In Part 1 of this blog series, we examined how organizations can mature their workplace stress programs and support improved work environments for employees through the use of discovery analytics. We acknowledged how wellness within the walls of the organization is correlated with employee burnout, and various means of measuring and improving upon this aspect. However, many of the aspects of burnout are driven by safety and culture in the workplace. Therefore, our second installment is focused on the impact that safety and culture has on stress, and the progressive means of improving the measurement of success as an employer through centralized data and initiative impact analysis. Additionally, we’ll consider some success stories on how analyzing culture and safety positively impact organizational wellness.

Workplace Stress in the Healthcare Environment

Magnet Recognition® from the American Nurses Credentialing Center (ANCC) is the highest and most prestigious distinction a healthcare organization can receive for nursing excellence and high-quality patient care. With only 8% of U.S. hospitals earning the Magnet designation, it's referred to as the gold standard. Matthew McHugh, PhD, JD, MPH, RN, professor at Penn Nursing and primary author of a study focused on Kaiser Permanente’s efforts to certify their locations as Magnet status states, "Our results suggest that a less expensive and less difficult strategy to achieve good outcomes like Kaiser Permanente may be for hospitals to consider Magnet designation, a proven and cost-effective strategy to improve process of care through investments in professional nurses."

The shortage of nursing skills in the workforce may be linked to unrealistic nurse workloads. One of the first studies of nurse burnout was driven by Dr. Linda Aiken, Ph.D, RN, showing nurses are more likely to experience burnout in high patient-to-nurse ratios.
In order for leaders to be accountable for their actions, or rather, lack of action, a system of organizational principles that can measure root cause analysis needs to be in place
The study was driven by the identified need to mandate nurse-to-patient ratios by the California legislature back in 1999. While the increase in workplace stress is obvious with more patients, what some research has shown is that outcomes are also improved in hospitals that focus on Magnet status, which includes appropriate nurse-to-patient ratio standard adherence. We’ll dive further in alleviating stressors in the healthcare environment throughout the article.

Alleviating Stressors to Enhance Wellness Programs

Stressors for healthcare providers are ostensibly different than those working with heavy machinery. Consider a study by the Agency for Healthcare Research and Quality, that concluded work conditions, such as time pressure, chaotic environments, low control over work pace, and unfavorable organizational culture, were strongly associated with physicians’ feelings of dissatisfaction, stress, burnout, and intent to leave the practice. Consider the research from an East Central Florida community hospital, which utilized a system designed to understand accident causation, called the Human Factors Analysis and Classification System (HFACS), in order to understand surgical cases linked to workflow disruptions and team communication breakdowns.

Successful use of HFACS originates from the aviation industry, where  its framework is based on James Reason's well-known "Swiss cheese" model of accident causation. HFACS bridges the gap between theory and practice in a way that helps improve both the quantity and quality of information gathered in aviation accidents and incidents.

Through this evaluation process, East Central Florida’s focus was improving the efforts in the trauma care setting, by analyzing 19 categories for classification and human factors analysis (including organizational influences, unsafe supervision, preconditions for unsafe acts, personnel factors, errors and violations). The program results show two key takeaways. First, health organizations can take appropriate measures to move the needle in cultural improvement by focusing on latent failures, or those not directly correlated with an accident. Secondly, considering close to half of the classifications within the program focus on human factors tied to social psychology – this emphasizes the ability to design a program that optimizes the way programs focus on interactions between colleagues, managers and employers. If we apply human factors engineering to healthcare and focus on how a wellness program that encompasses safety, leadership, and culture analytics that are both visual and transparent for HR and administration, we can assume that organizations can improve employee retention and decrease burnout.

Across other industries, let’s first look at programs that have been successful in implementing and improving safety with analytics across an enterprise. At Andeavor, Teradata partnered with executives to wrap analytics around a monitoring tool created for the safety of front-line staff at their refineries. Statistical analysis used to model operational data reduced the amount of time a unit was in review for a safety deviation. Unlocking the potential of this data has also lead to additional unintentional benefits, like using environmental information for energy efficiency projects around the plants.

Additionally, at ConocoPhillips, Teradata enabled a 20% improvement in field safety and reduction of permit violations. Through consolidation of compliance and Environmental Health & Safety (EHS) reporting requirements and data sources, they experienced reduced maintenance costs and increased asset life. ConocoPhillips leveraged Teradata’s platform as an IoT accelerator, in addition to Teradata QueryGrid™ and Listener™, API connectors and bespoke interfaces into legacy data sources and physical assets. But how are safety analytics related to employee wellness? We’ll walk through a case study by Alcoa to explore this connection.

Measuring Safety and Cultural Improvement Through Root Cause Analysis

Paul O’Neill is a famed executive that improved the work ethic in a company that had little to no motivation of improving. Alcoa Corporation’s Aluminum segment was going through a restructure and was looking to increase profits. His focus—much to the surprise of investors—was not on profits or improved output, but on employee safety. By rewarding efforts that would drive core habits at the organization, O’Neill knew that he was able to reinvent the internal culture of the organization. By the time he retired from the company, Alcoa had increased profits by 5-fold; 6-fold if you include the dividend over that time.

In the case above, O’Neill indirectly addressed several factors emphasized in the Bergen Burnout Inventory (BBI), such as cynicism toward the meaning of work, exhaustion at work, and sense of inadequacy at work, by driving up safety protocols and leadership accountability at the organization. As a result, Alcoa’s improved culture and safety corresponded with an improved workplace environment, and in turn, more productivity.

As his program moved forward and having been at the organization for a decade, Paul O’Neill encountered some challenges along the way. One complaint arrived from a plant in Mexico, where workers allegedly had been getting sick from the fumes. Paul checked his records and found no such evidence.  He rounded up his leadership staff to understand the root cause, and through this process, also determined a key executive overseeing plant operations had not followed protocol to enter the incident into their database or report the issue, but had installed ventilators to alleviate the issue. This lack of reporting the issue was perceived as negligence and a direct misalignment with the company’s culture, and the executive was fired several days later.

Now, the purpose of this anecdote is not to draw attention to leadership failures, but to help with the argument that in order for leaders to be accountable for their actions, or rather, lack of action, a system of organizational principles that can measure root cause analysis needs to be in place. Earlier in Paul’s career, he worked for the government and had been assigned to work with officials studying infant mortality rates. He digested the problem from all angles, working with researchers, trying to determine a true root cause for the issue. It turns out, after bypassing many clinical recommendations, that in order to improve mothers’ diets at the community level (which would reduce malnourishment of babies), women had to improve their diets before becoming pregnant. Which meant they needed to be educated about nutrition before they became sexually active. Which meant teaching them about good nutrition in school. Which meant making sure that high school teachers (especially in rural areas) were proficient enough to teach good nutrition. Which meant improving how teachers were trained. Poor teacher training, the officials working with O’Neill finally figured out, was a root cause of high infant mortality. If you asked providers or public health officials for a plan to address infant deaths, few at the time would have suggested changing how teachers are trained.

Employees Like Customer Service, Too: Continuous Education

Every new and even long-standing employee experiences the same challenge: understanding corporate policies and protocols to execute on the job. The amount of training a medical staff member must absorb in order to successfully deliver on a variety of protocols is staggering. Therefore, in addition to the burden of documentation compliance, many of the stressors associated with healthcare providers can be attributed to ‘decision compliance’ stress, both to ensure optimal care for their patients but also to deliver within the utilization guidelines of the organization. Here, we discuss how interacting with your employee base to support training requests—such as poorly defined or understood protocols—is an area of ‘customer service’ that administrative or organizational leaders should consider as a component of their wellness programs.

At UC Davis Medical Center, Anna Olszewski contributed to their Magnet certification process by evaluating their training approach. “We assess staff educational needs and learning styles to relay information about the Magnet journey – I enhance what already exists within my unit and amongst my colleagues,” added Olszewski, emphasizing the knowledge transfer as a critical component of maintaining high levels of care. Increasing your organization’s access to continuing education is one way to reduce the impact of decision compliance as a burnout stressor. It is also widely understood that just in time reminders and training are one of the most supportive software or programs executives can enact to drive employee satisfaction. Apart from protocol search embedded in the medical record system, healthcare organizations are finding value by enacting an “education alerts” program, which allows nursing staff to voice over hands-free badges or text their concerns about training regarding a given protocol or need. By capturing this data semi-anonymously (with only floor or ward information), organizations can respond real time through a team leader, and gain insight on how to adjust their training programs.

Similar to how Teradata’s AnalyticOps can predict sentinel events in acute care settings, Teradata’s approach to improving on wellness programs can then take this unstructured data, align the information with proven frameworks, such as the Magnet certification criteria, and point the models into a predictive mode, rather than a reactive mode. Leadership can visualize where they need to help their staff perform better in the field with this information, even extending the program to patient safety incident reviews utilizing Teradata’s sessionization capabilities.

Employees across all industries will continue to struggle engaging in workplace stress management unless organizations take a look at how they intake data and measure employee success factors, both inside and outside of the workplace. In turn, interactions with your employees should be as specific and timely as Teradata’s well-known Customer Interaction Management software. With margins and competition across all industries continuing to be a driving force across economies, investing in a robust workplace management program that uses advanced analytics could mean all the difference in separating your organization from the competition.

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References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4892964/
Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction. JAMA. 2002;288(16):1987–1993. doi:10.1001/jama.288.16.1987
https://www.ncbi.nlm.nih.gov/pubmed/26056204
https://www.ahrq.gov/professionals/clinicians-providers/ahrq-works/burnout/index.html
Shappell S, Wiegmann D. Applying reason: The human factors analysis and classification system (HFACS). Hum Factors Aerospace Safety. 2001; 1:59-86.
Cohen TN, Cabrera JS. Proactive Safety Management in Trauma Care: Applying the Human Factors Analysis and Classification System. J for Healthcare Quality. 2017; Vol. 40. No.2: 89-96.
Dan Ulatowski

Dan Ulatowski is a thought leader and former epidemiologist at the Mayo Clinic, focused on improving organization data processes and strategic initiatives. His current role at Teradata leverages his clinical background and trusted advisor approach, serving clients looking to take the next step in data-driven initiatives. Having led strategic design of quality outcomes programs for accountable care organizations, advised on enterprise data investments, and designed solutions with clients for digital transformation and value-based care, Dan sees great promise in merging statistical analysis of social science and medicine. His passions include the impacts of epidemiology on practical medicine, psychometrics and design theory.

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