Stay or Go?
Why do people stay? In a snowstorm? To watch a soccer match? What level of crazy is this? Is it the FOMO? Loss aversion? What level of behavior is displayed here?
Behavioral economists spend a great deal of time answering these questions, especially when consumers have choice. Should a fan (who has invested emotions, money, time, etc.) choose to go to the game or watch on a screen depends on many, many factors. But professional sports requires fans. Without fans, there is no merch, no streaming contracts, or ticket sales. Getting the fans' collective attention is inherent in the business of professional sports.
But when it isn't a matter of simple choice, but a deeper level of (crazy?) commitment that compels a fan to drive through a blizzard to watch soccer, what can we learn from this? And how can we apply the same insights with our healthcare workforce.
The cliché (and the feedback that supports it) that folks leave work because of their (or relationship to their) boss is time tested. But why do people stay?
Fans have attraction to their team for a variety of reasons, but ultimately develop a psychological commitment. From there they display attitudes that are deeply loyal. And then their behaviors reflect the loyalty, such as sitting in an open stadium during a blizzard.
Organizations are the beneficiaries of three types of commitments. The first is normative. Wherein the worker's values and beliefs align with the work of the organization. Healthcare, in its ideal, is ripe for this commitment. Someone who wants to clinically care for people, chooses to work in a hospital or a clinic. The second is continuance. The worker will stay in the same state, same town, the same company forever (if possible) because their whole life (family, friends, religious ties, community groups) is centered around so much of the environment that they couldn't possibly go anywhere else and find something better. The third is affiliative or affective in which the worker really likes the company. For whatever reasons.
It is the last one that is most akin to sports fans. A skilled worker, such as a nurse, may stick with a hospital (regardless of the other two types of commitments) because they really like it there. And will then behave accordingly. And will be loyal even in the face of stormy weather such as today's healthcare landscape.
It has been postulated that sports fans' loyal behaviors reinforce their sense of well-being. I love the Cleveland sports teams. All of them. And, I haven't lived there for nearly 40 years. Cleveland is part of my identity. It was cemented in me. And my taking on the tribal display of "my" teams serves to reinforce who I am. My lived experiences. My memories. Bonds with friends and families gathered in basements watching the games, or even better, going to the stadium with my brother, with my father. I don't even think about it. When the game is on, I just put on the jersey and dress like I'm a player (which makes me an absolute clown, of course, because I do NOT look like a professional athlete, unless we are talking about the 5th grade spelling bee which I lost in the final round to Jill T. A competition sure, but mental athletics really doesn't count here, does it?!)
When our workers put on their work uniforms and show up in all kinds of conditions, they are displaying any number of commitments, but those that are showing up BECAUSE THAT IS WHO THEY ARE and that IS WHAT THEY DO are treasures to be cherished. They affiliate. And that requires some attention.
Thomas Lee and Patrick Ryan addressed this in a great HBR article about why they stay last year. In it, they mention the various tactics used in recruitment and retention (and there are many for both) to attract talent in a shrinking and evolving labor market. These tactics designed "to improve compensation and mitigate the deadening aspects of work have merit, but organizations should not rely upon them to create the loyalty." Rather they stress "in health care that means focusing organizational culture on the role of caring for the sick (or in their words, "the noble cause of reducing patients’ suffering") and that this is THE operational imperative. Many administrators tend to use the language of "patients first" but co-opt it to drive outcomes that serve their own managerial needs.
Thomas Lee has also stated in another article that at a time when physicians and other clinicians are leaving healthcare, positive factors (found in multivariate regression analyses) that reduce EXIT included feeling valued, good teamwork, and "having values that are aligned with those of leaders." "Leaders must also listen to understand their employees’ hopes for what their work means to them and reinforce the aspirations that brought their employees to health care to begin with."
What brought fans to the stadium during the blizzard in the first place?!?!
What brings folks to work in the ICU, the ED, the OR, the bedside in the first place???
What are we doing to support their commitment? What alignment of values do we show? How do we make them feel like it is worth their while to actually like us? Affiliate with us? Trust us? Earn their loyalty?
Many in the soccer world blasted the league officials for conducting the game in such terrible conditions. The players were at tremendous risk of injury. Stadium workers had to drive to/from work in the blizzard. Who does this?
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Healthcare is facing epic conditions. Some are actually blizzards while others are quite analogous to a blizzard. The structural conditions do not appear to be changing any time soon. The brutal facts must be confronted. And while back office support teams and operations officers are getting pummeled by the Change Healthcare cyber meltdown, folks still have to SHOW UP each day (clinicians and non-clinicians) to get the job done, which is to CARE FOR THE SICK. To HEAL THE WOUNDED. To RESTORE HEALTH. Somebody has to show up in the blizzard, like it or not.
So, ask yourself, are you aligned with your workforce? Are you about the mission? Do you walk the walk? Are your values their values? Are you the calm in the chaos? Will you drive through the blizzard, sit in the seat in the snow next to them, tell their families that everything will be ok, cheer them on when it seems pointless and bleak, hold their hand when they suffer loss? Is your jersey the same as theirs?? Or more importantly, will they put on their jerseys for you each and every day without giving it a second thought?
In the rule of thirds, 1/3 of your workers will dislike you regardless (and may stay because of family or other needs outside of your control), another 1/3 will brave all storms to carry on (they simply love what they do), but the 1/3 in the middle need to know that if you make a painful decision, that you will get down on the soccer field with them in the driving snow and bitter wind in a T shirt and shorts and show them your commitment to the love of the game.
If you say that you are mine
I'll be here 'til the end of time
So you got to let me know
Should I stay or should I go?
One day is fine and next is black
So if you want me off your back
Well come on and let me know
Should I stay or should I go?
-writers: Joe Strummer, Mick Jones, The Clash
System Director of Adult Medicine, Ortho/Ortho Trauma, Urology, Gastroenterology, Psychiatry and Podiatry Hospital-Based Physicians/APPs | Master's in Healthcare Administration
8 个月Those questions are really tough. But I do believe it is possible. Many organizations shy away from the term “family”. But why is it bad? How can organizations get every individual to believe that everyone in the organization is part of their work family? Would this create that bond? How do we create a culture where we want to know and support every person we encounter in our organization? I am often seen as a little to optimistic, but I think this is possible. I see some of this work happening today by shared meetings across divisions, solidifying true shared goals, and creating space to get to know people outside of our direct daily work teams. It’s much easier in smaller organizations, but I do believe it is for larger ones as well. One of the things I saw in the past few weeks that really peeked my interest involved capturing the next generation of workforce in the children in the community from grade school to high school. The example was a leadership workshop that include using virtual reality to simulate running a clinic setting. If we can capture the hearts of the next generation to think of our organization as a family, it will be that much easier. I feel like I could write so much more..but I am out of space.
System Director of Adult Medicine, Ortho/Ortho Trauma, Urology, Gastroenterology, Psychiatry and Podiatry Hospital-Based Physicians/APPs | Master's in Healthcare Administration
8 个月Great article, Dr Scheinbart! You mention the ER and asked ‘why do people stay’. That hits home. There were so many days I remember going home so physically and emotionally drained. In that moment, the thought crossed my mind, how can I continue doing this. The answer was always the same- the people we serve and the TEAM around you. The bond that is formed when you stare down life and death situations together is so strong. It’s a bond that last a lifetime. It’s how you can face each day after the shift prior. The shift where stand as a united team to resuscitate a child unsuccessfully and have to immediately collect yourselves and comfort a grieving family. Outside of the ER, it’s not much different. The days can be equally tough, but the affiliation and bond with your work family is stronger. I believe this is why people survive things like a pandemic, a financial crises or a horrible boss and continue with loyalty.