How can we decrease burnout and safety workaround behaviors in health care organizations? The role of psychosocial safety climate

This explored the indirect effects of psychosocial safety climate (a type of safety climate and not psychological safety) on workarounds via mediation of physical fatigue, cognitive weariness and emotional exhaustion.

Sample was 562 staff across the health sector in Quebec.

Psychosocial safety climate (PSC) is an organisational climate composed of individual perceptions of practices, procedures and practices.

These are “reflected in management commitment, organizational communication, management priority and organizational participation concerning the value of the psychosocial health and safety of employees in the workplace … [and]?to enhance PSC, senior management supports workers’ psychological health, prioritizes the psychological health of employees over productivity, and commits to and supports psychological health and well-being” (p4).

The conceptual model is shown below:?

Providing background on workarounds:

·????????Healthcare workers are seen to be “masters” of workarounds. The care sector is a high-hazard industry, where employees` actions (or inactions) can lead to injury or even death of patients

·????????Complicating this is that work in healthcare is seen to be “characterized simultaneously by routine, highly structured and ultra-safe practices, but also by irregular, erratic and harmful demands” (p2)

·????????Moreover, health workers are expected to learn on the job while conversely required to display professional autonomy

·????????Work within health is often within complex systems but increasingly requires standardisation. This drive for standardisation occurs while “employees develop inconsistent and idiosyncratic work patterns that they believe increase their performance and patient safety” (p2)

·????????These practices are called workarounds – signifying a alternate work practice to address a perceived or actual block in that workers workflow

·????????Workarounds aren’t necessarily intentional, but for some internalised as part of their duty towards ensuring patient safety. Workarounds can make a worker feel more efficient and able to manage complicated rules that slow or impair patient safety

·????????Workarounds also allow workers to develop creative solutions and more efficient work practices and draw attention to blocks or obstacles in workflows that need revision

·????????Workarounds can be both positive (increasing safety) but also create new failure modes and less system reliability

·????????Some workers spend as much as 10% of their work time workaround around operational failures

·????????Some factors are more conducive to driving workarounds. These include: heavy workloads, negative org climate characterised by poor leadership, few opportunities for professional development, lack of involvement of workers in decision making, lack of perceived human resources management and support, incompatibilities between ordained policies and actual requirements

Providing background on burnout:

·????????Inadequate resources more likely to disengage from their work, higher thoughts on leaving their job, less motivated to follow rules and more likely to practice workarounds to ease their work

·????????Stress or burnout results from lost resources, threaten to be lost or when there’s a bad return on investment in resources

·????????Regarding resources, those with lots of resources are more likely to win new resources and that initial gains in resources will lead to future gains

·????????Resource loss is disproportionately more salient than resource gain and thereby, people invest more resources to protect against resource loss than to gain new resources

·????????When people’s resources are exhausted, they enter defensive mode to preserve self

·????????Burnout can result from the above via an erosion of emotional resources (leading to disengagement from the tasks), a phase of cynic depersonalisation (leading to absence of fulfilment at work), and a lack of personal accomplishment.

Their hypotheses were:

·????????High PSC will decrease workarounds via decreasing physical fatigue as a mediator.

·????????High PSC will decrease workarounds via decreasing cognitive weariness as a mediator.

·????????High PSC will decrease workarounds via decreasing emotional exhaustion as a mediator.

Results

Key findings were that physical fatigue, cognitive weariness and emotional exhaustion were found to mediate relationships between PSC and workarounds.

PSC was found to be negatively related to all dimensions above of burnout: as PSC performance increases, a decrease in burnout occurs.

Moreover, burnout was positively related to workarounds: as perceived burnout increases, so too does the use of workarounds.

They discuss the findings, noting that as predicated workers are more likely to use workarounds when their resources have been depleted; leaving them with fewer resources to invest in prescribed work processes.

Other research highlighted that workers with inadequate or insufficient resources decreases their motivation, leaving higher intention to leave the company and less energy to follow established rules; thus, higher use of workarounds.

In this study PSC was modelled as a “resource passageway or organizational tool, which allows employees to gain more resources or to protect themselves from the loss resulting from burnout” and therefore “when employees perceive that organizations, managers, supervisors [etc] … offer policies, procedures and practices to identify and resolve problems that threaten their well-being and psychological safety, they feel that they have more stable and safer working conditions” (p15).

This then leads to higher work engagement and decreased likeliness that employees will use workarounds.

Further, workload pressures can make workaround behaviours subconscious actions that “constitute survival mechanisms for nursing and other health care professionals”.

Work system failures that don’t provide the necessary support or resources to staff have been found to increase burnout; like with nurses’ workload increasing from 5 patients to 5.3 patients. This difference may result in a 2% higher patient mortality.

Further, work system failures lead to nurses spending an average of 33 minutes per nurse per 7.5 h shift dealing with and working around operational blocks and processes.

This paper adds to a large body of works highlighting the value of considering organisational performance in terms of a systems lens rather than or in addition to an individual lens of process variance.

Link in comments.

Authors: Mansour, S., & Tremblay, D. G. (2019). Personnel review.