Making your workplace healthy
AORN is developing resources to help perioperative professionals create their own healthy work environments
By Carina Stanton
Senior News Editor/Writer
Consider for a moment how you interact in the workplace. If you don't feel empowered to question a colleague or can't effectively communicate with staff and leadership, then you may be working in an environment that is unhealthy, and your patients are likely suffering for it.
The Joint Commission in July released a sentinel event alert that disruptive behaviors such as verbal outbursts, physical threats or refusal to perform assigned tasks can undermine a culture of safety-putting patients at risk. As facilities prepare to meet The Joint Commission's new Leadership standard (LD.03.01.01), effective Jan. 1, 2009, that addresses disruptive and inappropriate behaviors, AORN is working to provide perioperative nurses with the tools they need to implement a healthy work environment.
"When we look at patient safety and the ways we make errors, 98% are related to communication," she said. "If people are afraid to speak out about unsafe practices or they are unaware that a practice is unsafe, this position statement will help to raise awareness of the importance of open dialogue in ensuring patient safety." AORN's Healthy Work Environment position statement will be presented at the 2009 Congress AORN House of Delegates in Chicago, March 15-19. "This position statement will provide perioperative nurses with a document from their professional association that they can take to their colleagues and leaders to establish a healthier work environment that fosters quality patient care," added Donna Pritchard, RN, BSN, MA, CNOR, NE-BC, director of perioperative services at Kingsbrook Jewish Medical Center in New York and chair of AORN's Perioperative Environment of Care committee. "When you support a healthy work environment you have content staff who are productive and want to stay at their place of employment. This is true for many professions, but you have to have the mechanisms in place to create a positive work environment." Safety through synergy Within Baylor Health Care System in Dallas/Forth Worth, Texas, the Baylor Hamilton Heart and Vascular Hospital (BHVH) works within a healthy work environment model they call the "Synergy Model." Based on information from AACN's Synergy Model for Patient Care, operating room nurses at the facility use this tailored model as their recipe for a healthy work environment. Communication is at the core of this BHVH synergy, explained Jennifer Maninang, RN, also a staff nurse at BHVH. "We have an open door policy and feel comfortable speaking with leadership, whether it is our president or the chief of surgery. Issues don't get swept under the rug here because we have a system in place to address problems before they can impact patient care." For example, last fall all vascular patients from Baylor University Medical Center began being transferred to BHVH. Taking on this influx of patients required a reevaluation of hand-off practices. Following the BHVH's 90-day rapid response policy for addressing problems and changing behavior, the BHVH staff began working immediately with medical center staff to ensure that all hand-offs were conducted in writing, as well as verbally. They have since continued to streamline their hand-off communications to improve patient care. To maintain their culture of communication, representatives from every BHVH hospital department, including the operating room staff, meet daily at 3 p.m. These meetings provide all staff representatives a chance to discuss problems or challenges from the day and to prepare with all departments for incoming patients scheduled for the next day. "Meeting daily gives us a chance to plan testing, prepare for complex cases and make sure we know which departments we will be working with. It's so valuable to have all disciplines involved-it puts everyone on an equal playing field," Maninang added. While the BHVH OR team admits their healthy work environment they work in is unusual, they say it is not impossible to create. "Leadership has to be behind the nurses to give us the power to make changes because we are the patient advocates who are responsible for recognizing problems, gathering evidence-based practice and presenting resolutions," Jackson stressed. "Working in a healthy environment gives nurses the power to be assertive and hold themselves accountable for their practice." This healthy work environment is prevalent throughout the Baylor Health Care System, according to Richard Gilder, RN, BSN, CNOR, BCNI, nursing analysis champion in the office of patient safety at Baylor Health Care System and a member of AORN's Perioperative Environment of Care committee. He is part of this committee's work group creating AORN's healthy environment position statement. Gilder explained that the healthy work environment at Baylor Health Care System links directly to improved recruitment and retention. "This healthcare system is a research and evidence-based practice magnet that attracts and holds like-minded people of all ethnicities who endeavor to enjoin themselves to be part of our mission to deliver safe and trusted health care as an enterprise and as a lifestyle," he said. "We have a saying around here, 'Patient Safety Starts With Me'." Creating a healthy culture Mower stressed that another critical element of this statement is the encouragement of professional practice and continued growth and development through continuing education and active participation in professional associations. "People who understand the reason why they are doing something typically do a better job, so if you can create an environment where certification, continued education and learning is encouraged, this will reflect in nursing practice and lead to better, safer patient care," Mower explained, noting that the framework for this position statement comes from healthy work environment research from professional associations, including AACN. As Mower, Gilder, Pritchard and other members of the Perioperative Environment of Care committee continue gathering research and working to develop AORN's healthy work environment position statement, they encourage healthcare professionals to think about the health of their work environments and what they can do today to promote positive change. Additional Resources AACN's Healthy Work Environment Initiative Read more news in AORN Connections.
Open communication among members of the surgical team is a critical element to creating a healthy work environment that promotes optimal patient safety.
Photo credit: Baylor Hamilton Heart and Vascular Hospital.
"The connection between healthy work environment and patient safety is well understood by perioperative professionals and the broader healthcare community-the tricky part is effecting facility-wide change through interdisciplinary support," said Julie Mower, RN, MSN, CNS, CNOR, a perioperative nurse and credentialing and education project manager with the Competency & Credentialing Institute who is working with members of AORN's Perioperative Environment of Care committee to create a position statement on healthy work environment.The statement will clearly identify practice standards for a healthy work environment in the perioperative arena. Mower defines a healthy work place as "a positive environment that encourages safe patient care practices and optimal outcomes by enabling all members of the perioperative team to communicate, collaborate and appreciate each other."
Healthcare facilities and other associations have been working to address healthy work environments, including the American Association of Critical-Care Nurses (AACN) and Magnet™ facilities like those in the Baylor Health Care System.
The “Synergy Model” provides a recipe for success in creating a healthy work environment for perioperative nurses at Baylor Hamilton Heart and Vascular Hospital, part of the Baylor Health Care System in Dallas/Forth Worth, Texas. Image credit: Baylor Health Care System.
"Our goals each day are rooted in a synergistic approach that combines patient needs and nurse competencies with evidence-based practice and a culture of inquiry," explained Cynthia Jackson, RN, BSN, a perioperative staff nurse at BHVH. "No member of the team is above another, so a team leader may mop the floor if that is what is needed to maintain our work flow and provide optimal patient care."
Adapting to change
Maninang, Jackson and their colleagues admit that the "Synergy Model" does not prevent challenges from arising, but they say that through the model, which is based on open communication, they have a system in place to address problems and adapt to change.
A healthy work environment is rooted in a culture that supports collaboration, communication and accountability, according to the draft position statement that AORN members like Gilder and Mower are creating.
Council on Surgical and Perioperative Safety (CSPS)
Statement on Violence in the Workplace