other revenue generators with substantial financial payouts.

An imaginary world? Actually, no. This is the reality many front-line healthcare workers live every day, and this is the system impacting our staff, patients, families, and communities.

Is it any wonder hospital errors occur in one-third of all hospital admissions and adverse events in hospitals are actually 10 times greater than previously shared with the public?

In quality improvement speak, "every system is perfectly designed to get the results it gets" and we healthcare leaders have designed systems that are doing great harm to our front-line staff, patients, families and communities.

At a minimum, healthcare systems have a relationship crisis--typically the focus is on public relations, which is significant as well, but in this case it's a front-line staff relations crisis.

As healthcare leaders we must be transparent with our front-line staff, we must engage these individuals, we must listen and learn from them, we must support them and we must honor them. To do so we must reestablish our true north so care is our paramount focus and the care we provide is for all who participate in the healthcare system.

The good news: Once we refocus and reset our true north toward care our imaginary world will transform from a nightmare to a dream. A dream in which front-line staff are embraced, supported and honored, and they in turn are well positioned to honor their calling to heal and ensure patients are well cared for and safe.

And by the way, doing so also will improve the hospital bottom line.

It's time to rededicate ourselves and make this our new reality.

Thomas H. Dahlborg, M.S.M., is chief financial officer and vice president of strategy for the National Initiative for Children's Healthcare Quality (NICHQ), where he focuses on improving child health and well-being.