Allyship. It's a good and important neologism, one which I've not seen in a few years until late last month when I noticed it in a thoughtful piece, "Addressing the Nursing Workforce Crisis Through Nurse-Physician Collaboration", written by Deena Kelly Costa, PhD, RN, Thomas Valley, MD, MSc, and Christopher Friesse, PhD, RN in JAMA Internal Medicine.
Dr. Costa and her co-authors retrace the familiar root causes of the nurse staffing/vacancy crisis -- "burnout, chronic understaffing, moral injury, low salaries, and poor working conditions" -- while highlighting the primacy of chronic understaffing. They go on to compare and contrast the findings from large samples of RN's with the 2024 American Hospital Association's Healthcare Workforce Scan executive summary which references only "stress, burnout, and retirement" as reasons for the RN exodus, concluding that the AHA "omission of chronic understaffing as a root cause is glaring." From there, the author's criticize hospital executives and consultants engaged at the behest of executives who, they contend --
"...(e)ffectively reduced registered nurse positions and increased patient assignments beyond safe levels. Moreover, to stifle dissent, consultants blocked input from practicing nurses and physicians on these disruptive changes. Collectively, these efforts contributed to poor practice environments, accelerated resignations, increased patient safety events, and exacerbated nurses' distrust of executives."
Improve Healthcare Practice Working Conditions to Retain Nurses
Putting aside the authors' tendentious claims about hospital executives' and consultants' motivations and behaviors for a moment, let me hasten to add that I absolutely agree with their conclusion:
"(T)he key to improved nursing workforce stability is a concerted focus on retaining nurses through improved working conditions. [emphasis added] The best way to improve working conditions is through structural changes with physicians as allies. ...Front-line nurses and physicians are best posed to collaborate and generate the needed solutions. As examples, clinical teams, composed of nurses, physicians, advanced practice clinicians, pharmacists, social workers, and other allied health professionals can cocreate new care models that meet the needs of the patients they serve."
Engage Directly with Front-Line Staff to Redesign Care Models
As a former hospital CEO with experience using Lean and other problem-solving/system redesign tools, engaging directly with front-line staff to redesign care models is absolutely the route of choice. Changes -- whether in staffing or workflow -- unilaterally introduced to or imposed on the care team will rarely if ever succeed; indeed, a "top-down" approach is more likely to engender unwanted consequences: diminished team cohesion; exacerbation of burnout and moral injury; potential diminutions in quality, safety, patient and staff satisfaction; and heightened clinician antipathy toward the c-suite. By contrast, if executives embrace the notion of allyship -- that is, to view clinicians as fellow knowledge workers who can be constructively engaged in redesigning care models with an eye toward eliminating bottlenecks, unnecessary steps, waste, and other "flow stoppers"; identifying opportunities to automate or re-assign data entry and other burdensome administrative tasks; maximizing clinicians working at the top of their licenses; and designing flexible staffing/scheduling models -- one will have taken a giant leap forward in making their organization a preferred setting for clinicians, clinical practice, patient care outcomes, and financial results.
Organizational Wellbeing Solutions for Hospitals, Health Systems, and Medical Group Practices: Leadership-Driven Changes
The locus to curing clinician burnout and staffing shortages runs through the c-suite. Here are examples of leadership-driven changes my colleague Paul DeChant, MD, MBA and I often recommend:
regard clinicians as knowledge workers who are given significant latitude to make clinical decisions without unnecessary administrative encumbrances or delays
consistently apply one or more of the improvement sciences (Lean, six sigma, operations research, agile, design thinking) in consultation with front-line staff to improve workflow and reduce delays, waste, inefficiency, and job skill mismatches
expect all leaders, but especially senior executives, to do periodic job shadowing of front-line staff (where observing and deep listening are emphasized) in lieu of "rounding" (a largely ineffectual, if widely practiced activity)
create and require leader standard work (LSW).
develop and deploy a sophisticated, deeply ingrained, and rigorous daily management system (DMS) supported by visual display boards or monitors
judiciously invest in AI/ML solutions -- selected, tested, and endorsed by front-line staff -- that eliminate or at least markedly reduce data entry, administrative requirements, and/or repetitive tasks that are non-value add
support near-continuous optimization and remediation of the EHR (there's no such thing as "it's all set")
get rid of superfluous or outdated policies, procedures, redundant approvals and other stupid stuff (GROSS)
Ready to transform your hospital or workplace?
Are you frustrated by adversarial relationships between front-line clinicians and senior leadership? Organizational Wellbeing Solutions was formed to enable senior leaders to identify the specific drivers of clinician burnout in their organization; and to support leaders in designing and executing a comprehensive plan to stop clinician burnout, increase retention, and improve operating results. A hallmark of our consultancy is correcting the all-too-frequent distrust and alienation clinicians feel toward the c-suite generally and the CEO in particular. Let us help you help your organization and its clinicians develop a more trusting, aligned, and productive working relationship.