What do you do if you’re a healthcare executive and your recent employee engagement data indicates that you have a significant bullying, burnout, and turnover problem? Do you sigh and say, “Well. That’s just the way it’s always been?” Do you conveniently overlook the comments about how bullying is impacting the overall health and well-being of your employees? Do you call a mandatory meeting with your leaders and tell them to “fix this problem” or else? Or, do you take responsibility and do something? Did you know that only 6% of healthcare leaders identify bullying & incivility as a top priority yet 90% say they have a problem? As a healthcare leader, if you want to reduce bullying, burnout, and turnover, you need a new approach.
Culture and conduct are more important than anything; especially now.
Several recent studies reveal the direct impact a toxic culture has on employees and organizations:
- McKinsey reported the #1 cause of burnout and intention to leave are toxic workplace behaviors.
- An MIT study indicated a toxic culture is 10.4 times more likely to contribute to attrition than compensation.
- A Safety and Healthy Practitioner study reported the impact of incivility to employees:
- 48% intentionally decreased their work effort
- 80% lost work time worrying about the incident
- 55% said their performance declined
I think the reason why leaders don’t act is that they don’t know what to do or where to start. Tackling a problem that’s been swept under the carpet for decades can feel like an overwhelming task. But it doesn’t have to be that way.
Do What This Leader Did
One of our clients received feedback during exit interviews and through surveys, that many of their newest nurses were leaving because of bullying. These were his words, “Well. Now that we know we have a problem, we have to do something about it. I’m not an expert. Who is? If we are going to tackle this, we need to get help.” It just so happened that a friend of mine was at the meeting and recommended me. I’ve helped them reduce bullying and turnover – done.
The key here is that once you’ve identified a problem; don’t try to tackle it alone. Get help. Why? Because we’ve seen organizations adopt a knee-jerk reaction and try to put a band-aid on it or worse, invite everyone to a 60-minute in-service on bullying and then check the check box that they’ve addressed and fixed the problem.
If you really want to create and sustain a professional, healthy work culture and reduce bullying, burnout, and turnover, you need to adopt the trifecta approach: Strengthen the Organization, Equip the Leaders, and Empower the Employees.
How to Reduce Bullying, Burnout, and Turnover in Healthcare
Strengthen the Organization
Make culture and addressing disruptive behaviors a strategic priority. The goal is to create a healthy workforce culture that fosters teamwork, honest and respectful communication, and professional practice in order to retain the best employees and deliver quality patient care. You can’t do that unless you hardwire strategies throughout the organization. This includes augmenting and adapting the following:
- Policies and procedures
We’ve seen some policies that are so vague related to professional behavior and some that are so prescriptive an employee can easily talk their way out of corrective action. Make sure there are policies that clearly define:
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- Bullying and incivility
- Harassment
- Discrimination (separate policy); and,
- Workplace violence (separate policy).
A clear process needs to be established for how complaints of disruptive behaviors will be handled. Believe it or not, most organizations fail to clearly define this process.
- Initial and ongoing educational content related to culture and conduct.
Look at your current educational programs that are available for the entire interprofessional team (i.e., orientation, nurse residency programs, preceptor programs, and leadership development programs). Identify opportunities to incorporate educational content that addresses bullying and burnout into these programs. It’s that simple. Don’t create new programs – just augment your current educational programs.
- Incorporate “healthy workforce” as a standing agenda item in every meeting throughout the organization from the top down (i.e., Executive-level to department-level meetings). Hardwire the strategy by talking about it and sharing content related to bullying and burnout. Many leaders reach out to us and share at the beginning of their leadership meetings, they show one of our YouTube videos or share an article we’ve written on my blog. They watch/read and then they engage in a conversation about the topic.
Equip Leaders
If you’re only able to implement one strategy to reduce bullying, burnout, and turnover, focus on your frontline leaders. In our experience at the Healthy Workforce Institute, we’ve never found an organization that educates frontline leaders on how to deal with disruptive employees. Yet, these leaders spend 25% to 50% of their time dealing with employees demonstrating disruptive behaviors! Organizations need to do a much better job equipping frontline leaders with the essential skills they need to set behavioral expectations and hold their employees accountable.
- Educate new leaders
This can be a new leader to the organization or new to a leadership role. You must include educational content during their initial orientation on how to handle disruptive behaviors.
- Ongoing education
Leaders are afraid to ask for help! You must make it safe for them to admit they are struggling. At least once a quarter, provide occasions for leaders to come together and learn about setting behavioral expectations and holding employees accountable. Create opportunities for an interprofessional leadership team – dyads with nurse and physician leaders to engage in conversations about bullying, incivility, burnout, and culture. And don’t forget to include an HR representative in these conversations!
- Support frontline leaders when they want to terminate a toxic employee
I’ve heard repeatedly from frontline leaders how they want to terminate a toxic employee but are not “allowed” for whatever reason. By not supporting your leaders who are trying to establish expectations and hold people accountable, you are encouraging disruption among the team. Please support them.
Empower Employees
If you truly want to create a professional, nurturing, and supportive work culture, you can’t just gather a group of leaders and then sit around the table talking about strategies. You MUST include front-line staff.
- Raise awareness
Talk to your team members about behaviors that undermine a culture of professionalism, trust, respect, and that undermine a culture of safety. We’ve normalized bad behaviors for so long, that we fail to recognize bullying and incivility when it occurs. Does, “well, that’s just the way she is…” sound familiar?
- Engage them as partners
Involve your team to establish unit-based expectations for professional behavior towards each other, new team members, the interprofessional team, and external support staff (travelers, agency, float).
- Ongoing education
Provide the team with ongoing education, tools, and resources to recognize and confront disruptive behaviors.
If you truly want to reduce bullying, burnout, and turnover, it can’t just be “sign this code of conduct (note: signing a piece of paper doesn’t change behavior) or a one-time in-service on bullying. You can’t check a box when it comes to transforming the way people treat each other. Changing a culture requires organizational buy-in, leadership development, and employee involvement.
