This essay is a draft chapter from my upcoming book called Ducks in a Row: Reimagining Patient Engagement.
I once had a position in a hospital where the staff morale was excellent. Staff described the workplace as being part of a family. There were pictures of staff members on the wall when one walked into the facility. People stood and chatted in the halls, and there were friendships nurtured outside work hours. Staff yoga was offered at lunch and there were craft sessions in the library at employees’ break-time. There was a constant stream of employee social events – teas, skits and barbecues.
I was hired to advise about patient centred care. Many staff were offended by the very idea of me – of a person brought in to improve the patient experience. They felt strongly they were already patient centred. The staff were satisfied with their work family and wanted to keep it that way.
It was obvious who came first at the hospital, and it was the staff. The culture was strongly staff centred, which was great for morale, but not necessarily great for patients.
Patients shared feedback that they felt dismissed and not listened to. Patient complaints were often ignored, their messages left on voice mails for weeks. Information given to patients was chock full of deficit-heavy medical jargon. Diagnoses were shared with patients in a dark meeting room with no windows, instead of the bright sunny boardroom downstairs.
“We know what’s best for the patients,” staff would tell me.
I spent months storytelling in an effort to encourage compassion. First I told my own story about how it feels to be a patient in the health system. Then I engaged patient speakers who told their own patient stories. I started up a book club, where both staff and patients were invited to talk about books together like Ian Brown’s The Boy in the Moon and Anne Fadiman’s The Spirit Catches You and You Fall Down.
With a growing group of dedicated patients, we chipped away at recalibrating the focus of the hospital to include patients. I lobbied (unsuccessfully) to invite patients to the yoga class. I managed to replace the staff pictures on the wall with colourful art to better reflect the people who were being served and to change the first impression when people first walked into the hospital. I had some successes but mostly failures before I finally left my position.
I wasn’t trying to take away staff morale; I was attempting to include patients in the staff’s happiness. There’s a difference between experiencing joy at work and feeling joy in work.
My caveat here is that I enthusiastically agree that staff well-being affects patient well-being. If a nurse gets yelled at in the staff room, it is very challenging to then immediately walk into a patient room and offer good care. Patient safety is at risk in hostile work environments. As a patient, you can immediately tell if staff are unhappy, through their demeanour, lack of smiles and eye contact. This is absolutely not ok and makes for a miserable environment for everybody.
Some may say that patient-centred care has tipped too far into the patient’s needs. Let us not forget that patients are the health care’s very reason for being, We are the raison d'être. Patients are the one thing in common for everybody who works in health care.
When patients are excluded from the culture of well-being of a health care workplace, this can cause additional suffering. Patients can feel like uninvited guests in hospital work environments, as if they are a bother and an afterthought. I still feel like that when I go to the cancer hospital, apologizing as I check in at reception. The receptionist always looks up reluctantly, clearly annoyed at my presence.
I will continue to champion staff well-being and shout about the importance of it from the highest mountain. This is both selfish – as a patient, I know that happy staff means better treatment for me – and because I do care about the health professionals in my life. Start with staff well-being, but factor in patient well-being too.
It is crucial to not forget about the patients in a quest for a healthy workplace. Staff and patients are tightly intertwined. As the tired old pandemic saying goes, we are all in this together.
For health care staff, well-being is not just about experiencing joy at work; it is about honouring your greater purpose. Your greater purpose is the reason you choose health care to begin with, which is your joy in work.
Centre your practice on your purpose, and you will evolve from merely being happy at work to feeling deeply rewarded for doing what is perhaps the most important work at all: caring for people who are sick and suffering, who present to you when they are at their most vulnerable, often in the darkest time in their lives.
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