Health workers overloaded: Study

Research at 4 Ottawa hospitals reveals causes, solutions

At both the Queensway Carleton Hospital and the Royal Ottawa Mental Health Centre in Ottawa, there are a variety of issues that contribute to unhappy workers, such as understaffing, competing priorities, an urgent organizational culture, complex work and greater interdependence among tasks.

And workers don’t fare much better when they get home. Many similar issues — such as competing tasks, not having enough time and a lack of support from family — also emerge, according to a recent study that focused on the health-care industry.

Most of the findings “sound about right, to be honest,” said Gary Earles, vice-president of HR and organizational effectiveness at Queensway Carleton.

“The whole issue of what’s going on in your family life and also the industry we’re in, health care, that really wasn’t a surprise that that would have a significant impact on stress levels,” he said.

The result is role overload — too many responsibilities and too little time to attend to them. Undertaken at four Ottawa hospitals among 1,396 employees, the research found the employers provide few supports to help employees cope. Only one-quarter of participants reported high perceived organizational support while 33 per cent reported low support.

Factors contributing to role overload

Several issues contributed to role overload:

• a lack of resources (such as staff and equipment)

• unrealistic expectations (such as demands for documentation or a lack of time for training and education)

• the nature of the work (unpredictable)

• a lack of reward and recognition

• culture (saying “no” is career-limiting)

• communication (inefficient or ineffective).

Despite the downsides, workers said they enjoy their jobs.

“Most of the time they feel enthusiastic, they enjoy what they do, they feel they make a difference. But that’s part of the problem — because they like the work and they feel they make a difference, then it’s harder for them to say, ‘No,’” said Linda Duxbury, a professor at the Sprott School of Business at Carleton University in Ottawa and co-author of the study.

“That’s the real challenging thing about workers in this system is we’ve downsized, we’ve restructured, we’ve taken away people, we’ve taken away time, we’ve taken away resources but we can’t not provide the care as health-care people,” she said.

An employee may be able to walk away from an office job but it’s harder to walk away from a sick patient, said Christopher Higgins, a professor at the Richard Ivey School of Business at the University of Western Ontario in London, Ont., and co-author of the study The Etiology and Reduction of Role Overload in Canada’s Health-Care Sector.

Consistent themes emerge

There’s a fair amount of consistency in terms of the themes coming out of the health-care industry, whether for acute or mental-health care, said Cal Crocker, chief financial officer and vice-president of HR at Royal Ottawa, which has 1,800 employees.

“Families in mental health are much more knowledgeable and more demanding and want the right things done for their relatives,” he said. “Certainly there is constant change in this organization… and the constant pressures on budgets and the systems constantly evolving in terms of the expectations on staff.”

Hours worked is not a top predictor of role overload but instead it’s the nature of the work, said Duxbury, with unpredictability and greater task interdependence and complexity.

“Adding more people to a system like this is just going to add up to more stress for the overworked people,” she said. “It’s a Band-Aid solution.”

It’s only once the processes are as efficient as can be that a conversation about resourcing should start, said Earles, whose hospital has about 1,800 employees.

“If some of your processes aren’t as effective as they could be, adding two extra staff members using the same not-so-effective processes doesn’t really do you a whole lot,” he said.

You can have two employees working the same hours of work but each has different abilities to cope with the stress and anxieties that go with home and work, he said.

“I was a little surprised in terms of the hours of work not being a significant driver,” he said. “It was more to do with the amount of control people had over their work situations, be it hours of work, priorities in a given day, how much ability they had to make their own decisions.”

Improving managers, culture

To reduce the negative impact of total overload, health-care organizations should start by focusing on two areas — the immediate manager and the organizational culture, according to the report.

When it comes to managers, the data is astounding, said Duxbury, with 80 per cent feeling overloaded and stressed, amplified by a lack of role clarity.

“We want them to be everything to everybody,” she said, such as operation experts, people managers, coaches, mentors and labour management gurus. Some, for example, are responsible for staff 24-7, even when they’re not at work.

“I felt very bad for that particular group, especially since I don’t think within the system people recognize how overworked their managers are,” she said. “People feel this tremendous responsibility for their staff and I believe that’s being exploited by our government.”

Two years ago, Royal Ottawa developed a five-year strategic plan and hired a consultant to look at its structure, particularly from the management level, such as role clarity and reducing the number of their reports.

“Employees constantly say they don’t feel they’re recognized,” said Crocker, and in health care, managers often have a staff of 100 or more reporting to them. “In that kind of environment, there’s no way you can have a supportive manager. The span of control is just too large.”

The centre is also developing a management-development program and planning to look at the committee structure, as people are often stretched by these obligations, leading to role overload, said Crocker.

“That’s taking away from something else or putting pressure on you because you know you’re not getting something else done, so we are certainly doing work in that area,” he said.

A respectful workplace policy was also introduced in 2010, which includes a complaint process that must be followed. All this should help with the culture, but it will take probably five to seven years, he said.

Study after study demonstrates it all comes down to management, said Higgins.

“If management understands their employees and are flexible and treat them with respect, things work,” he said. “The employees with the most supportive managers have fewer problems than those with non-supportive managers, in any industry.”

Queensway has not made any final decisions on how it will respond to the findings but since teams are often a source of anxiety and frustration, that’s a potential priority to focus on, along with managers, said Earles.

“If we can focus on the team issue, we can probably address some of the issues related to culture, at least some of them, and also some issues related to supporting our managers more effectively,” he said.

When it comes to improving the culture, that entails building appreciation to weaken the negative relationship between role overload and absenteeism or turnover, said the study, along with a cohesive, values culture that embraces teamwork.

In endeavouring to change culture, the first step is getting serious about it and that means allocating time, resources and money, not just talking about it, said Duxbury. One of the big problems with the sector is the question around leadership, as there is huge turnover at the top with ministers and deputy ministers, she said, and culture change takes sustained will.

“Most health-care workers aren’t going to jump on the bandwagon and say, ‘Oh yeah, let’s change again,’ when they don’t see that the will is there,” said Duxbury.

Queensway has strong support from senior management and its board about changes that need to occur, said Earles. The challenge is “to make sure we have appropriate change management processes in place to help our staff understand the change, be equipped to deal with the change and, in some cases, even lead it and be champions of the change.”

Going forward, the study’s authors plan to run “interventions” with the Ottawa hospitals to provide suggestions and strategies around issues such as management and teamwork. They will then return to the hospitals in two years’ time to gauge the success of these initiatives.

And with expected funding from Ontario’s Workplace Safety and Insurance Board — which helped fund this report — the three plan to investigate the police services in the Ottawa region. The findings of the hospital study certainly can apply to other industries, said Duxbury.

“Any of these jobs that are highly unpredictable with high interdependence that are in public scrutiny that have life and death consequences, you’re going to see the same kind of thing.”

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