The trust bestowed upon the nursing profession by the public is a privilege and requires professional accountability for continual practice enhancement. Research finds that efforts to improve the culture of the perioperative work environment consistently lead to better teamwork and communication among staff. These enhancements will positively impact the safety of surgical patients. Guided by effective nursing leadership, a team’s culture can be transformed.
The Employee Workforce Engagement Survey, administered by Press Ganey Associates, a leading third-party research firm, features more than 50 multiple choice items and two open-ended questions. The survey, taken by Plainview Hospital perioperative department staff in 2014, provided an opportunity for them to verbalize their work experiences, including what was working well and what needed improvement.
Plainview, a 219-bed acute care community hospital located in Plainview, New York, is part of Northwell Health, a large health system with 23 hospitals and more than 700 outpatient centers.
In 2014, the engagement indicator at Plainview’s perioperative department was 3.40, which meant the department was at approximately the 17th percentile for employee engagement nationwide. By 2018, the Plainview engagement indicator rose to 4.57—the 99th percentile nationwide. How did that happen? The perioperative leadership team at Plainview effectively changed its culture from one that was complacent, noncollegial, and counterproductive to one that is mission-driven, engaged, enthusiastic, transparent, and empowered. With unwavering commitment, staff empowerment, resilience, communication, collaboration, and zero tolerance for incivility and disrespect, the department continues to thrive.
In April 2018, Northwell’s Perioperative Corporate Services sent a team to speak to the perioperative services staff at Plainview about the unprecedented improvement in employee satisfaction and engagement. The majority of feedback from staff members was that the incredibly supportive culture was directly related to the actions of the leadership team led by perioperative services director Winnie Mele, BSN, RN, NE-BC.
The main themes identified by staff were overall accountability, a zero tolerance for negativity, a profound respect for work-life balance, the expectation of interdisciplinary mutual respect, and leadership visibility. Although accessibility is a vital competency for a leader, it is often difficult to manage in the overcharged, fast-paced, stressful perioperative environment. Mele and her team leaders managed to maintain a sense of accessibility while setting realistic boundaries and encouraging staff empowerment and accountability. They mirrored expected behaviors: “Be the change you want to see.”
An environment of trust is essential for relationships to form and flourish. By gaining the trust of their staff members, the perioperative leadership team played an essential role in improving the dynamics of the department.
The leadership team united employees and motivated them to embrace a shared vision—to provide exceptional care to every patient, every time. Cultivating a high-trust culture is not a “soft skill”—it’s a hard necessity. Trust comprises two-thirds of the criteria when deciding Fortune’s “100 Best Companies to Work For.”
Although employees typically come to work and perform the work expected of them, staff members who trust their leadership team increase their performance dramatically. Taking care of your people, recognizing employees for a job well done, and truly listening creates trust. Such an environment increases communication and transparency, which are crucial for creating a safe patient environment.
The leadership team values everyone’s contributions and regularly seeks out staff members’ opinions. By listening well and treating team members with kindness and respect, leaders develop team members who do the same for the customer. Leaders gain respect by:
• being consistent
• being responsive
• holding staff members accountable
• being comfortable admitting their weaknesses
• working to improve themselves
• forgiving others and themselves for making mistakes—mistakes lead to learning.
Leadership visibility had a profound effect on the morale of the units. Mele and her team’s idea of visibility is being present with people when conversing, proactively rounding, and engaging in honest and authentic communication so that staff know the leader is with them. The leaders embrace issues rather than avoid them. Courageous leaders invest in the thinking, time, and energy needed to manage effectively, and they are prepared for the vulnerability of being with people. By doing this, they are inspiring people to greatness.
A process for staff to raise concerns on a regular basis was implemented and ultimately evolved to include leadership concerns as well. Mele explains:
“Early in my tenure, the staff members brought a list of concerns, asking that they be addressed. Some of the items on the list needed to be addressed, and leadership embraced them. However, there were many items on the list that needed to be changed that belonged to the staff.
“While we were addressing the issues, we were clear that no one arrives like the guest of honor—only the patient. Everyone has to be involved and engaged to make real change. Going forward, I asked that during our Tuesday morning education sessions, the staff bring forward any heartburn issues that were getting in the way of them being able to provide outstanding service to the surgeon and stupendous care to the patient. That process became known as ‘Heartburn Tuesday.’
“If we were able to make the changes or address the issue, we would. If it wasn’t possible, we would tell staff members why. That piece was important. We needed to build their trust. Even if it was a purchase they wanted and we couldn’t get it approved, we would tell them: ‘We’re trying,’ or ‘we won’t give up.’
“When it did get approved, we would celebrate! As a team, we learned to compromise—this fostered collaboration. We modeled the Serenity Prayer: Let’s change what we can. Let’s spend our time and efforts where it matters.
“Some issues or requests were not negotiable. I would say to them: ‘This is not a survey.’ They learned to trust us, to know that we were their champions. Eventually, when we developed an atmosphere of trust, the concept of ‘Heartburn Tuesday’ worked both ways. I was now bringing my heartburns to the team in the same forum. There is give and take. We are working together for the good of the patient. Today, we continue with ‘Heartburn Tuesday.’ It works.”
Despite the demands of the perioperative work environment, the Plainview leadership team has created and maintained a positive work-life balance for their staff members and themselves. Staff and leaders consider life’s events, big and small, to be a priority, and leaders accommodate staff’s schedule requests whenever possible.
Staff members do not hesitate to assist one another. Team cohesiveness—which is dependent on loyalty, motivation, and commitment—has never been stronger.
As an example of what prompted the philosophy, “the patient is the guest of honor,” Mele explains: “I was making rounds in one of the departments. The staff were having loud personal conversations and discussing their weekend plans. In the waiting room with the door open was a newly diagnosed patient with breast cancer sitting with her mother. Staff members were so embedded in their own ‘drama’ that they lost the focus of the mission. We needed to reignite our dedication to the patient. Every patient is the guest of honor.”
Mele leads by example, continuously providing opportunities for growth to the formal and informal leaders. She thinks and behaves strategically while being available to do whatever is needed, at any time, blending leadership with service. Mele is candid, frank, truthful, empathic, kind, and caring. She discourages criticism of employees. Any staff member who hears negative talk or gossip is empowered to address the individual who is bad-mouthing someone. The concept is, “if you permit it, you promote it.”
Plainview’s perioperative leadership team turned its focus inward to develop a patient-centric culture of excellence. They worked to improve and sustain interpersonal relationships between team members, and modeled servant and transformational leadership. By promoting the well-being of those around them, these leaders demonstrate empathy, listening, stewardship, and commitment to the personal and professional growth of their colleagues.
To help staff achieve their best, each leader actively listens to staff members. When people are heard, they feel more comfortable and appreciated, and they are more productive.
Transformational leaders maintain strong relationships with team members, inspire team members to attain shared goals, foster team commitment, build trust, remove obstacles, and create opportunities. Despite stressful situations, long hours, difficult decisions, and dealing with difficult people and circumstances, Mele and her team have sustained a culture change by building trust and accountability.
Leaders who exemplify vision, determination, optimism, energy, kindness, and a passion for excellence can sustain change initiatives and create cultures that emanate staff engagement, resiliency, happiness, productivity, loyalty, and motivation.
The best leaders make people their priority. The ability of the Plainview leadership team to reboot its environment through creative, cooperative, ethical, transparent efforts proved to have exceptional, sustainable results. True leadership leads to a safer patient and employee environment that is based on dignity, respect, and empathy. Great leadership has the power to transform patients’ and employees’ lives. ✥
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