Coach, don’t boss: 5 keys to effective well-being in the OR

There is an abundance of wellness programs in American workplaces. In 2017, the Centers for Disease Control and Prevention reported that 46% of 2,843 employer worksites offered some type of wellness program or health promotion. Hospitals are high users: 83% of the hospital respondents said they provided a workplace wellness program.

Mike Ellrich

While most US organizations claim that they have this benefit, “wellness” differentiates quite a bit from a “well-being” program, said Mike Ellrich, healthcare portfolio manager and principal consultant with analytics and advisory company Gallup, in Washington DC. In his view, well-being is a much more comprehensive approach to take in the OR suite and in health systems in general.

Wellness programs tend to focus on financial well-being and/or physical well-being. Gallup’s definition of well-being is quite different, says Ellrich. It does address the financial and physical, but it also covers other aspects of a life well lived, such as community, social, and career well-being.

Tending to all five aspects of well-being result in thriving individuals, workplaces, and communities. “We derive a lot of our sense of personal value from our work and we spend a huge chunk of our time doing work every day,” says Ellrich.

In an interview, he discusses why OR suites would benefit from a “well-being program,” offering 5 pillars for improving the health of staff while fostering good management and individual strengths of employees.

This calls for managers to transcend from the role of “boss” to “coach,” advises Ellrich, who will be dispensing more advice about well-being at a pre-conference workshop at the 2023 OR Manager Conference in September.

Q: Do you think employee well-being is a high priority for health systems?

The sense of well-being among healthcare employees, which includes clinicians, physicians, nurses, and others, was at its all-time high in May and June of 2020, during the height of COVID-19. Organizations understood what was at stake.

They stepped in and provided care and resources that let employees know that they were a top priority. Regardless of cost, healthcare leaders were going to make sure that employees were safe, both physically and mentally. They put a lot of employee focused programs together in short order. They basically went all out.

Since then, we’ve gone from a high of about 49% down to about 25%, in terms of the degree to which employees believe that their company cares about overall employee well-being.

Q: Why do you think that is?

Maybe it wasn’t sustainable. As we got further and further away from the high point of COVID-19, healthcare organizations had to step back on a lot of those programs because of cost constraints. Staff thought, “Hey, you’re concerned about me during the pandemic, but as soon as that ends and the pressure’s off, you’re going to dial back many of the programs and gestures that made us feel leadership cared about us beyond the work that we do.”

Q: What specific mental health challenges do people in the OR face?

It is a very unforgiving environment. There’s no room for error, although errors do occur, and we know that they occur. You have the life of a human being literally in your hands if you’re working in an OR suite.

If you can excel in such a high pressure, high stress environment because of the stakes, then you will succeed and probably advance. But the pressure can get to you if you are not 100% accurate in terms of what you’re handing the surgeon, what the patient needs, or making sure that everything’s getting tracked and traced so that nothing gets left inside a body cavity. All those things make it an incredibly stressful environment.

Q: If you’re an OR manager and want to establish a well-being initiative, what is the first step?

There are probably about five things that OR managers can do. The first aspect is to make sure that everyone on the team knows their greatest areas of strength and can use them daily.

Do individuals, whether they’re in a medical or surgical environment, know what they do best and do they get the opportunity to play in that space with regularity? Ultimately that helps to create an employee experience that leads to a culture of high development, which is so critically important.

Turnover right now in healthcare and certainly in many organizations is incredibly high. And yet when we focus on an individual’s strength, that’s the first step I think, in really creating an environment where well-being can thrive.

The second element is that organizations and teams really need to be clear about their tolerance of managers who are directly and indirectly adversely impacting the work lives of the individuals that the surgical suite is relying on to get that work done.

Healthcare, along with many other industries, tends to use two criteria to select and promote new unit or department managers and leaders. One, they’ve been there the longest, and two, they’re the best in the role out of which they’re being promoted (bedside registered nurse, pharmacy tech, physical therapist, etc). In my experience, those two criteria are not in any way predictive of great manager or leader talent.

Tenure has nothing to do with leadership or management ability, and neither does your ability to perform in a previous job. If the manager role doesn’t work out, the individual tends to leave the organization—that means poor manager selection and succession planning have cost the hospital or clinic one of their best individual contributors, and it’s back to the drawing board. Now they need to replace a great individual performer and an unsuccessful manager.

A third element to consider is upskilling managers to be more of a coach than a boss. If you think about the best coaches, regardless of the field, they’re the ones who provide regular guidance and in-the-moment learning, pointing out things that are going well, as well as pointing out some challenge areas for individuals who are working for them.

Managers need to become experts in a couple of areas to ensure the sense of well-being or wellness. The first is appropriate goal setting for those that report to them. The second is providing meaningful feedback at least once a week. Believe it or not, the average manager, regardless of the setting probably is providing some level of directive feedback that’s either corrective action or recognition. In-the-moment coaching typically happens about once a month, which is far too infrequently. Those conversations need to take place around goals and objectives for each individual; understanding and recognizing what they do well.

Q: And the fourth?

The fourth is to make well-being part of career development conversations. We tend to have those once a year when we have conversations about compensation or pay increases. Career development conversations should be taking place two times a year or more.

Here’s why: Within healthcare, when people are asked why they’re leaving as part of the great transition, regardless of generation, all of them say it’s because they don’t believe that they have a clearly articulated plan for development.

That’s the purpose of those developmental conversations. They need to be done more frequently, and they need to be done from the perspective of a coach as opposed to that of a boss, whose primary purpose is to hold people accountable and whom employees may perceive as wanting to catch them in errors.

The fifth measure is to ensure that team members are spending time throughout the day with people they like and who give them positive energy. Many managers don’t put a lot of thought into team assignments. I think that’s folly because ultimately, when you have arbitrary teams where there are strong players forced to work with weak players or if you have employees that don’t get along with one another, it can become particularly disengaging, not to mention dangerous. The OR setting specifically and healthcare in general are examples of where team misalignment can put safety on the line.

When we see that there’s something that’s not working between individuals, managers need to reassess and perhaps think a little bit differently about who and how we bring people together in a way that is inspiring and motivating. Top performers will always be the first to leave, if forced to work with low-talent colleagues or managers, because they can.

Q: Any parting advice?

If you have two employees, and one has a miserable work life, and the other is in an engaging work experience, they have differentiated life outcomes.

When we look at Gallup analytics and compare employees who are engaged in the work that they’re doing and feel as though they’re thriving in life, those employees are 61% less likely to report being burned out, 48% less likely to have daily stress, and 66% less likely to spend a significant portion of the day worrying.

Any manager or organization that doesn’t focus more broadly than just on financial and physical wellness, needs to start doing so. Even though career is the most impactful well-being element, all five elements must come together to create the best possible life.

—Jennifer Lubell is a freelance medical and health policy writer based in Rockville, Maryland.

Reference

Centers for Disease Control and Prevention’s National Center for Chronic Disease Prevention and Health Promotion. Workplace Health in America 2017 survey.