VON CANADAVON CANADA

Healthy Workplaces for

Health Workers

Dr. Judith Shamian, President & CEO

April 12, 2007

The Journey:…1999…2007….

1999-We had a problem….Nurses have the highest absenteeism rate among 40+ occupations.

Fast ForwardFast Forward

“The way to better healthcare is through healthier healthcare workplaces and it is unacceptable to work in, receive care in, govern, manage and fund unhealthy healthcare workplaces”

QW-QHC 2006 (Quality worklife-quality healthcare collaborative)

QWQHC= QUALITY WORKLIFE-QUALITY HEALTH QWQHC= QUALITY WORKLIFE-QUALITY HEALTH CARE COLLABORATIVECARE COLLABORATIVE

• Partnership among 11 National Organizations: CCHSA, CCHSE, CNA, CMA, CHA, CFNU, CHSRF, ACAHO,ACEN, NQI, ONP-HC and 40 health care leaders who working together to develop an integrated action strategy to transform the quality of work life for Canada’s healthcare providers

TodayToday

1. Current reality: data & action

2. What is next? What are some of the “new/old ideas”

Current reality: data & Current reality: data & actionaction

In 2004, 68% of CEOs recognized that attracting and maintaining top quality employees was a major priority, up 10% from 2003(KPMG, 2004. Tenth Annual Survey of Canada’s Most Respected Corporations, p.17)

Across all socioeconomic groups, regardless of income, family status and life cycle, work-life and well-being is becoming a social and political priority.(Branham 2005)

IntroductionIntroduction

The Canadian Council on Integrated healthcare estimates the annual burden of workplace health in Canada at $32.5 billion (Blonnett, C., and Yardley. J., 2003)

A pilot study in 2002 of 11 nursing units in 6 countries revealed an average nurse turnover rate of 9.5% in six months at an average cost to the system of $21,514 US per nurse.(Shamian, O’Brien-Pallas & Laschinger, 2003)

Every year the pressure is mounting as early retirements of the baby-boomer generation increases.

What does the Data Show?What does the Data Show?

Work Life• 25% of all physicians without dependents

worked less than 40 hours per week, a number that appears to be on the rise (Physician Resource Questionnaire Results Ottawa: CMA, 2002)

• 50% of Canadian physicians considered leaving medicine (The Canadian Medical Association Centre for Physician Health and Well being)

• 17% of nurses in 2001 were planning to leave their jobs in the next 6 to 12 months (Aiken et al., 2001)

What does the Data Show?What does the Data Show?

Wellness• 46% of physicians are moderately to severely burned

out (Canadian Medical Association Centre for Physician Health and Well Being)

• Although 86% of physicians are satisfied with their relationships with patients – only 66% were satisfied with their professional life and only 50% satisfied with work life balance. (The National Physician Survey)

• Nurses are the most overworked, stressed, work-life-unbalanced and sickest workers in the country, with absenteeism rate 80% higher than other workers (McLennan, M. 2005)

What does the Data Show?What does the Data Show?

Work life• The proportion of the nursing workforce with multiple

employers increased from 12.8% in 2004 to 14.1% in 2005 (CIHI 2006)

• The majority of nurses in management positions range in age from 46-55: (Heather Laschinger et al)

Senior Nurse Leader

Middle Manager

First-line Manager

26-35 - 2.2% 6.3%

36-45 17.7% 32.0% 32.7%

46-55 69.4% 53.1% 50.0%

Over 55 12.9% 12.7% 11.0%

Percentage of nurses and all employed people working Percentage of nurses and all employed people working unpaid and paid overtime, by sex, Canada, 2005unpaid and paid overtime, by sex, Canada, 2005

49%50%

26%

41%

30%

0%

10%

20%

30%

40%

50%

AllNurses

Female Male

Nurses

All Employed

Employment characteristicsEmployment characteristics

• Higher proportion of nurses are unionized: 82% of nurses vs. 34% of all employed

• Nurses worked more paid overtime: Women: 30% of nurses vs. 13% of all employed Men: 37% of nurses vs. 28% of all employed

• Among nurses, unpaid overtime more common than paid overtime; 50% reported unpaid overtime, averaging 4 extra hours per week.

8

Role overloadRole overload

62%67%

45%

57%54%

Often arrive early orstay late to get work

done

Often work throughbreaks to complete

workload

Often too much workfor one person

Not enough time todo what is expected

in job

Too much to do, todo everything well

13

Percentage distribution of nurses, by reported Percentage distribution of nurses, by reported changes in quality of patient care at workplace in changes in quality of patient care at workplace in

past year (2005)past year (2005)

27%

16%

57%

Deteriorated

Remained theSame

Improved

Data Source: 2005 National Survey of the Work and Health of Nurses

Nurses reporting physical assault by a patient in past yearNurses reporting physical assault by a patient in past year

10%

9%

50%

30%

44%

28%

29%

Other

Community health setting

Long-term care facility

Hospital

Male

Female

Total nurses

12

Rate of depression in past year among nursesRate of depression in past year among nurses

9%

7%

9%

4%

9%

Total nurses Female nurses All employedfemales (21+)

Male nurses All employedmales (21+)

17

Summary of multivariate modelling relating fair/poor physical Summary of multivariate modelling relating fair/poor physical or mental health to working conditionsor mental health to working conditions

• Few associations emerged between ill health and factors such as shift work or long hours. The factors most consistently related to the variables reflecting nurses’ health were: Low autonomy

Low control over practice

Poor nurse-physician working relations

Low respect from superiors

Role overload

What does the Data Show?What does the Data Show?About 12% of nurses in BC reported that they had

occasionally or frequently been injured on the job in the past year, the highest proportion in the country. The proportion nationally was 9%

Nearly one-third (32%) of BC nurses said they had been physically assaulted by a patient in the year before the survey. The national figure was 29%.

About 17% reported that their organization was not taking sufficient precautions to prevent the spread of contagion. The percentage nationally was 15%.

(National Survey of the Work and Health of Nurses 2005: Provincial Profiles)

• 35% of nurses said that quality of care deteriorated the range in the country is 15-29%

• Nurses in BC had the highest job strain 34% (psychological demands of the job exceed discretion in deciding how to do the job)

• BC Nurses were positive about their working relationship with MDs

• 16% of BC Nurses (the highest in the country) taken time off due to mental health (the national figure is 12%

• BC Nurses missed and average of 18.3 days of work vs 23.9 of national average.

Unhealthy NursesUnhealthy NursesUnhealthy Nurses Poor Patient OutcomesPoor Patient OutcomesPoor Patient Outcomes

Unhealthy WorkplacesUnhealthy Workplaces Unhealthy NursesUnhealthy Nurses

Age Injury & Absence

Nurses Workload

Injury & Absence Nurses

Overtime Injury & Absence

Nurses Overtime

Impact on Quality of Care and Patient SafetyImpact on Quality of Care and Patient Safety

ImplicationsImplications

Many Initiatives have Begun…Many Initiatives have Begun…

• Nursing Strategy 2000

• CNAC 2002

• The 2003 First Ministers’ Accord on Health Care Renewal underlined the importance of health human resources (HHR) within Canada’s health system

• The 2004 Ten Year Plan to Strengthen Health Care reiterated a commitment to HHR

• The Pan-Canadian Strategy on Health Human Resources provided the policy lever to move forward on relevant HHR issues such as recruitment and retention and the promotion of health workplaces

• Physician Human Resource Strategy for Canada

Many Initiatives have Begun…Many Initiatives have Begun…

BC is the only province with Ergonomics Requirements: Prevention and Early Active Return-to-work Safely (PEARS)

To reduce incidence and duration of musculoskeletal injuries (MSIs)

Injury rate for healthcare workers in BC has been consistently higher than the injury rate for all industries combined, with MSI representing the predominant type of WCB claim.

MSI due to patient handling or other manual materials handling represent more than half of the overal WCB claims in healthcare.

(Trends in Workplace Injuries, Illnesses, and Policies in Healthcare across Canada – funded by Health Canada, Office of Nursing Policy, March 31, 2004)

Many Initiatives have Begun…Many Initiatives have Begun…

BC’s policy and practice changes since 1998 have seen a decline in time-loss injury rate Occupational Health and Safety Agency

formed in 1998 reducing the provincial injury rate by 27% for the

healthcare industry between 1998 – 2002Annual days lost per 100 FTEs dropped 38% between

1999 – 2002WCB premium rates fell representing about $51 million in

reduced costs to the sector in two years(Trends in Workplace Injuries, Illnesses, and Policies in

Healthcare across Canada – funded by Health Canada, Office of Nursing Policy, March 31, 2004)

Time Series of British Columbia Injury Rate to Time Series of British Columbia Injury Rate to Legislation and Intervention ChangesLegislation and Intervention Changes

0.00

1.00

2.00

3.00

4.00

5.00

6.00

7.00

8.00

1996 1997 1998 1999 2000 2001 2002

BC Time-LossInjury Rate(100 FTE)

MSI Reg. Implemented

Bill 14 Act & Regs

OHSAH Formed

Restructuring HAs

“No Lift” MOU

Ministry “No Lift” Funding

FPT Health Human Resources (HHR)FPT Health Human Resources (HHR)Action Plans & Targets Action Plans & Targets (reported ones only) (reported ones only)

  BC

AB

SK

MB ON

QC NS NB

PE NL YK NT NU

Planned Activities to Address Workplace Issues

    X   X X X X    X   X X

Succession Planning                    X   X  

Relocation Assistance             X            

Bursaries and Tuition Support         X   X X    X

X     

Incentive eg. Education Programs Enrollment

              X          

Full-time jobs for nurse graduates         X                

Continuing Education     X   X   X X          

Career Laddering         X                

Mentorship     X         X       X  

Professional Development and Training

    X   X   X X       X  

Salary adjustments               X          

Conversion of Casual Work to Permanent

              X          

Leadership Training     X              X   X X

Occupational health and safety and programs to reduce injuries

    X   X             X  

Phased Retirement Programs               X          

Employee Recognition Program               X       X  

Initiatives & Targets*

What is next??

What are some of the What are some of the “new/old ideas”“new/old ideas”

1. Succession Planning

2. Generation Gap

3. Practice Issues

Succession PlanningSuccession Planning

• Recognize emerging leaders

• Support and guide emerging leaders

• Provide opportunities

• Leadership Pipeline

Mentoring:dyad, triad, networkMentoring:dyad, triad, network

• Mentoring is a dyadic relationship that is developed by both members and has outcomes for both parties

Mentoring relationships have been found to be related to a variety of organizational, career, and development outcomes:

• Develops the human assets of the organization

• Helps to transfer important tacit knowledge from one set of employees to another

• Aids in the retention of employees

• May result in career progression and higher incomes

• Protégés report more career satisfaction

• Protégés report more mobility

Source: Harvard Business Essentials. Coaching and Mentoring. Boston: Harvard Business School Press, 2004.

and Higgings, M.C., & Kram, K.E. (2001). Reconceptualizing mentoring at work: A developmental network perspective. Academy of Management Review, 26: 264-288.

Understanding the Understanding the Generation GapGeneration Gap

How are values

different for the next generation filling health care positions?

Generation Gap (Generation Gap (Stephen Sheperd)Stephen Sheperd)

Generation GapGeneration Gap

Why make employee well-being a Priority (The Why make employee well-being a Priority (The Vanier Institute of the family)Vanier Institute of the family)

• Structure of the family changing

• Baby boomers retiring (more competition for quality employees)

• Employees less willing to sacrifice personal life for work

• Cost of inaction is evident, benefits of action very apparent

• No longer just work/life balance, now “employee well being” is important

Practice IssuesPractice Issues

Span of Control

Workload

Autonomy (moral distress)

Violence in the Workplace

Interprofessional relationships

SummarySummary

1. Current reality: data & action

2. What is next? What are some of the “new/old ideas”

Positional Bargaining

Interest-Based Bargaining

vs

von

von

The race is picking up…..

THANK YOUDr. Judith ShamianJudith.shamian@von.ca

• www.nursingleadershipstudy.ca

• www.von.ca

• www.vifamily.ca

• http://www.longwoods.com/home.php?cat=456.