Culture

A Systemic Lens Perspective

Joy W. Goldman RN, MS PCC:  CEO SixSEED Partners

Background:  

On March 10^th of this year, I published a blog focused on “Caring for the Organization AND Caring for the Workforce.”  The higher purpose of that tension was to support a healthy ecosystem within healthcare.  Writing this close to six months later, not only is that tension still relevant, it has reached a crisis point in healthcare as droves of physicians and nurses leave their organizations and/or professions.  How do we take care of healthcare as a system, as we take care of the public’s healthcare needs?  In this writer’s opinion, right now we are failing.  The purpose of this blog is to invite creative, systemic solutions to this thorny challenge.

Impact and Case for Change:

Panagioti, Geraghty, and Johnson published an article in JAMA Intern Med 2018 (10) entitled: “The Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction.  Their review of the literature revealed that there is a 2-fold increase in odds for unsafe care, unprofessional behaviors, and low patient satisfaction amongst physicians experiencing burnout.   Reith published another article in Cureus titled: Burnout in United States Healthcare Professionals: A Narrative Review.   He expands the impacts from both physician and nursing burnout to include higher rates of patient mortality; transmission of hospital-acquired infections; increase in medical errors and an increase in medical student alcohol abuse and suicide.  Of note is that both of these articles were published in 2018:  prior to Covid 19.

One less quoted yet just as serious sequelae for nursing and physician burnout is your ability to get timely and effective care for you and your loved ones.

Complex and Interdependent Challenges:  Variations of Individual AND Team Tensions:

Many of us are familiar with the process of looking at root causes for problems to permanently eradicate the disease.  The challenge with Covid and burnout in healthcare is that they are not problems to solve.  They are systemic and interdependent challenges to leverage that can be boiled down to a tension between meeting individual needs AND meeting collective needs.

Look at the below examples:

Impact (So What?):

  As Einstein said: “The significant problems we face today cannot be solved at the same level of thinking we were at when we created them.”  We must facilitate dialogues that address these thorny challenges, and which include healthcare worker well-being. If we don’t, physicians and nurses will do more of what they are starting to do which is saying “no more.”  They are saying this as they submit their resignations; leave for higher-paying jobs; or leave the profession altogether.  This leaves hospitals struggling to manage the finances of healthcare with their mission to serve and meet the needs of their communities.  What solutions are people creating to respond to the fear of closing beds and not being able to meet expense needs?  We hear from our clients their staffing challenges as Traveling Nursing companies are perceived as stealing staff from hospitals less equipped to pay higher salaries and offering to those who can.  I liken this strategy to one that hopes to improve nutritional health by offering organic produce to affluent communities while depriving or limiting healthy food choices to lower socioeconomic communities.  When will we learn that localized or individual approaches will not eradicate systemic challenges?

SixSEED Partners Interdependent Solutions:

We believe that these times of epidemic crisis require a different way of thinking and acting to sustainably impact and transform these issues.  Examples include:

• Leverage Competition & Collaboration:  bring local hospital systems together to look at community health needs and discuss how blending resources and talent might be able to better meet community needs and organizational needs.  Instead of three hospital systems vying for digestive disorder patients, consolidate and refer specialties across hospital systems, in service to patient care AND provider well-being.

• Medical and Nursing Professional Associations uniting in lobbying their governments to establish temporary laws that promote access to resources and prohibit possible poaching of scarce resources by any one organization at the expense of others.

• Leverage social media to impress the public of OUR responsibility.  Just as we’ve seen the near -death lung cancer patient with poor color, on oxygen, doing commercials on TV, healthcare workers should be posting photos on social media of their tears; their marked faces; bodies lining hallways due to lack of beds and/or staff.    The story of healthcare’s reality must be presented unfiltered, visible and in a media venue that the public see’s frequently and consistently.  The public has a role and responsibility for decreasing the demands on our healthcare systems and this is one way to keep the public informed of what is happening behind the scenes in the delivery of healthcare.

• Gather regulatory, professional and education/ training organizations in dialogue around training that could take place to upskill volunteers or provide jobs for those needing work in supplementing nursing and physician staff.  As with scribes, how can we lessen the burden on our clinicians so that they are doing only the highest acuity patient care needs.  The  other tasks which require less clinical expertise can be done by other members of the care team.   

These examples require both/and thinking and require us to get out of our silos, holding our greater purpose and not just our lone survival as paramount.

SixSEED Partners is looking for leaders and systems who are ready to do this work.  We have no time to waste.  The time is NOW.  Will you join us?  If you are curious, please email me directly:  joy@sixseedpartners.com.  

#systemintegration #leadershipecosystemcapacitation #wellbeing #burnout #ecosystem