What are the different ways that hospital managers can increase employee morale after downsizing or “restructuring”? This is one of the questions that Vanderbilt hospital has asked itself, and the purpose of this paper will be to present a sustainable solution to that problem. To understand how to increase employee morale, we need to first understand the reason behind hospital downsizing. In the past few years, hospitals have received less funding, due to the rest of the slowing economy, and Vanderbilt has experienced this.
That is the bottom line. So, to keep operating, hospitals have had to decrease the workforce and other costs. But, they didn’t decrease the workloads…in fact, workloads have increased because the workforce has decreased, which left more work for the surviving employees. And, when there is less staff to admit patients, patients suffer by not getting the care they need right away while waiting to be admitted.
But, to save money, shouldn’t the executives get a pay cut, rather than take more employees out of an already busy workforce? Apparently, one executive’s pay could pay for 5 housekeeping staff’s salaries and 4 CNA’s salaries. Does this mean that executives are being paid too much, or are the others being paid too little? The answer to that question remains unsolved, but if the budget were to be reorganized, there might be less “downsizing”. This is a controversial topic that will not be covered here at this time, as it is something Vanderbilt is trying at all costs to avoid.
Does this affect patients as well? What are the impact and ramifications for patients? The impact of hospital downsizing impacts not only affects employees, but the patients as well, which is seen with heavier workloads for the nurses and patient re-admissions to hospitals after dismissal, due to less staffing and insurance policies. But what other ways does this impact the patients? In the 1960s, the idea of releasing mentally ill patients into the community, or de-institutionalization, was based on the theories that treatment in the community enhances the quality of life for the patient and that the shift of care would conserve limited funds and resources. The theory stated that hospitals wouldn’t have to bear the cost of keeping patients, but rather shift the cost to the community-based programs and outpatient centers (Burke, 2002).
Another theory stated that if the patient were to be near relatives and community jobs, they would recover faster than in isolated treatment. This became possible more frequently, especially after new medicines were developed to help control schizophrenia. And since there were more outpatient clinics, they were able to shift healthcare costs to the government through Medicare, Medicaid, and SSI. This was the theory given to the public.
But was the motive for these changes really to better the patients’ lives, or was it a scheme to cut costs to put more money in the executives’ pockets? Much of this was thought to help the patients, but some of these changes actually hindered recovery and treatment of the patients. Whether or not this was a scheme to put more money in the executives’ pockets remain to be seen, but it didn’t really work as they had hoped.
What were the consequences of this? What was discovered after all was that the patient’s quality of life did not get better than they really needed the structure of the hospital. Because of this, more patients turned to crime, became homeless, or lived in substandard housing. They were unable to find jobs or any other means to earn a living. Because they didn’t have the money or resources to live decently, they also didn’t have the money to get the help of medicines they needed.
Patients needed the structure that the hospital gave them. They needed daily meals, showers, a place to sleep, and interaction with people who actually cared. After being “thrown” out into the community, patients began to commit crimes, just so they can go to prison for the structure. Others, who did not want to go to prison, often became homeless. The job market was not a friendly place to individuals with “problems” and did not hire them. So, with no job and no place to live, patients did not receive treatment as they needed. Recovery was not happening, and many people suffered, just because administrators and executives decided that their lives would be better out of the hospital.
Community programs also cost more per day than hospitals. Hospital programs cost $300 per day per patient, while community recovery programs cost up to $1,000 per day, per patient. Community programs and outpatient centers also cost more to maintain than hospitals and institutions do. But even if they are state-funded, they receive less than the hospitals. This was because money from the state for healthcare purposes rarely makes its way to the community centers. So, this de-institutionalization obviously didn’t save money in the long run!
So, how does hospital downsizing, or “restructuring” affect employees? Less job security = less job satisfaction, which leads to less happy and more distressed employees, and this was realized by Vanderbilt. But this also affects physical and mental health. Employees who survived the occasional layoffs, experienced psychological distress and reduction in health, along with more absenteeism and lowered job commitment. They also respond with less trust in the hospital, more anger and heightened cynicism. These are the results of the way the downsizing and restructuring are planned, communicated, implemented and managed.
But instead of hiring more qualified staff, the hospitals hire those who are less qualified to save money. Vanderbilt has admitted to this practice and is currently trying to revise this issue. Is this practice safe? If there are less qualified nurses, patient care could suffer, leading to more work for the more qualified nurses who are left on the job. Paperwork could suffer in the fact that patients could get the wrong medicines, diagnoses, and be discharged when they were supposed to stay in the hospital longer. These are life-threatening results that can lead to more than just mixed up paperwork—it could lead to consequences that wouldn’t have happened, if there were more qualified staff hired, rather than the lower qualified staff currently in the workforce.
Nurses who are still working are becoming more stressed and frustrated, because they are required to perform more supervisory duties for the less qualified nurses, on top of other added duties, which may include more patient care, dealing with patients’ families, and increased paperwork. Nurses are worn out, stressed, and demoralized, and worried about the future of their jobs. Service quality decreases when there are fewer employees and inadequate staffing to perform those services. This becomes worse when they don’t feel like they are important to their jobs and the hospital. Employees and nurses experiencing this low morale and job stress are less likely to be productive, have more absent days, and experience poor health. In fact, this job insecurity has added to the increase of nurses and other employees seeking mental health services.
Managers get worn out too, just having to deal with the stress of this downsizing, besides wondering if they are going to lose their jobs as well. If they survive the layoffs, they might have a reduced work commitment and effort, along with a reduced effort to be productive. Just as their employees, managers who are scared about losing their jobs are showing poorer health and reduced psychological well-being.
However, there is hope, and the researcher has several ideas to propose to help Vanderbilt. What should managers and administrators do to help their employees adjust positively to this downsizing? First, senior hospital leadership needs to embrace efforts to revitalize their organizations. This will involve time, money and efforts that many may not want to put forth. But they must, if they want to increase employee morale, they must acknowledge that the morale is suffering. They must first turn around the nursing staff’s reactions to previous layoffs and downsizing to boost morale.
One thing to remember while planning to increase morale is that if employees feel like they are important to the hospital, they are more likely to want to contribute, increasing their job satisfaction. They want to know that their opinions matter—like they have a say and that they are taken seriously. This shows that managers and administrators need to create a pleasant workplace, including showing respect, creating happiness versus anger and depression, and providing support for their employees. (This is discussed later in the paper.) People want to feel needed, and when they do, they are less likely to be absent as much with fewer sick days, and less likely to quit, reducing the turnover rate of employees. Employees will likely be more productive as well. Reassurance that while the market is falling at the moment, they are the ones who have survived the layoffs. Therefore, they have a job to do, and a difference to make in other people’s lives.
Ways of implementing this knowledge are to begin by listening to the employees—find out what they like to do, what their opinions are about the workplace, and if they have any suggestions to make it better. Then follow up on those suggestions. Make them feel like their opinions and suggestions were good enough to be used.
Show support to the employees. If they have a problem, don’t just shoo them away; give them undivided listening time, then follow up on the conversations. Have info-sharing meetings; get involved with their lives; let them have input. All these ways are just a start, but it will go a long way to making them feel needed, and therefore, have more job satisfaction. Everyone wants to be valued and taken seriously. Use this knowledge to their advantage, and the hospitals!
Managers who can empathize with their employees go a long way in improving morale. Employees also want to be appreciated for their efforts. Other companies have realized this, and have done extraordinary things to show their appreciation to their employees. For example, Land’s End and IBM have created small cards to thank each other for the little extras that their employees do each day. Other ways to show appreciation include a pat on the back, a short note of thanks, or a voice mail message of thanks from a manager (Grimm, 2002).
Employees want to be treated with respect. Ways to show this can include: creating a code of respect between employees, passing out paychecks personally to get to know each employee, keeping confidential items confidential, and acting respectfully towards everyone. The American Hospital Association holds an annual “Day for Play” at work, inviting family members of employees to come to see where Mom/Dad works. They also play games, earn prizes, and take tours of the workplace. This shows that managers and executives care about their employees and families (Glanz, 2002).
When managers are enthusiastic about their work, it rubs off on their employees. Managers need to set high-performance goals, and contagious enthusiasm about the importance of those goals. Meetings should be held to discuss those goals and maybe ask employees about how things are going. Be flexible though, as some people may not be able to reach those goals as fast as others. These people should not be looked down upon, but rather helped, and encouraged. This shows respect, and allows that person to be able to feel the same job satisfaction as the other employees (Jayne, 2002).
Respect can be shown in other areas as well. For example, grievances should be handled professionally, rather than ignored and rejected. Employees appreciate honesty, so managers should dispel any rumors being spread, and tell them exactly what is happening in their workplace (Greenglas, 2002). On that same token, managers should not take things too seriously and should encourage their employees not to take things too seriously as well. Of course, in life and death situations, life should be taken very seriously! But when it isn’t that serious, managers should encourage their employees to have some fun with life. Work isn’t the end-all to life, and people should be able to enjoy themselves at work sometimes.
Some examples of this might include wearing a Halloween costume to work when it isn’t Halloween; giving out “fun packs” meant for kids at restaurants that have coloring books and crayons in them, or making balloon animals out of rubber gloves. Make an animal farm out of those animals. Managers need to keep in mind that not all of life is serious, and should reflect this at work and home.
Encourage employees to care about their community. Life isn’t just inside the walls of the workplace—life encompasses the community as well. Managers should model this by getting involved in the community themselves, showing employees that they can “walk the talk”, so to speak. This is also a great way to overcome depression in people who are upset and fearful about the reduction in workforce. If they see others in worse situations, and are able to help, then they will see that things aren’t so bad after all. They will be a little more willing to put more into their jobs (Minzer, 2002).
Help them to see that it is more than just a “job”—show them that what they are doing impacts a lot of other people. Emphasize that this is more than just a job—it is a way of life and a career. They are helping increase the quality of life for many people. If managers model this, employees will soon follow that behavior. Show them that this is a career choice, with many possibilities for fulfillment. However, if a person really just doesn’t like this career, there is nothing that a manager can do to help that person. Maybe the person would be happier in another field.
Managers are humans too—many employees seem to think that managers are either angels or devils. If managers present themselves as human beings, with feelings, desires, and goals, as well, employees will respect that and initiate some of the better working environments as well. When employees see that they are working for the greater good of an organization or company, they tend to take on more and push themselves more to do better. Ways that managers can influence this is to act that way themselves. They need to bring attitudes of teamwork to their staff so that the staff will be more willing to have the same attitude of teamwork. If they feel as if they are part of a team, they are likely to have higher morale, higher job satisfaction, and a feeling of better job security.
Hospital downsizing and restructuring do not have to contribute to low employee morale, and Vanderbilt can use the strategies discussed above to help resolve these issues. As discussed, there are many ways to increase morale, as well as many more that have not been discussed yet. Managers and hospital administrators can do a lot towards contributing to high employee morale by being honest about policies, what’s going to happen, and listening to their employees’ opinions and following through with implementing some of the suggestions made. Respect goes a long way towards increasing morale as well. Get to know employees and their families take time to listen to them and be nice. Then, and only then, will employees begin to feel as if they are part of the team?
References
Burke, R.J. (2002). Restructuring Stressors and Perceived Hospital Effectiveness. Web.
Greenglas, L. (2002). Impact of Restructuring, Job Insecurity and Job Satisfaction in Nurses. Stress News Vol. 14, No. 1. Web.
Grimm, E. (2002) Impact of the Potential Downsizing of Eastern State Hospital on the Patient Population” Journal of Young Investigators. Web.
Glanz, B. (2002). Tips to Rebuild Employee Morale. Web.
Jayne, F. (2002). “Hospital Downsizing”. Web.
Minzer, R. (2002) “Hospital Downsizing”. Web.