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Reducing Staff Turnover and Burn-out by Creating a Culture of Excellence at Island Health
Reducing Staff Turnover and Burn-out by Creating a Culture of Excellence at Island Health

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Overview: In the early days of the Covid-19 pandemic, Trina Knight, a Nurse Manager at Island Health in the Child, Youth and Family Acute Care Centre faced many challenges.

In light of the associated risks and stressors of the impending pandemic, many of Island Health’s senior staff members, already nearing the end of their careers, were opting out of hospital work to seek safer pandemic planning roles. 

This high staff turnover rate left the hospital struggling to maintain high levels of patient care with primarily new staff members at a time when stress levels were high, patience had worn thin, and morale was failing.

Trina was right in the thick of it all - staring down a hospital environment that was already stressed under the weight of the pandemic but further compounded by the challenges of staff turnover and a culture focused too heavily on problems. 

Trina needed to find a way to move her team forward despite the complex circumstances they were all tossed into.

Following her intuition, Trina found ways that she was able to start making some improvements to morale. 

She began the daily practice of sharing with her team stories of success and everyday kindnesses between staff and patients.  

Not long after beginning her morale-boosting program, Trina enrolled in the Evolution of Thinking™ (EOT) program.

During EOT, Trina found her stride as she learned the power of a simple, compelling vision coupled with a balanced focus on uncompromising results and excellent team relationships.

Thanks to the complexity leadership skills Trina gained in EOT, she was able to achieve great things with and for her team during the growing pandemic, including:

> Providing more integrated care

> Launching individual learning plans for all staff

> Observing her staff engagement improve continuously, as evidenced through:

  • A lower turnover rate
  • Reduced absenteeism
  • the enthusiastic adoption of learning plans
  • Improved adoption of new technological tools
  • The willing adoption of new programs for the parallel mental health and substance abuse crises exacerbated by the pandemic.

Approach: How did the Child, Youth and Family Acute Care division achieve such incredible gains in the face of overwhelmingly complex early pandemic challenges? 

“The course came at the perfect time.” says Trina. “I learned how to trust my strengths as a leader, to let go of the details and trust my staff. Before the course I always felt guilty when I didn’t know all the details. I learned to trust and empower my staff.”

Trina learned the importance of a clear and compelling vision.

“It’s a simple one,” remarked Trina, “’Great patient care,’ and ‘A place where you want to come to work”.

True to her leadership strengths, Trina didn’t get bogged down in the details of how to express the vision. Instead, she trusted that every staff member knew what ‘great patient care’ was and what constituted a ‘place where you want to come and work’.

Trusting this simple but compelling vision Trina turned up the volume on her celebration of success, instituting regular Friday shout-outs for staff.

“Knowing how that [regular Friday shout-out] supported the vision, and improved feelings of safety and teamwork gave me even more confidence to trust this strategy.”

Spending some initial time communicating the vision and celebrating what was working laid the groundwork for Trina’s next challenge; tackling skill development with her new staff amid the biggest staff burnout event of the century.

But it wasn’t a case of demanding of staff what she wasn’t willing to do for herself.

Learning to face conflict

Trina identified a reluctance in herself to have performance conversations, preferring to put off what she anticipated would be difficult conversations.

“I used to push them away and procrastinate. But I learned that it creates a negative culture if you don’t deal with staff conflict and bickering right away.” 

Now Trina regularly consults the Evolution of Thinking™ tools ‘Choose your Focus’ and the ‘Expanded Drama Triangle’ to orient herself and her staff toward achieving their shared vision and away from problems and drama.

By encouraging parties to listen to each other and come to a mutual understanding, Trina can redirect their focus from trying to meet individual interests to the shared vision of ‘great patient care’ and ‘a great place to work.’

The change in approach is paying off. 

In one case, Trina guided staff in questioning the assumptions fuelling conflict. Instead of allowing the accusations to escalate, Trina’s empathetic, transparent, and vision-centred approach resulted in mutual understanding, increased trust between parties and a withdrawal of allegations.

Moving toward a growth culture

“I also learned to listen, just to listen, not to try and fix everything.”

As Trina faced conflict and listened to understand the perspectives of her nursing staff, she found ways to align their career aspirations to their learning needs AND the department’s needs.

As a result, introducing individual learning plans was a resounding success with very little pushback. Trina found her staff developing new skills and enjoying cross-training, even during the pandemic!

“Some newer staff took on a project to share information about different ways that women having babies can labour. They emailed me with a proposal - created cards, got pictures taken, and developed tips for the rest of the staff. It was really great. And they had fun doing it!”

Results and Outcomes

By Spring of 2022, Trina had completed Evolution of Thinking™, its companion program Evolution of Performance™ and developed her confidence in having effective performance and growth conversations.

As a result;

Learning Plan Adoption

Individual staff learning plans were completed, and ongoing coaching is underway. 

Trina has completed initial meetings with 76 staff, and the feedback so far is excellent:

  • Staff are work and learning focused. The team’s positivity continues as new staff members come on board. There has not been any negative feedback.
  • Staff feel supported, and interpersonal quarrels are dealt with immediately without escalations. 
  • The suggestions that staff bring forward are patient-centered; “they’re more aware of what we have control over and what we don’t. 

Med-scanning statistics are improving

In true growth culture fashion, Trina’s department took on the challenge of improving their “med-scanning’ statistics. 

Instead of focusing on the problem of low compliance to the med scanning process, Trina stressed how scanning meds into the new system would improve patient care and decrease errors. She set a target of 80% med-scanning, and is actively working with individual team members in their 1:1 meetings to encourage and celebrate their improvements.

Regular reports are in place to track the unit’s med-scanning success, and in the last report, some very marked improvements came up with some staff going from 14%-50% to 63%-100%.

The EOP course has helped Trina have performance-based conversations with her team and to set expectations more readily.

The pediatrics team shows a growing willingness to deal with patients with mental health challenges

A challenge that had long faced staff on the ward was how to deal with patients’ increasing mental health needs.

Historically, the nurses tried to avoid dealing with any mental health issues, but now that the vision of ‘great patient care’ was front and centre for the team, their thinking changed.

“They realize it’s part of the vision of ‘Great Patient Care’. We have to care for these patients, and they’re engaging in developing the skills to do so safely and well. I’m having front-line staff take on and own that work. They are engaged in making the workplace and patient care better and safer. 2 - 3 years ago, when we had mental health patients - staff really struggled caring for them. Now they ask, ‘How can we make it better? What can we do?’ They are part of the solution for being able to care for those patients. The work is still hard, but we’re in it together and trying to find solutions to make it better.”

New approaches to staff shortages

As the pandemic continued and the hospital began facing more serious staff shortages, Trina’s department was one of the few not suffering. 

Thanks to her departmental success, Trina had to balance the hospital’s needs for staff with protecting the essential resilient culture she’d curated on her team.

How could she support the hospital without burning out her staff?

Once again Trina drew on the vision of ‘great patient care’ and commitment to creating ‘a place where you want to come to work’. 

She messaged out the hospital’s needs to staff and asked what types of off service patients would they feel comfortable caring for when the hospital capacity is high.

As a result staff were more willing to care for other surgical patients and were more willing to accept off service patients even when the unit was busy.

She and her leaders encouraged staff to select additional shifts that best align with their skills and interest when they could and where they could make the most contribution to great patient care.

Staff members know they are able to work with the leaders and are able to be creative with adjusting their schedules >10 days out to fill shifts and cover vacancies while possibly getting other shifts off to support their own relief, recovery and renewal

Trina’s staff have also cross-trained to other areas within the Child Youth and Family program, creating bigger pools to fill shifts from.

The team protected their culture and even contributed to filling gaps while retaining the enthusiasm and sense of team.

All this and special projects too

Staff is also going above and beyond expectations by helping to launch significant community projects to house and support mental health and substance abuse patients nearer to their health care supports. 

These are long term, major initiatives in the community, often undertaken on their own time, to serve an even broader vision of Great Patient Care than could ever have been anticipated at the outset.

Conclusions

A real hallmark of engagement is the willingness and enthusiasm of staff to do what it takes to achieve the vision. 

Through her complexity-leadership training and skills, Trina created a culture that fosters willingness through a clear and compelling vision and a culture that celebrates effort, teamwork, and results.

While numbers like sick time, turnover, staff retention, missed shifts and closed beds are easy enough to measure; we can’t reliably mandate changes in numbers in times of increasing change and complexity. 

Instead, as Trina aptly demonstrates, we need to carefully foster the conditions that call people to excellence in a way that inoculates them from the potential exhaustion and burnout too often associated with uncertainty and high demands. 

Although Trina’s focus was not on the numbers she was nevertheless able to achieve a 17% reduction in sick time between 2020 and 2022 even though overtime rates during the pandemic had to increase
by 33%.

In developing a clear and compelling purpose, a workplace culture that celebrates effort, kindness, excellence, and supportive growth conversations on an ongoing basis, Trina put our Performance Evolution Pyramid to work and, without focusing on the numbers at all, achieved real quantitative results.

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