Health care settings, particularly hospitals, can be God-awful places to work. The work can be punishing, the smells putrid and abundant, the pressure relentless, the politics bitter, the processes infuriating, the bureaucracy stifling, and the bullying ubiquitous. Between all the sniping and fighting and finger-pointing and - let's be blunt - cruelty among and between members of the so-called health care team, it's a wonder the epidemic of burnout, mental illness and suicide among health professionals isn't orders of magnitude worse than it already is.
The stock response to this list of laments is a call to "fix the culture in health care", and urgently. But, asking with all sincerity, what does that entail, or even mean? What is it we're hoping to "fix"? And to what end? Is the goal to put an end to interpersonal abuse? To improve the quality of life of doctors, nurses and allied professionals? To rid the health care setting of hierarchies and based on some combination of profession, ethnicity, and/or gender?
What happens when these goals are in conflict? Or when the transgression isn't objectively clear? If you see a coworker use an ethnic slur or grab a coworker's behind, absolutely call out the bad behavior. But if someone communicates poorly with a patient or coworker of a different ethnicity or gender without being obviously disrespectful or rude, is that something that needs to be adjudicated through a formal grievance process, if at all?
Suppose we do go through the lengthy process of making sure every health care worker is trained in every competency deemed relevant, setting aside how that list of competencies is arrived at. Does that guarantee that health care workers will function as cohesive teams on a clinical and interpersonal level? How do we decide where irreconcilable personality differences cross a line from merely unhelpful to toxic? What happens when there's a change in the zeitgeist, particularly around hot-button issues of race, religion, or gender?
Moreover, how much can we realistically add to the expectations placed upon health care workers? The job in health care is ultimately about treating the sick and the suffering. That demands maintenance of technical skills and mastery of an ever-changing, ever-expanding knowledge base. There are only so many hours in a week, and we're all busy people with lives of our own. What can we honestly expect to change in the way grown adults think?
If we somehow decide that our approach to health care needs to be torn down and re-imagined through a lens of customer service or oppression or complex systems or some other model of thought, what happens when that way of thinking isn't adequate for the aims of health care? Or is discredited? Do we accept a flawed, "toxic" workplace as what we're stuck with?
The point isn't to argue against any change, nor in any way to dismiss the legitimate grievances of women, LGBT, visible minority, or Indigenous health care workers. Certainly any inequities in pay, prestige, or promotion constitute something we should all see as unacceptable and inexcusable. Some cultural change is inevitable, simply by virtue of the growing diversity of people working in health care. And we should welcome concrete suggestions to make life better for one another: brainstorming ways to let doctors and nurses raise their families without undue hardship; negotiating better work hours and loosening time pressures; crafting clear policies around discrimination; and setting firm guidelines for how to deal with dilema behaviors from any member of the team.
But making abstract promises to change an even more abstract "system" is at best a platitude, and at worst a recipe for meta-argument...fighting about what to fight about. Health care is ultimately about people working with people in the service of people. The "culture" is nothing less and nothing more than a reflection of the attitudes and actions of the people that work in it. If the culture is the problem, the people are the problem.
So what can we do? How do we make a busy clinic or a hospital a better place to work?
We act with decency. Humility. Understanding. We listen. And when we face those inevitable moments of crisis, when the stress is extreme and words are harsh, even hurtful, we wait until the fires are out and admit our mistakes. By far the biggest cause of complaints against health care workers arise from poor communication. Why should we expect it to be any different between health care workers? We're just as human as everyone else.
We shouldn't wait for governments or administrators to see the light, because they aren't looking for it and don't care. We shouldn't try to force people to change how they think, because we can't. And we shouldn't reduce every human interaction into a checklist of binary descriptions.
An apology, a hug, and a shoulder to cry on will do more than any code of conduct or policy paper ever will. It's time to stop putting our trust in arbitrary ideas, and start putting our trust in one another.
The stock response to this list of laments is a call to "fix the culture in health care", and urgently. But, asking with all sincerity, what does that entail, or even mean? What is it we're hoping to "fix"? And to what end? Is the goal to put an end to interpersonal abuse? To improve the quality of life of doctors, nurses and allied professionals? To rid the health care setting of hierarchies and based on some combination of profession, ethnicity, and/or gender?
What happens when these goals are in conflict? Or when the transgression isn't objectively clear? If you see a coworker use an ethnic slur or grab a coworker's behind, absolutely call out the bad behavior. But if someone communicates poorly with a patient or coworker of a different ethnicity or gender without being obviously disrespectful or rude, is that something that needs to be adjudicated through a formal grievance process, if at all?
Suppose we do go through the lengthy process of making sure every health care worker is trained in every competency deemed relevant, setting aside how that list of competencies is arrived at. Does that guarantee that health care workers will function as cohesive teams on a clinical and interpersonal level? How do we decide where irreconcilable personality differences cross a line from merely unhelpful to toxic? What happens when there's a change in the zeitgeist, particularly around hot-button issues of race, religion, or gender?
Moreover, how much can we realistically add to the expectations placed upon health care workers? The job in health care is ultimately about treating the sick and the suffering. That demands maintenance of technical skills and mastery of an ever-changing, ever-expanding knowledge base. There are only so many hours in a week, and we're all busy people with lives of our own. What can we honestly expect to change in the way grown adults think?
If we somehow decide that our approach to health care needs to be torn down and re-imagined through a lens of customer service or oppression or complex systems or some other model of thought, what happens when that way of thinking isn't adequate for the aims of health care? Or is discredited? Do we accept a flawed, "toxic" workplace as what we're stuck with?
The point isn't to argue against any change, nor in any way to dismiss the legitimate grievances of women, LGBT, visible minority, or Indigenous health care workers. Certainly any inequities in pay, prestige, or promotion constitute something we should all see as unacceptable and inexcusable. Some cultural change is inevitable, simply by virtue of the growing diversity of people working in health care. And we should welcome concrete suggestions to make life better for one another: brainstorming ways to let doctors and nurses raise their families without undue hardship; negotiating better work hours and loosening time pressures; crafting clear policies around discrimination; and setting firm guidelines for how to deal with dilema behaviors from any member of the team.
But making abstract promises to change an even more abstract "system" is at best a platitude, and at worst a recipe for meta-argument...fighting about what to fight about. Health care is ultimately about people working with people in the service of people. The "culture" is nothing less and nothing more than a reflection of the attitudes and actions of the people that work in it. If the culture is the problem, the people are the problem.
So what can we do? How do we make a busy clinic or a hospital a better place to work?
We act with decency. Humility. Understanding. We listen. And when we face those inevitable moments of crisis, when the stress is extreme and words are harsh, even hurtful, we wait until the fires are out and admit our mistakes. By far the biggest cause of complaints against health care workers arise from poor communication. Why should we expect it to be any different between health care workers? We're just as human as everyone else.
We shouldn't wait for governments or administrators to see the light, because they aren't looking for it and don't care. We shouldn't try to force people to change how they think, because we can't. And we shouldn't reduce every human interaction into a checklist of binary descriptions.
An apology, a hug, and a shoulder to cry on will do more than any code of conduct or policy paper ever will. It's time to stop putting our trust in arbitrary ideas, and start putting our trust in one another.
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Tuesday, April 17, 2018
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