Promising Practice 3: Create Opportunities for Employee Influence
Employees’ ability to influence their work conditions, individually or collectively, is another important aspect of job control; scholars often refer to this as worker voice. Recent research suggests that American workers want more say in the workplace than they have currently. In one nationally representative survey, more than a third of respondents indicated they have less influence than they want over different aspects of their work conditions (such as how they do their jobs, their schedules, and the time available to do their work). Giving employees greater input into the nature of their working conditions can be an effective way to enhance their sense of job control and well-being.
Worker voice can be incorporated into work design initiatives through a participatory approach in which employees are invited to play an active role in problem identification and implementation of workplace changes. The strategy is intended to both enhance worker empowerment and commitment as well as improve organizational performance. Experimental research exploring the effects of participatory strategies has found structured interventions that incorporate worker voice are particularly effective in enhancing worker well-being.9 The following case study highlights a high-quality experimental study that successfully used a participatory approach to improve well-being outcomes for primary care clinicians.
CASE STUDY: Can Participation in Workplace Change Improve Clinician Burnout?
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Strength of Evidence: Strong
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Background:
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Clinician burnout is a serious problem for doctors, nurses and residents nationwide, with some studies showing a burnout prevalence of over 50% in this group. also shows that primary care clinicians are dissatisfied with their jobs, not recommending the field to students, and at risk of leaving medicine themselves.
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The Work Design Initiative:
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This study aimed to reduce clinician burnout and turnover intentions by inviting physicians, physician assistants, and nurse practitioners to participate in a structured process of identifying and addressing problems in their work environment. At the start of the study, clinicians filled out a survey assessing their work conditions and various provider outcomes (for example, stress, burnout). Next, they were given summaries of the baseline survey results so that they could participate in a guided discussion to prioritize workplace problems and improvements they wished to implement. Clinical teams chose from a menu of proven interventions and they customized each type to their specific clinical context and needs; each team was then actively involved in the implementation of these workplace improvements.
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What Changed?
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Compared to nonparticipants, clinicians who engaged in the systematic workplace improvement process showed significantly greater improvements on burnout and job satisfaction measures, with a trend towards reduced intention to leave their jobs. This study suggests that active staff participation in a guided process of workplace problem diagnosis and improvement can lead to meaningful increases in clinician well-being and potential benefits for employee retention.
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Having the opportunity to influence work conditions is important in ordinary times but may be particularly critical in times of crisis when conditions are highly unpredictable and may be changing rapidly. For example, when faced with a crisis like the COVID-19 pandemic, frontline workers, who were often closest to the problems induced by the pandemic, needed to have the opportunity to share their concerns and their ideas for problem solving. Our qualitative, exploratory study (which is described in more detail under Promising Practice 4: Creating Conditions for Effective Teamwork) explored how Certified Nursing Assistants (CNAs) working in two hospitals coped with workplace challenges during the pandemic. CNAs in one of these hospitals identified the practice of “lean huddles” as a particularly important way for them to voice their concerns and ideas and contribute to practice innovations during this time. Lean huddles are a type of lean management strategy (see Work Design Principle # 2 for “helpful resources” on this approach) consisting of brief daily meetings to support dialogue and workplace improvements.
Furthermore, CNAs noted that huddles implemented during the crisis were an effective medium for communicating and problem-solving about staff health and safety concerns. The CNAs felt these daily huddles were effective because they provided a regular opportunity to focus everyone’s attention on key safety concerns and other issues related to employee well-being, and because staff progress on addressing these issues was tracked visually over time on a board. When asked how much of a ‘say’ she felt that she had about her work, one CNA remarked:
We all do. We all have a say. We have huddles in the morning. And that's where you express your concerns, that's where you can learn how we could do something better…We can voice anything. And our manager is amazing at making sure that she resolves each issue in a timely manner. It might not be that day or that week, but eventually she does get it done. She hears everybody out.
Lean huddles fostered innovations to address recurring safety and patient care challenges during the pandemic. One participant remarked on the active role that CNAs played in coming up with solutions:
We would offer suggestions every day in huddle of what would be helpful to us. And [supervisors] were pretty good at listening; but it was definitely up to us to make these changes because we were the ones dealing with it.
Innovations ranged from smaller adaptations to more significant ones, such as the idea of installing windows in doors to permit CNAs acting as patient care observers for COVID-19 patients to observe their charges from outside of the room, thereby minimizing their risk of exposure to the virus.