Administration of a 300-bed hospital was concerned with employee complaints about working relationships among several medical specialties and services. Reports indicated incidents of individuals refusing to cooperate and of open hostilities during procedures. These incidents had led to unwanted turnover in two units at a time when health care is suffering from a diminishing labor pool of experienced professionals. Lack of experience and questionable work values of some replacement personnel had worsened tensions. Board awareness of these concerns led to an informal review by a senior administrator and discussions with legal counsel regarding implications for patient safety and liability. A decision was made to initiate improvements and lower financial risk to the hospital.
The consultants conducted structured interviews with representatives of each function in order to identify problems and begin to develop productive communications. Administrative, nursing, and physician personnel were all included in the assessment, and each group identified their concerns, interests, and needs. Participants reported both significant differences among the groups as well as significant congruency of shared values and goals. Results of the assessment indicated specific operational risks having negative impact on employee satisfaction and on patient safety. The consultants also noted opportunity costs associated with lowered productivity. Systemic factors were also identified, suggesting a need for improvements in certain procedures that tended to promote avoidance of communication and cooperation. Work-related stress was seen as "normal and acceptable," however, additional stressors from poor performers and caustic verbal behavior were identified as an additional source of burnout.
Two primary barriers to risk reduction were identified: 1) each group was misperceiving the role demands, professional needs, and motivations of the other groups; and, 2) administration was reacting to its fears that addressing these issues head-on could lead to greater disruption, additional unwanted turnover, and possibly an uncovering of liabilities that had not yet risen to a level of awareness.
The consultants collated and analyzed the assessment information for a facilitated discussion with a representative task team. A joint report with recommendations was prepared for presentation to administration. A meeting with administrative and board members led to suggestions for several procedure changes, sponsoring of inter-function collaboration meetings, and the setting of specific performance goals and measures.