In recent years, many workers have quit their jobs for better wages, more stable hours and better working conditions. The Great Resignation, as it is called, hit the healthcare community particularly hard. In the United States, according to some estimates, 20% of health personnel have left their jobs in the last two years and of this number, 30% are nurses. Moreover, in a survey, out of 1000 health professionals, 28% would have left because of burnout.
Posted at 10:00 a.m.
In Quebec, too, the pandemic has exacerbated problems. There is a lack of medical staff, the cases are heavier, and the workload has only increased. As a result, employers are imposing compulsory overtime, contracting with employment agencies and closing beds. All this makes the task of organizing work and schedules more difficult. However, each employee who leaves their job puts enormous pressure on the rest of the care team. The workload for the remaining employees is increased, there is more fatigue, more exhaustion and others leave in turn.
The Savoie report
On June 22, 2022, the Deputy Minister of Health, Ms.me Dominique Savoie, filed a report to explain certain difficulties experienced during the pandemic and to propose an approach to improve the health network.
Mme Savoie writes that the pandemic has shown that since the 2015 reform, central authorities are too involved in the day-to-day management of operations, that managers in the field are in short supply for the teams, that they do not have enough autonomy and accountability, and that the insufficient presence of middle managers has limited local management and remoted decision-making.
Let us remember, 7 years ago, the Minister of Health at the time eliminated 1,300 management positions out of a total of 6,000, abolished the boards of directors of health establishments and centralized decision-making around 22 agglomerations, the CISSSs and CIUSSSs. In some administrative regions, these cuts have represented up to 25% of the management workforce.
However, the workload has not decreased, managers have more responsibilities, more employees, and there are more facilities to cover.
Mme Savoie recommends refocusing the role of the Ministry of Health and Social Services around the development of policies, strategies and orientations. And she suggests letting the establishments organize health services, monitor budgets and ensure that the teams are functional, autonomous and cross-linked to other hospital teams.
Many health systems in European countries are encouraging hospitals to become more or near-autonomous. Networks where decision-making structures are decentralized so that the right players are in charge of personnel and financial responsibilities.
In Great Britain, for more than 20 years, hospitals have been able to acquire more autonomy over management, the organization of care and finances. Hospitals that are efficient and save money can keep surpluses and reinvest them in new resources and many services.
Review governance
In a journal article Health Affairs August 2015, researchers from Harvard and Stanford universities wanted to demonstrate the importance of the management and boards of health establishments in the organization, delivery and quality of care offered to the patient. The study in question assesses the activities of the boards of directors and the management practices adopted by administrators of 103 hospitals in the United States and Great Britain.
In their research, the authors point out that management plays a crucial role in the overall performance of hospitals and that hospitals with excellent management practices, that is to say, which had obtained good results in the areas of operations, the achievement of targets and human resources, are more associated with a board of directors that is proactive and efficient.
This leads researchers to say that incentives and training must be designed to align hospital management and governance with quality of care and organizational performance objectives.
The 2015 decision to put 6,000 executives on waivers to eliminate 1,300 could be questioned. Indeed, in teams, each individual knows the other people in the group, which helps build a work environment where there is an understanding of what needs to be done. Hence the importance of middle managers, coordinators, team leaders to manage teams and maintain cohesion within the team.
Hospitals must be able to count on managers capable of motivating, inspiring and seeking out the best in each employee. Leaders who have free rein to support the teams in the field.
Many medical practices, both first and second line, are organized as a team. Hospitals are subdivided into units, departments and specialties in order to provide care and services to patients. Others, like the Cleveland Clinic, have reshaped their teams around certain treatments. The goal is for nurses, doctors and other staff to work closely together to break down silos.
In a journal column The Economist, the journalist points out that the work of managers is almost always necessary, despite what some people think. That teams need leaders regardless of the quality of the people in charge, even if they don’t save lives. Because someone has to make the decisions to keep the machine from getting bogged down in endless arguments.
The sustainability of hospital care cannot be achieved without a genuine local management policy where management is firmly in place and teams are present and in sufficient numbers in the field. Network employees have not lost their passion for health, but they want to be respected, feel good at work and have a better work-family balance. Which is completely normal.