Fluent work in the heart of a hospital district
Hazardous psychosocial loading, caused by haste, stress and continuous disruptions to the work, should be taken seriously. This problem has been tackled effectively in the hospital district of Satakunta.
Work in the social and health care sector is demanding and very loading in nature. The employees treat sick patients, and work in the midst of life and death. Responsibility weighs heavily on the personnel, and haste and stress are constantly present. Insecurity is caused by changes related to the imminent social and health services reform, and uncertainty about the future. Maintaining the well-being of the employees is essential, so that they can cope with their demanding work.
– The on-going ’Good work!’ programme carried out at the Satakunta hospital district is not a campaign. It is our permanent work culture and it promotes our well-being, explains Katri Mannermaa, the hospital district’s occupational well-being chief.
The promotion of well-being at work aims at fluent, meaningful work in a safe, health-promoting and career-supporting environment and work community. But the sector is unstable, changes occur continuously, and for example the incomplete social and health care reform causes concern.
– The words ’fluent work’ reflect our goal, which is taking care of people. That is our main responsibility. We come here to work. Of course job satisfaction is important, but it isn’t the goal of what we do here, Mannermaa points out.
“We come here to work. Of course job satisfaction is important, but it isn’t the goal of what we do here.”
Structures in order
The well-being at work programme of the hospital district has two parts. In the structural part, supervisors are encouraged to make sure that leadership and know-how are up to par, so that the work is done well. Helping to create a positive work climate and ensuring safety are also a part of leadership. The second part of the programme deals with the responsibility of individuals. Employees are motivated to focus on their own know-how and work ability. Interaction skills are emphasized. They are also encouraged to take care of their own well-being and recovery from the work. The results of the Työsyke (‘Work pulse’) repeat-questionnaire of 2013 by Keva (Public sector work pension provider) were utilized in designing the well-being programme.
– Each one of our units draws up its own well-being at work plan which emphasizes the need to manage change. The plan takes into consideration the vast amount of new information that has to be absorbed. The employees’ perception of haste and the insecurity factors of the future are dealt with. The programme aims to tackle all these questions, says Mannermaa.
The hospital district is definitely on the right track. It received an honorary award in the ‘Controlling stress’ campaign of the European Agency for Safety and Health at Work (EU-OSHA).
Santtu Koivula is pleased with the autonomous work shift arrangements.
Zero tolerance to bossy behaviour
Hospitals have always been criticized for having a hierarchical pecking order, and for the bossing of subordinates. The hospital district of Satakunta wants to be totally rid of this old-fashioned work culture. Openness and transparency are its guiding principles. Supervisors are trained to recognize and bring up problems sufficiently early and to intervene when necessary.
– Mannermaa knows that a good work climate is now a more important criterion than ever before, when professionals are being recruited.
The culture of speaking out openly is supported at Kajastus. A multi-professional group sitting around a table is exchanging ideas: Outi Priia, manager of the residential unit, Merja Paavola, manager of social services, nurse Santtu Koivula, and occupational safety delegate Tero Järvimäki, as well as Katri Mannermaa, manager of well-being at work.
An atmosphere of open discussion
Kajastus is a residential unit of the Hospital District of Satakunta. For several years in a row, the results of the personnel surveys on well-being at work have been very good. The recipe for the success of Kajastus consists of simple ingredients, available for everybody.
– Speaking is the main ingredient. Although leisure-time topics are discussed, the emphasis is on professional work matters. We sincerely care about our clients and their well-being, says unit supervisor Outi Priia.
– Kajastus is the home of our clients, and each person is a unique individual. We stress this continuously to ourselves and each other.
Substitute workers and students at Kajastus are encouraged to give feedback and to challenge existing ways of doing things. The positive and motivating climate at the workplace is reflected by the high ratings in the well-being at work surveys.
Multi-professionalism is an asset
A nurse, three assistants and three practical nurses work at Kajastus. In addition, a personal assistant and a vocational trainee are part of the team. The supervisor works jointly also in a similar unit in the neighbouring municipality. Our multi-professional team also includes an interpreter for clients with serious speech defects.
– We make use of multi-professionalism every day. Our team decides on the best action model for each client. We don’t have a personal nurse for each client, instead, our employees are divided into two equal teams.
Outi points out that no one ’owns’ clients.
– All of us are here for them, and everything is brought honestly and openly to the knowledge of the whole work community.
The residents of Kajastus are mainly physically healthy young adults. But they need help and support in managing many areas of their daily life. At times the personnel have to endure a full load of harsh critique from the clients or their families. Even the threat of violence is present.
– Problematic situations and complaints are handled openly and as quickly as possible by the work group. Regular work assessment discussions and work counselling help in solving problems, says Outi Priia.
Finland’s one hundredth jubilee year can be seen from the way in which the common spaces are decorated. Decorators: Outi Priia, Hannu Kuusisto and Santtu Koivula.
“An open work climate motivates people to ask questions, make suggestions, and even challenge existing ways of doing things.”
Division of responsibilities and work guidance
A balance between the team’s joint responsibilities and the responsibilities of individuals prevails at Kajastus.
– All tasks and responsibilities must be delegated unambiguously. A problem is easily overlooked if it is not clearly someone’s responsibility. We bring up problems to our workplace meeting, we come up with a solution, and decide who in future will be responsible for looking after the matter in question.
Delegating responsibilities is based on work guidance.
– The employees can’t just be expected to master any tasks whatsoever, unless they have the required training for them. Nobody is left alone without help.
At Kajastus, everyone, including students and substitutes, feels comfortable enough to open their mouth.
– The students continuously give us positive feedback for this. An open and free atmosphere encourages people to ask questions, to make suggestions, and even to express their doubts about existing practices. New ideas and points of view prevent us from becoming stagnated.
The work shift arrangements at Kajastus are autonomous.
– The arrangement motivates people and works well here.
Priia mentions still another important point that is related to well-being at work.
– Definite plusses of the work are: Successes at work, the satisfaction of the residents, and getting positive feedback after a successful endeavour. We regularly give praise to our workmates!
The residents practise housekeeping and preparing meals in their own apartments. Hannu Kuusisto is washing dishes and chatting with Santtu Koivula.
Clear rules of the game
Already at the end of the 1990s, a quality control system was started in the sector of services for special groups within the Satakunta hospital district.
Nowadays, a certified ISO 9001:2008 quality control system applies to the entire social services sector of the hospital district.
– It facilitates the integration of guidelines into daily work routines and problem situations. It also lessens the risk of mistakes due to various interpretations, and helps to ensure that the services are of uniform quality, says Merja Paavola, manager of the hospital district’s social services.
The operation area of social services is large: there are altogether 17 residential units in ten municipalities of Satakunta. In addition, there is the Antinkartano rehabilitation centre in Ulvila for special groups. It concentrates on treating demanding cases requiring expert-level rehabilitation in a facility, and also offers specialist services to outpatients.
“The transparent culture of open communication in our work community, regular work counselling and the possibility to use other specialists, when needed, help to resolve crises.”
The threat of violence is a stress factor
Physical violence and its threat, as well as psychological violence, are stress factors to the personnel, especially in the rehabilitation facility for special groups.
The client relations with mentally disabled persons are usually long-term. This requires intensive cooperation with their families and other close persons, as well as with a wide network of multi-professional experts.
– When a disabled child moves from his or her childhood home to a rehabilitation facility or their own residence, the parents go through many kinds of emotions. They may even have views that conflict with those of the personnel of the facility. Promoting and supporting the residents’ autonomy are nevertheless among our primary tasks, Paavola points out.
Occasionally the views and opinions expressed in public regarding the care of mentally disabled persons can load the personnel.
– We are bound by strict confidentiality regulations, which means that we cannot discuss publicly the affairs of our clients, nor talk about them even with our own family or closest friends. The transparent culture of open communication in our work community, regular work counselling and the possibility to use other specialists, when needed, help to resolve crises.
Good leadership, acting in accordance to our values, clear goals and rules of the game, the know-how of the personnel, and an open culture of discussion support the well-being of individual employees as well as of the whole work community.
Threatening situations may arise especially in the evening or night-time, when only a few employees are present.
Occupational safety delegate Tero Järvimäki is pleased with the changed attitudes: now well-being at work is increasingly a shared responsibility.
Help from professionals
Occupational safety delegate Tero Järvimäki at the Satakunta hospital district is pleased that there are more and more work communities like Kajastus.
– It’s wonderful to have a strong team spirit at work. The employees are encouraged to bring out their own strengths. Experienced supervisors motivate the employees, delegate responsibilities, and listen to their opinions.
Järvimäki is aware of the problems that arise from the structural changes in social and health care services.
– Long-term expert-level treatment in facilities is being dismantled, and the pressure in out-patient care increases. Threatening situations may arise in facilities, especially in the evenings and during the night, when the number of staff is limited. The slowness of getting help is a problem. The time for guards or the police to arrive may be very long. These concerns increase the overall stress load of employees.
Work counselling supports well-being at work.
– Debriefing is available whenever needed. In addition, the employees have an opportunity to get work counselling as individuals or in a group, when needed. The services of an occupational health psychologist are also available.
Earlier, eight persons in the hospital district served as occupational safety delegates, in addition to their regular job. Now this arrangement has been replaced by three full-time delegates.
– The attitudes toward delegates have changed considerably. We are no longer viewed as trouble-shooters, but as the genuine voice of the employees, respected by the employer. Well-being at work is definitely a common value, says occupational safety delegate Järvimäki.
– It’s easy for people to contact our occupational health services. A well-functioning network of experienced occupational health professionals – nurses, physicians, and an occupational psychologist – are available to the employees of the hospital district, says occupational health physician Liliana Baltseva.
Get rid of unnecessary interruptions
– Interruptions in the work are typical psychosocial loading factors in health care work. The aim at the Satakunta hospital district is to minimize unnecessary interruptions in order to let the employees work in peace, explains Liliana Baltseva, occupational health physician at Länsirannikon Työterveys Oy (West Coast Occupational Health Co.).
Various units of the hospital district are taking part in the Aivotyö toimivaksi project (More Efficient Use of Brains).
– The purpose of the project is to investigate the psychosocial loading caused by repeated interruptions. On the basis of the results, work practices will be improved, says Baltseva.
Attentiveness and fluency are especially important in care work: a nurse may just be portioning out medicines, a doctor may be writing a prescription, or an employee may be recording patient data into the database. Continual unnecessary interruptions, as well as other disturbances in the work environment, such as noise, render people liable to make mistakes, which in turn endanger patient safety.
In connection with the ‘More Efficient Use of Brains’ project, new practices are being developed in workshops in various units of the hospital district. It is important to agree together on rules that help to ensure work peace, and to follow them.
Reducing loading of the short-term memory
More attention than ever is being paid to cognitive ergonomics. Having to carry out multiple tasks at the same time is typical to our times. Many people simultaneously listen to their colleagues speaking, read patient data, or go over their e-mails, and answer the telephone. The situation is worsened by background noise, which may lower the ability to concentrate and thus increase hazardous loading even more.
– The capacity of humans to handle information technology and a continuous flow of information is nevertheless limited. The short-term memory becomes over-loaded, and the information isn’t stored permanently. The situation is improved when an employee is provided with some disturbance-free time, and unnecessary interruptions are avoided, Balseva says.
One small concrete step is making use of a ”Do not disturb” tag that can be slipped on the door knob of the office, as in hotels.
“The challenges and requirements of the work must be in balance with a person’s know-how.”
Take care of yourself, give positive feedback to others
Liliana Baltseva leads a team of 13 members in the Pori unit of West Coast Occupational Health Co.
She praises the expert personnel of the hospital district of Satakunta, and the fluency of cooperation with them.
Baltseva emphasizes that the goal is not zero loading at work.
– Work cannot be done without any loading. It’s important to find effective means of eliminating harmful psychosocial loading, and consequently improve the well-being of the employees.
Preventive measures keep situations from becoming critical and thus causing burnout and illness.
– The challenges and requirements of the work must be in balance with a person’s know-how. Employees should take an active interest in their own well-being, and be in control of their own life. They should make sure that they get enough rest and physical activity.
According to Baltseva, meaningful and rewarding work is a positive resource.
– Even in a work community that is pressed for time, the importance of positive feedback should be remembered. Praise and thanks for work well done should be given when there is cause.
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