Incivility Affects Healthcare Workforce Planning: Three Strategies for Change

Wouldn’t it be great to have just the right number of health care providers in each jurisdiction across the country? Instead, projects anticipate that we’ll have not enough doctors, not nearly enough nurses, and those available will be concentrated in the more pleasant places to live to the disadvantage of the periphery.

Yesterday I listened to a talk by Adrian MacKenzie about a simulation model for health human resource planning. It is a way of thinking about things health policy makers can do to close anticipated gaps. The model is comes from a research group at Dalhousie University headed by Dr. Gail Tomblin-Murphy.

One of the lessons of this model is that withdrawal is costly. People chose to leave their jobs or even their profession after receiving a significant investment in training and developing expertise through on-the-job experience. Filling that gap requires not simply another live person, but one who has received the training and developed the experience.

Although quitting is the most definitive form of withdrawal, there are milder forms that impose a drain on the health care system. Absences through sick time reduce the percentage of an individual’s potential contribution. Showing up but lacking enthusiasm at work reflects a more subtle form of withdrawal, but one that has the impact of a reduction in the knowledge or energy that people bring.

Poor working relationships, as reflected in incivility or other signs of disrespect, drive people away. When things are quite bad or opportunities are quite available, the likelihood of employees quitting increases. Short of these conditions, people withdraw in more subtle ways, through absences and apathy.

These are expensive leaks in the health care system. Simply training more providers is not an answer. The current level of withdrawal is unaffordable. Reductions in these sorts of exits from engaged work will compound upon one another to make an enduring and meaningful difference. Addressing civility issues will increase organizational resilience through building a sense of psychological safety.

Three steps towards a more pleasant workplace community.

  1. Put civility on the agenda. Problems in working relationships can persist. Although most people work out minor differences quickly, some don’t. Once poor relationships establishes itself, they can persist a long time.
  2. Empower first-line managers to resolve people problems. Few managers have the confidence necessary to step into a difficult work environment to work towards a resolution. These are capable people who could contribute a lot with the right support systems.
  3. Take workplace respect seriously. Random platitudes do not drive an organizational culture. Senior leaders must make public, effective, and frequent actions to confirm a commitment to respect at work.

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