By Barbara Bronson Gray, MN, RN
Illustration by Malcolm Garris/PhotoDisc
September 10, 1998

Call it a crisis of confidence or just battle fatigue, but staff, managers, and executives in health care are questioning whether their organizations have lost their souls in the struggle to survive.

The question being asked in hallways and boardrooms is simple: Has the need to meet the bottom line become so central to work that health organizations have forgotten their central purpose?

John Izzo, PhD, co-author of Awakening Corporate Soul, (Fairwinds Press, 1997), says the long effort to adjust to tight cost restrictions has detoured many facilities from their mission. "A lot of leaders have lost sight of what they’re about," said Izzo, who frequently consults to healthcare organizations on this topic.

Izzo says that many healthcare workers feel as if they’ve lost the battle, and they wonder if it will ever be any different. "My grandfather used to talk about a good tired and a bad tired, and we’re talking about a lot of people in a state of being bad tired," he said.

While it’s not unusual to hear front-line staff talking about their frustration and fatigue, it’s always been rare to hear executive and mid-level management reveal such discontent. Yet, more and more healthcare leaders are expressing concern about the loss of corporate soul.

Light bulb

The first signal of trouble was a general sense of psychological malaise for Peter E. Makowski, president and CEO at Citrus Valley Medical Center in West Covina, California. About two years ago, Makowski felt he was "going through a funk." But after evaluating everything from his health to his personal and professional lives without uncovering anything amiss, he found Lee Bolman and Terrence Deal’s book, Leading With Soul (Jossey-Bass, 1995), and says a light bulb went off. He realized there were many in his organization who probably felt the same way.

Makowski researched the topic and went to the hospital’s board of directors to express his concerns. Finding support, he even tied solving the problem to his personal goals and financial reimbursement. He’s working on a plan to re-invigorate the sense of mission throughout the complex organization, a newly merged combination of two hospitals and a hospice. "This organization needs to have multiple bottom lines. We can’t just focus on finance. We also have to focus on quality and spirituality and our organization’s contribution to society," Makowski said.

Back to reality

Yet, some policy experts contend that health care’s new cost constraints are nothing new to other mission-driven organizations, such as religious institutions. "It’s back to the real world, where there’s never enough money to go around," said Merrill Matthews Jr., PhD, vice president of domestic policy for the National Center for Policy Analysis in Dallas. "In the last decade, and especially in the last four to five years, health care has had to put financial issues on the table and try to balance them with quality. Now healthcare providers are under the same strains that religious institutions have been under for centuries. Demand is greater than supply … and the real challenge going on is to create a system that facilitates access without encouraging overuse."

Matthews said that just as some hospitals can appear more dedicated to increasing revenue than to helping people, so can churches. "In both cases, it just looks to us like a perversion of the mission," he said. But tighter times shouldn’t by necessity be forcing a mass disconnect with the ultimate purpose, he said.

Trickle down

Disillusionment is contagious. When an organization’s leaders are uninspired, it can deflate staff, said Mary Ann O’Connor, MN, RN, senior consultant with Innovia Health Inc. in Del Mar, California. Working with healthcare organizations across the country, O’Connor is seeing fewer heroes in organizations. "When you’re a staff member, you need somebody you can focus on, someone who walks on the unit and you say, Yes, that’s why we’re working so hard," she said. "I see staff saluting, but they’re not inspired."

O’Connor said she sees lots of staff involvement in committees to resolve quality issues or problems, but people aren’t there for the same reasons as in the past. "They’re participating not to touch base with charismatic leaders but to try to offset the decisions they’re afraid leaders will make," she said. "A lot of our leadership has lost its spirit and the ability to inspire."

Change is hard

Endemic change is behind the perception of the loss of corporate soul, according to the Rev. Dennis Brodeur, PhD, senior vice president for stewardship at SSM Health Care System in St. Louis. "I personally think the singular focus on healing has remained, but a lot of people have lost sight," he said. Brodeur offers a litany of changes that have rocked health care, including increased payer involvement, shifts in delivery sites, and the new focus on healthier communities rather than disease. Perhaps healthcare organizations haven’t lost their souls at all; they’re just dizzy.

Many experts say the key to an organization’s ability to resurrect its soul—if it is indeed moribund—lies with the people closest to the patient. "The words of a mission statement come alive with the people," said P.J. Maddox, EdD, RN, coordinator of the Health Systems Management Program in the College of Nursing and Health Science at George Mason University in Fairfax, Virginia.

"What makes you able to face an irate family at 3 in the morning isn’t the corporate mission; it’s pride in your work group," Maddox said. From her research on corporate culture, Maddox found that the key factors to create a deeply satisfying work culture are somewhat basic. "The quality of involvement of staff at the point of service and the ability of first-line supervisors to get out of the supervision mode and focus on motivation and enabling workers, that’s what is most important," she said. "Sometimes what we think is losing soul is really frustration at the workplace."

Reconnecting

Bringing the staff back in touch with essential values in health care doesn’t have to be overwhelmingly difficult, said Jon Crozier, director of human resources at Cottage Health System in Santa Barbara, California. But first, leaders have to recognize that the huge number of changes in hospitals and the demands on the system have left their mark on employees.

Crozier said the emphasis on efficiency has left some staff weary. "For a while the focus shifted to business, with everything going on, and employees felt they became a commodity or an expense. Now we have a group of survivors," Crozier said.

Some experts say the widespread malaise is typical of what occurs at the end of an era or a major cultural shift. "Things have really changed in every sector," said Tim Porter O’Grady, EdD, PhD, RN, a healthcare consultant in Atlanta.

"In health care, we’ve come late to the information age and to the focus on value. The basic work has changed. Nurses are excellent at taking care of the sick. The problem is, that’s not the agenda anymore." Instead, he says, the focus is on whittling down the time patients spend in hospitals.

Nurses and others will feel more at home in the new value-focused culture of health care if they learn to make decisions in a new context, O’Grady said. Decisions for patients have to be based not on what kinds of treatments or technologies are available, but rather on what will provide long-term, measurable results, O’Grady said. "It takes wisdom and courage. If you’re only advocating for patients when they’re in the bed, it’s too little, too late."

Values booster

Izzo says that what is critical is an honest, open, frequent discussion about purpose that permeates meetings and decision making. Employees at every level need to be talking about how they can re-infuse the workplace with values that fit the work itself.

Leaders also have to think about what they really want to be known for after they’re gone, Izzo said. "What seems to work well is to ask leaders about the legacy they want to leave. It goes beyond the numbers—the bottom line or the declining length of stay—to what they want to have accomplished when they eventually leave the organization."

No matter how much discussion goes on, experts agree health care is now about tough decisions and tight resources. "It will always be a balance between mission and survival," Izzo said.

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