Cameron A. Barnes, MHA, B. App. Sc. (MRA), AFCHSE, CHE
Morale. Try to reach out and touch it. If you can see it in this room, stand up now, yell and point it out to me. That is the thing about morale--It is everywhere yet it is nowhere. In workplaces where there is none, it is palpably absent. In a workplace where there is strong morale, it can be all encompassing. Like any great structure, morale can take years to build but conversely only days to destroy.
Snuggled between moral and morass in the Chambers Dictionary lies morale. Its description includes condition or degree of confidence, optimism, strength of purpose in a person or group."1 This is a very clinical definition. To me, morale is almost indefinable.
I am sure most of you have walked into different workplaces and immediately been able to make a judgement on whether there was good staff morale or not. My belief is that there is an over-riding level of morale, which is generally consistent and varies only over longer periods. I term this super morale. Lying under this level is what I call medium morale. This morale is much more variable and may fluctuate in much shorter time frames. Both are important but super morale is really the bedrock upon which departments are built and will serve both managers and employees better over the longer term. So, with these points in mind, I progress.
Let me ask you this. Please raise your hand if you want your workplace to have both a super and medium morale. Good! Why I wonder? I will assume that it is because you believe that morale improves efficiency and effectiveness, reduces staff turnover, makes work a more enjoyable place to be, enables change to be implemented without as many issues that could occur, and perhaps reduces union action.
This paper is not about whether or not morale exists in the workplace. This presentation is not an examination of what is gained by increased morale or whether there are advantages of having good staff morale. This presentation makes the assumptions that morale is a good thing for a department, it is hard to build, easy to destroy, and all of us want more of it in the workplace.
During almost 15 years of managing staff, up to 72 at one time, I believe that luckily I have learned some things about people and what improves their morale. I would like to discuss some of the techniques that I have used over the years. Some have been more successful than others. However, my failures could be your success. Conversely, that which has been successful in my workplaces may not succeed in yours. What is vital though is, as a manager, to always try to reinvent both yourself and the workplace. In my time as a manager, it is when I run out of new ideas and ways of doing things that I begin to become less effective. It is at this time, I believe I should move on. Not just for your own sake but for your staff as well.
According to Bass and Avolio (1990) and Huber (1996) in Grindel,2 it is the role of the manager or transformational leader to motivate staff to perform to their full potential, over time, by influencing a change in perceptions and providing a sense of direction. The constant state of flux in healthcare institutions in Australia, and indeed the world, means that erosion of staff morale has become commonplace. Reduction in staff numbers, uncertainty of employment, constant demands for more with less, and the like has created an atmosphere of organizational distrust.
It is up to the leaders and managers of these staff to attempt to make them feel that there is indeed a future in healthcare, that they are supported, and that they are not purely being driven harder and harder to produce outcomes. The examples that I furnish today are not great scientific breakthroughs, they are certainly not all original, and they have not all been raging successes, but they have all been genuine attempts at raising staff morale.
Almost all healthcare settings and indeed business today have a vision and mission statement. I wanted to create one for Health Information Services. I did the usual gathering of information from other settings to try to come up with some sentences that encapsulated HIS's goals. What I came up with was frankly uninspiring and bordering on cliché.
I decided that it was time to use the well-worn phrase of "think outside the square." I decided that what we needed was something that the staff could actually grab and hold on to--morale that was in fact a thing instead of a just a notion. A department mascot fitted this bill, and I thought the best one would be the cutest and cuddliest animal I could find. I would like to introduce our department's mascot, mission, and vision--S2AMPIE. S2AMPIE represents what we are trying to achieve in HIS, and that is Service, Safety, Achievement, Management (of records and staff), Persistence, Integrity, and Enjoyment of work.
Every month, either individual staff or a team is awarded S2AMPIE. Staff that has embodied the spirit of S2AMPIE over the previous month is awarded S2AMPIE. This might be for catching up with a backlog, continuing to produce results when there has been a shortage of staff, or for doing a job above and beyond their job description. They are then to look after him for that month, which usually means having him in their area overseeing the goings on.
The best aspects of S2AMPIE are that the staff often will come up and suggest whom he should go to for that month. This means that the staff is aware of not just their own little patch but that good outcomes are happening in other areas. Also, it has meant that I have been able to reward staff in a meaningful way in a department that is often unheralded for its work without having to give out rewards such as movie passes, which can be expensive over time. The biggest problem with S2AMPIE has been always coming up with staff that has performed above and beyond the call of duty. The months seem to fly by and to be honest sometimes finding an individual or team is difficult. In addition, it is often the same performing above and beyond, and so it may be the same staff that receives S2AMPIE.
In the end, it has meant that all staff in the department, 45 people, has received S2AMPIE either as an individual or as part of a team. Although I must say that not all staff embodies what this little pup stands for, it is probably astute to have awarded it across the board. The last thing that he should promote is jealousy or resentment. Overall though, this little pooch has been a real boon for the department and has made a significant contribution to staff morale. The staff was rapt when it heard that he would be making this trip, which I think summarizes what he represents in their eyes.
Now this idea could be slightly more controversial.
Once a month on Fridays at afternoon tea time I will bring out a couple of bottles of wine for the staff to imbibe some of Australia's finest red or white. Some staff will have half a plastic glass full and enjoy a more casual chat in the company of alcohol and their peers. I realize it is very commonplace to have after work drinks and nibbles at some companies, but I suppose I wanted to have it during work hours to give an opportunity for all staff to be involved. I am not sure what it is like at your hospitals, but at RCH, it is difficult to entice staff to stay out of hours for a social gathering. Although drinking in hours can be frowned upon, in the role that we do, and the minimal amount drunk, I believe it has never presented any issue regarding performance. It provides just a touch of social lubricant, given the staff a reward for their efforts during the week and month, and also sent them home (although always keen for the weekend to start!) with a positive frame of mind, even if the week itself has been one to forget.
Some staff doesn't drink, some staff may not think it is appropriate to drink during work hours, and others complain they don't like wine, but those that do get involved, I think, appreciate the implied thanks and social interaction. I always notice a better work atmosphere in the last couple of work hours on Wino Fridays, and I think this outcome exhibits that this morale booster although a trifle controversial can be successful. The biggest risk for me is buying wine that is no good and the accompanying complaints that brings!
Implementing morning teas is not exactly innovative. However, we schedule four per year and particular work groups host them. The HIM professionals invariably come up with a theme (although the clerical doesn't ever seem so inclined) that is usually related to the time of the year or events going on in Melbourne, for example, a Halloween theme, the Queens birthday, etc.
All of the staff members on the hosting teams bring food, and it is invariably over-catered resulting in a table full of goodies left over, which are nibbled at throughout the day.
These teams build team work, allow staff to catch up with others who work in different areas, and also (as they usually last longer than the allocated tea time) give the staff a reward in theoretical "time off."
It's important, however, to make sure that work continues during tea break, for example, phones are answered and that the days work is still completed. Usually there is one day of the week that is a bit quieter, so I would recommend that the teas be held on that day.
One of my greatest failures was that of my great idea for team posters. You know the type--inspirational messages designed to make the staff feel as if they are an integral part of our dynamic team providing great service to the rest of the hospital. So, on a Friday night before departing I went around the department and put up about 20 posters with clichés, such as "there is no I in team" and "a team is only as strong as its weakest link."
Well didn't that go down like a lead balloon! Approximately 3.8 seconds after walking into my office on Monday morning the department's union representative and shop steward descended into my office like the proverbial ferret down a rabbit hole. She explained some of the staff felt harangued, pressured, and imposed upon by the posters, and they should be taken down forthwith. Not surprisingly, I felt dumbstruck by this perceived problem. However, after further discussion, I realized that perhaps my approach had been a little heavy handed.
Sheepishly later that day I took all the posters down but did keep half a dozen up in my office on a wall that staff could see...I was disappointed and a bit resentful that something I thought was positive was perceived so negatively. I still had my pride to hang those posters on! However, I would suggest that positive reinforcement mantras can still play a role in a department, just perhaps used a little more subtly than mine.
Striving for Excellence
The striving for excellence awards was plagiarized from my Australian Rules Football team. The award is split into two. There is an "up and coming" and "established" players award presented at the team's Best and Fairest.
What I did was to separate the two into new staff, who had been with HIS for less than a year, and long-term staff who had been employed for greater than a year (with our longest staff member coming up to 33 years now). These awards are presented annually at the end of the financial year to the two staff members who have exhibited consistent excellence of work, attitude, and attendance.
In some respects, this is an individual S2AMPIE, however, it does take into account different work performance and is less subjective in that I encourage other HIM professionals to nominate staff that they believe are deserving of the award.
I think that the striving for excellence awards encourage long-term staff to persist, as there can be a tendency for them to get into a rut. In addition, new staff that has performed well is given an early pat on the back that encourages their continued high level of performance. Variations that could be considered in your workplace could be that all of the staff votes from a short list of nominations or you divide all of the staff into the two categories. In this way, it would be seen as significantly different from S2AMPIE. Make sure, however, that the staff is fully aware of the criteria for voting.
In HIS, the clerical staff does not have formal performance appraisals. This is for a number of reasons, including the time and effort required plus the fact that many clerical staff have fed back to me when the idea has been mooted previously that they are extremely fearful of performance appraisals and the perceived issues surrounding them. There were three ways in which this could be overcome I believed. Ditch the idea of performance appraisals entirely, conduct them but in a way that made the staff more comfortable, or just do them anyway.
I decided the best course of action was to still conduct them but in a much more informal way and in effect not actually appraise their performance, as good managers really should be doing that daily not yearly, but give staff members a private forum to discuss any issues they may have. This I dubbed the yearly yak. Staff members are given time around the date of their anniversary to sit down and discuss with their direct supervisor any issues they wanted to discuss. Many staff members will (and should) approach their manager often with issues that arise. Conversely, some staff members do not have the confidence or even believe it their "place" to discuss work matters with their managers. The yearly yak gives them an opportunity to do so in a relaxed environment where they can say nothing or everything. I encourage the managers to take the staff outside the department, for example, to the cafeteria or the park to have their yak. Some staff will literally take three minutes to complete while others will grab the opportunity with both hands, and a search party may end up having to be sent out!
The yearly yak is a great way for the staff to know that they have a formal, structured way of discussing any work issues while not feeling they are under pressure. When used intelligently by the HIM professional, it also gives them the opportunity to raise issues that may not be worth raising in normal circumstances but can be inferred in such a circumstance.
Public Affairs Manager
Although it may be different in the US, it is commonly accepted in Australia that HIM professionals have a low profile, with the department being simply a cobwebbed dungeon storing about 50 records, two or three skeletons, and a cranky old Medical Record Librarian with a bad attitude and halitosis. Halitosis excepted, I think it is important for HIM professionals to dispel these myths. Therefore, I decided to appoint an HIM professional who has a portfolio including being the Department Public Affairs Manager. This is obviously only a subsection of their work, but they were charged with a variety of tasks. I think that being perceived as the clichés mentioned above is bad for staff morale. I think it is important for all levels of staff to be recognized for the work they do, what they stand for, and the importance of those tasks. If you are not recognized by the wider hospital community for what you do, then it is likely that feelings of under appreciation and reduced staff morale will result.
Therefore, the Public Affairs Manager was charged with the responsibility of producing the department newsletter, "For the Record," ensuring that HIS was mentioned in the hospital newsletter "Kids Talk" every issue, if possible, as well promoting the department wherever possible. I think this approach has resulted in many positive outcomes. First, the department staff were filmed for the opening musical number in our hospital's Good Friday Appeal, which meant the staff were on TV (including me of course!) for the charity concert. More than $10 million Australian was raised this year, and the staff had a great hour filming the clip with some Australian celebrities. This was a real morale boost. In addition, a photo of S2AMPIE and a description has featured in "Kids Talk" along with other achievements of the department.
I also believe that the "real" Hospital Public Affairs department now doesn't leave us out of events and invitations as before. We are now on more people's lips and backed this up by last year winning the RCH Team Award for excellent innovation in service.
Walk back into your department when you return to work from this Congress and assess whether you can feel the department's morale. If you can feel an overwhelming absence, perhaps think about implementing one or all of the above innovations. If you do feel the presence of a great level of staff morale, why not try out one or two of my suggestions anyway? As mentioned, morale is something that can take a long time to build but potentially only one incident or one staff member leaving or arriving to come crumbling down. After all, what do you have to lose?
- Chambers Dictionary . (2003). Edinburgh: Chambers Harrap Publishers Ltd.
- Grindel, CG. (1998). "Transforming the workplace." Medsurg Nursing , 7 (1): 60-61.
|Source: 2004 IFHRO Congress & AHIMA Convention Proceedings, October 2004|