Redefining the culture of care

Recommendations for culture change in healthcare organizations to support healthcare provider mental health and well-being

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Key recommendations

The COVID-19 pandemic placed immense pressures on Canadian healthcare providers (HCPs). Their prolonged service in stressful circumstances has taken its toll. In our research, we saw that three out of five HCPs were considering leaving their organization, and two out of five were considering leaving their profession altogether.

Our recommendations evolve from our research to understand the impact of organizational culture on HCP mental health and well-being. We surveyed 245 HCP and interviewed 26 HCP. The results of our findings are clear — a change in healthcare organizational culture is necessary to retain personnel and create thriving workplace environments where staff feel supported and empowered to provide quality care. Furthermore, healthcare culture MUST include care for HCPs.

This document summarizes the key ideas and themes endorsed by HCPs in our research. It contains culture-change recommendations by and from those who are part of the culture.

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Recommendation 1

Initiate processes and procedures that rebuild trust and enhance connection within the organization

HCPs explained that rebuilding trust and fostering connection help them to feel heard, listened to, respected, and supported, and provided them with a sense of belonging within the organization.

“…Come and visit the front line. Get to know your front line, and if they have solutions, if they’ve got issues, show them that you’re addressing them. Some of them are simple things that senior management or middle management can remedy… maybe that’s the way that they could do it, is to rebuild their trust and faith with their front line.“

— (Nurse-Supervisor)

Strategies

  • Acknowledge the unprecedented challenges HCP staff faced during the pandemic and express appreciation and gratitude.
  • Consciously increase leadership presence, active engagement, curiosity and visibility at the front line through regular visits, genuine expression of interest in what is going on, and checking in.
  • Improve availability of and accessibility to leadership/management by creating multiple platforms for interaction such as round tables, open door policy, team building programs.

Recommendation 2

Match words with actions

HCPs identified a discrepancy between the words and actions of leadership. HCP are told that mental health support, staff well-being, and patient care are priorities, but when it comes to accompanying actions, there is a perceived mismatch. Accountability structures can be built and operationalized to ensure that the values, policies, and promises that the organization stand for are adhered to in the everyday dynamics of the work environment.

“I think there just needs to be more of a connection, there just needs to be less talk on the part of the managers, about what they’re doing and how great they are and how supportive they are. And just more action that’s actually relevant and impacts us, because I think we are very much kind of left, we’re left to our own devices.”

— (Occupational Therapist)

Strategies

  • Ensure that promised mental health and other supports are available to staff.
  • Communicate how HCP evaluations or feedback are being processed and implemented with the organization.
  • Ensure that self-care activities, such as vacation requests, are respected and supported.
  • Follow through on promises and commitments related to workloads, schedules, staffing, and supports.

Recommendation 3

Foster an environment in which staff feel valued, respected, and empowered

HCPs need to feel valued and appreciated. They want to feel a sense of belonging to the organization and be seen as an invaluable resource. Mutual support, attentive listening and collaborative decision-making can help create an organizational climate where staff feel valued and cared for.

“If you’re collaborating, you’re taking people’s input into consideration. If you’re collaborating, you’re hopefully being accountable and following through on decisions that are made. So, I think that probably the biggest thing is for people to feel empowered. People feeling like they have a say in, you know, how they do their work and-and their work/ life balance, and how patients are cared for. And, I think that’s really important and I think it’s missing in where I work basically.”

— (Physiotherapist)

Strategies

  • Consistently communicate that staff are valued and appreciated through gestures such as staff appreciation programs or newsletter mentions.
  • Use existing team processes (e.g., team huddles) to acknowledge the work and contributions of all staff in multi-disciplinary teams.
  • Implement collaborative decision-making processes when decisions affect staff or when staff must implement decisions (e.g., redeployments, communicating constantly changing visiting policies, PPE requirements).

Recommendation 4

Prioritize wellness, safety, and mental health of staff

Take action to promote HCP mental health and well-being. Placing the onus for self-care on HCPs creates additional burdens for HCPs. Creating a culture prioritizing mental health care for staff begins with the direction and actions of leadership.

“I would like to have the organization acknowledge not only that the work can be hard – that people die – and that you have known for a long time that people are emotionally dysregulated. There is a system that doesn’t, you know, just a complete acknowledgment and that that’s really hard and that it’s normal to feel discouraged or frightened or cynical or all of the things that can come from that – because I think that helps to prevent that disengagement from work that can happen. And disengagement from the people that you’re serving.”

— (Physician)

Strategies

  • Honour vacation time to prevent burnout and signal to HCPs that their mental health and well-being is a priority for the organization.
  • Provide clear guidelines on available wellness, safety and mental health supports and how to access the supports.
  • Ensure that a range of formal mental health supports are available (e.g., in house mental health supports; benefit packages that include mental health care; access to mental health care supports for part-time staff) that can provide care to staff in the moment, as needed.
  • Promote self-care of staff and provide systemic support (e.g., manageable workloads, sufficient funds for mental health services in benefit package).

Recommendation 5

Take action to support the mental health and well-being needs of staff and leaders from equity deserving groups

HCPs want the organizations to acknowledge cultural issues at the workplace and be proactive in addressing them. They want the leadership to build trust with equity deserving groups by prioritizing staff’s mental health as an organizational priority. HCPs expect the organization to promote cultural safety, acceptance, and psychological well-being.

“I think everybody’s into diversity nowadays, and into the whole reconciliation and everything else, totally for it, totally get it, I think it was horrible what happened. But you don’t just throw the words around and not do anything about it. I mean, I don’t think it’s genuine, I think it’s, I don’t think it’s genuine, I think what they’re doing is to do, to check some boxes off.”

— (Nurse-Middle Management)

Strategies

  • Create an environment that is culturally safe and attuned to the needs and perspectives of staff and leaders who are members of equity deserving groups, including Indigenous peoples, members of ethnic and racialized communities, and members of the LGBTQ2SIA+ communities.
  • Recognize the unique stresses faced by members of equity deserving groups and provide space for discussion of these issues.
  • Implement a structure for reporting issues related to discrimination and provide culturally sensitive mental health supports for members of equity deserving groups. Do not be afraid to discuss these issues, recognizing that everyone will make mistakes and this is a learning opportunity.

Recommendation 6

Create multiple channels and platforms of communication to build dynamic, transparent, supportive team environments

HCPs have concerns about communication within healthcare organizations. They described a culture in which they do not believe they can share professional opinions with leadership without fear of repercussions. Strive to create a culture in which HCPs feel that that patient care and staff health and well-being are valued.

“Round tables… Depending on the organization, obviously, depending on how safe people feel, but having a round table even with a mediator, where ideas can be heard without being interpreted by another person hearing them – if that makes sense. If I wanted to put forth an idea that I think is really good and my colleagues think is good, but I know that this manager hates my guts – it doesn’t matter what I say, it’s always going to be no. Having an open safe space where people can talk openly and freely without worrying about repercussions.”

— (Nurse)

Strategies

  • Intentionally create spaces where staff are welcome and encouraged to use their clinical expertise to weigh in on issues.
  • Ensure leaders are accessible and open to receiving feedback.
  • Be transparent and have open communication with frontline staff about ongoing issues and problem solving.
  • Create open, safe spaces to share perspectives, contribute creative ideas, and voice valuable opinions without fear of repercussion. This might require including mediators for roundtable discussions with management and staff.
  • Ensure equitable opportunities for compensation, career growth and recognition for work.

Recommendation 7

Ensure transparency and collaboration in decision-making

HCPs perceive decision-making organizations to be top-down and to lack transparency. Transparency and collaborative decision-making, especially when staff are expected to implement the decisions made, can result in staff feeling included, respected and valued.

“And not just lip service, put [staff] on committees, and put them in charge of those committees, and don’t take away their ability to make decisions. People, just like with putting patients on committee, a lot of them were put there, because they were a patient, but nobody listened to them. It’s the same with staff being put on some of these committees, nobody listens to them. Have some actual staff run groups and committees that actually have decision making authority.”

— (Nurse)

Strategies

  • Provide a clear rationale for decisions made, such as resource considerations, scientific rationale, and community considerations.
  • Include considerations related to equity, diversity and inclusion and ensure these principles are incorporated into all decision making.
  • Involve staff to ensure that decisions incorporate staff perspectives (e.g., scheduling, changes in protocols, or organizing outpatient clinics).
  • Take steps to ensure that staff are consulted when creating policies that impact their practice or require them to take responsibility for implementation (e.g., redeployment decisions, masking or PPE requirements, visitor policies).
  • Provide staff opportunities to share their concerns regarding decisions.