This week I watched the First Ministers meet in Victoria and I couldn't help but shake my head at their calls for “more funding” from the federal government due to the “crumbling” health system. The evidence they have is that there are severe staffing shortages.
Why do I shake my head? Do I believe that healthcare workers deserve to be paid appropriately for the work they do? For sure I do. Do I think that we could modernize our facilities? Yup.
My hunch, however, is that the First Ministers and the PMO all believe they are dealing with technical issues that can be fixed with money. I do not believe money is the fix. People are leaving, calling in sick, going on short- or long-term disability, retiring, and switching careers in droves. There is one thing I am certain of – it not because of money.
The Canadian Medical Association’s (CMA) National Physician Health Survey from this year highlighted that 53% of physicians and medical learners describe feeling “burned out”, and they are doing something about it. If they aren’t leaving, almost half are considering reducing their clinical load.
Nurses are not fairing any better. The Registered Nurses Association of Ontario’s (RNAO) survey in July of last year highlights that 75% of nurses feel burned out, 69% are planning to leave the profession in 5 years, and 73% said their workloads increased “moderately or significantly” during the pandemic.
So yes, the healthcare system is crumbling, but it is not a money issue.
These issues are not “fixable” with money and investing in ways we usually do – to just get “more”. More staff, more agency supports, more infrastructure, more people. "More" does not address this issue. These symptoms of departures and burnout are issues of culture. Individuals and teams can achieve a lot, withstand a lot, and survive a great deal when they feel cared for, supported, connected and self-directed. They can stick together through adversity when a culture nurtures and supports growth and operates with compassion. People will stick around an organization for the people, and the feeling of satisfaction they get about the job and themselves as part of the collective.
The departures are not the problem – they are merely a symptom. The problem is the environments that the people work in. What we are witnessing is the crumbling of culture.
Who is to blame? Maybe everyone, maybe no one. Systems are tenacious in their stickiness and people quickly align to their system. Remember when you started a job, and you sat in a meeting were struck by the ways of speaking, doing, and interacting as they all seemed to be foreign? Likely within a few weeks you were assimilating, and no longer noticed the quirks of the group. Systems rarely change. Governments, agencies, service organizations and medical schools continually “do things like they used to” guided by the rules, behaviours and unwritten norms of the past.
Investment is indeed needed, but it is not the kind of investment we typically make. It is an investment in the “invisible”. It is investment in the professional culture of healthcare providers so that they can withstand the stress, challenges and pressures they are facing without losing themselves. It is an investment in leadership capabilities in all areas to understand how to manage and lead the “sticky” elements of culture. Adaptive organizations and leaders act differently, expect different things, and interact in different ways. “The way to do things” is not the usual course of action we currently see today.
How might an investment in people and cultures to behave in a way that positively impacts how people “feel” have different outcomes? Currently healthcare workers feel like they have no control, are not heard, are not seen, are not cared for and not connected to their colleagues. They feel like they can’t do their job. Those feelings have real consequences. They change psyches, behaviours and are the result of a system that normalizes this experience.
We are indeed in a crisis. A crisis of feeling.
The investment that is needed is an investment in the human capital and professional communities to be adaptive*. Shame on our federal and provincial political leaders for not seeing that or being willing to talk about it.
*Wondering what skills are needed for organizations and people to be adaptive? It is called Adaptive Leadership (Heifetz et al, 2009). It is about diagnosing issues to understand what can be fixed with existing knowledge, understanding and know-how, and which issues persist despite the know-how we have. These latter challenges are issues of culture need a different way of leading. What do adaptive leaders and organizations do differently? They surface the “unspeakables”, they share responsibility for the outcomes of their organization, they demonstrate and share independent judgement, they invest in leadership capacity, and reflection and learning are institutionalized. Sounds big? It is. But it can re-shape the stickiest of cultures.
Want to be an adaptive leader? Check out our Cognitive Resilience program starting this fall!