So I visited my home town (Peterborough, Ontario, Canada) for the weekend. While I was there, I took note of a headline in the local newspaper, by Kennedy Gordon. He wrote an interesting piece entitled Nurses ignored.
The gist is, executive management at Peterborough’s brand spankin’ new hospital made the decision to close 71 beds and eliminate 151.5 FTEs from the payroll to save $26.8 million over the next two years. Nurses made up a full 80% of the cut FTEs. Not surprisingly, nurses weren’t consulted for this decision, and neither was a recognized representative.The staff and administration from this hospital aren’t new. They transferred over from the older hospital. However, anytime there’s a massive shock of “new”, there’s often an equivalent level of optimism to go along with it. In an environment already plagued with morale problems from a flagging health care system, you’d think management would want to ride that rainbow for as long as possible. Such was not the case.
In my post from Saturday, Interaction at Work: Don’t Game the System, I picked up Mark Phillips comments about the importance of including others in the decision making processes that affect them. Personally, I’m very passionate about the need to include and inform, even during times of tough decisions. An organization is more than the numbers that make up its bottom line: it’s the experiences, skills, knowledge and insights embodied within the people that form it. When presented with a problem, even a difficult one, these very people will tap that vast reservoir of expertise to find a solution.
In Nicole Fink’s article “The High Cost of Low Morale“, she writes, “the Gallup Organization estimates that there are 22 million actively disengaged employees costing the American economy as much as $350 billion dollars pear year in lost productivity including absenteeism, illness, and other problems that result when employees are unhappy at work.” Among other possible causes, she identifies:
- poor communication,
- lack of empowerment,
- distrust of management,
- departmental layoffs or closures,
- labor negotiations and contract disputes,
- unclear expectations and corporate direction;
as reasons for low morale. I must admit based on my reading of Gordon’s article I saw all of the items in the above list.
The Ontario Nurses’ Association (again, not surprisingly) cites concerns for the care patients will receive. They note that “the incidence of morbidity (complications) and mortality (death) has been shown to increase as patients lose the expertise and skills that RNs bring. Studies have shown a seven per cent rise in patient complications and death for every additional patient added to an average RN’s workload.”
Michael Hurley, of the Ontario Council of Hospital Unions expresses similar concerns, since the hospital’s user base is “an aging population [that] is using its services in greater and greater numbers.”
Both the ONA and OCHU citations above indicate already-present problems may be exacerbated by these cuts. If that’s true, then by not consulting with those who could have worked to find a better solution to the financial problem, hospital management has exposed itself to a worsening of the very problems that prompted the construction of a new hospital in the first place. Of course, since a full 80% of the cuts are nurses (as opposed to other hospital workers, including management overhead), hospital management has shown exactly how much they care about nurses’ input.
Here’s the thing. As usual, I’m not going to comment about the right or wrong of the decision to exclude nurses from identifying a solution. I’m going to look at the consequences.
|Expected Results||Additional Results|
|1. (Hopefully) balanced books that incorporate the desired $26.8 million in savings.||1. A public relations mess. (What, the nurses’ union wasn’t going to notice?)
2. Trashed morale among nurses.
3. Increased risks to patient health care as overworked nurses miss important details (that should come as no surprise).
4. Increased risk to patient health care as demotivated nurses performance drops.
You can always hold individual nurses accountable for a decline in their personal job performance, but honestly, when management demonstrates a clear lack of interest in creating a positive working environment for the nurses who remain after these cuts, where does the problem really lie? While they may have solved a short-term problem with their most recent accounting project, given the additional consequences they may be facing, were the short-term results worth it?
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