Kaiser Permanente and the Alliance of Health Care Unions

Hank Spring 2016

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Hair on Fire? There's Hope

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Stress and health care work seem to go hand in hand. Here are ways to fix the problem.

Struggling with stress? Got the burnout blues? We’ve all been there. A long line of patients snaking out the pharmacy door; appointments running a half-hour late.

Yet not all things that trigger stress are bad—getting excited before running a race is stressful; so is falling in love.

“A little bit of stress is good,” says Dawn Clark, MD, an ob-gyn specialist and chief facilitator of physician wellness for the Southern California Permanente Medical Group. “It helps you avoid boredom and keeps you engaged and energetic. But too much stress burns you out.”

Unfortunately, the chronic stress that leads to burnout is commonplace in health care. A 2013 survey found nearly 60 percent of health care providers are burned out. A 2015 nationwide poll showed burnout affects nearly half of all physicians.

The result? A burned-out workforce is one with low morale and high rates of absenteeism, turnover and workplace injuries. Inevitably, service and quality of care slip.

This issue of Hank takes a look at the causes of health care stress and burnout—and at the solutions. Read on to find out more about how:

  • Individuals can take steps to handle stress better.
  • Leaders can be role models and make solving workplace stress a priority.
  • Unit-based teams can address the root causes of burnout, finding remedies for lasting change.

Burnout: A widespread problem

Stress is the brain’s response to the demands put on us. Your pulse quickens, your muscles tense and you breathe faster. Everyday stresses are like small flames keeping you on alert. Burnout—which sets in when stress and frustration pile up without getting fixed—is your own personal forest fire.

Your body wears down as the constant flow of stress hormones suppresses your immune system and other functions. You don’t sleep well, and you become edgy, irritable and cynical. You don’t make good decisions. In short, you shut down. Making matters worse, your black cloud is contagious and can quickly spread to your co-workers.

Experts say burnout is usually caused by:

  • inefficient work procedures—and no power to change them
  • no sense of meaning and purpose to your workday
  • lack of work-life balance

In health care, the problem is even more complex. Frontline employees are expected to be selfless and put others’ needs first. But patients may be unhappy or demand answers when there are no easy answers to give. That’s stressful, and even more so when busy schedules are factored in.

Stress/Signs of Stress - Color
An Antidote to Stress

For years, popular thinking held that workers should be like cogs in a factory machine. But science now shows what we all know in our hearts: Feelings do matter. Relationships matter. And unit-based teams help provide what people need to be happy at work:

  • a meaningful vision of the future
  • a sense of purpose and accomplishment
  • great relationships and teamwork
  • recognition for their contributions

To deliver the best care possible—to solve problems by looking at them from a patient’s perspective—team members have to be engaged. By engaging team members and making sure each person feels free to speak up and share ideas, unit-based teams are an antidote to stress and burnout.

For the Roseville Revenue Cycle team, the time invested in improving relationships had an impact. Team members are less stressed—and the team’s People Pulse work unit index score increased 11 percent.

“Two years ago, sometimes I didn’t feel good when I left work because I could never do enough,” Stacey Kearny says. “But now—we feel like we’ve accomplished something."

UBTs to the rescue

Poorly designed jobs and systems are a leading cause of burnout, which means UBTs have amazing power to improve matters.

Say, for example, overlapping processes make a member-patient feel like she’s getting tossed from department to department. Her justifiable frustration may get unleashed on employees. A UBT provides a forum where an employee can speak up and say: “This process needs to change. What can we do to make the system smoother for the patient?”

That’s what Michael Leiter, an expert on workplace stress, says has to happen to reduce burnout. To fix it, you need to “change something that really matters about how you participate in your job.”

Sometimes the solutions are relatively simple. For members of the Esoteric UBT in the Sherman Way Central Lab in Southern California, working in cold, noisy room that made it hard to concentrate was causing stress—but they worked together and were able to move a key piece of equipment to a more comfortable room.

“Now at the end of the day, it doesn’t feel like I’ve just finished climbing a mountain,” says Gene Usher, one of the team’s research scientists. “It was a UBT success.”

Working together on performance improvement can cure what ails a team, as the Revenue Cycle team at Roseville Medical Center near Sacramento discovered. It also learned—as many teams do—that before it could fix its processes, it had to clear up underlying tensions first.

The team had low People Pulse scores; old conflicts between co-workers had never been resolved. So the team chose to improve its response to the survey question about “having a say in influencing decisions.”

“We decided to do tests of change that involved the staff more,” says management co-lead and former UBT consultant Kimberly Jones.

Team members started working together on improving the annual vacation process—a big morale boost. The 37-member team also took customer service trainings and a Kaiser Permanente Courageous Conversations class, which teaches different ways of approaching conflict and taking responsibility for your actions.

The class “made it easier to approach someone if there was a work problem,” says Stacey Kearny, an admitting representative and SEIU-UHW shop steward. “Now we act more like a team. When we come onto our shift, we ask the person leaving, ‘Is there something I can help you get finished?’”

Now at the end of the day, it doesn’t feel like I’ve just finished climbing a mountain. It was a UBT success.

Gene Usher
Research scientist
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