Dr Mohit Tolani looks at the damage caused by unhappy work environments
Organisational context
A new journey after graduation, a new chapter in my life – I undertook my first job in a major regional public hospital many miles away from the bustle of urban life. Among the many health services it offered, the hospital contained a 12-surgery dental department providing a myriad of oral health services to the region including provision of a mobile dental service to aged care and nursing homes on a bi-weekly basis.
Given its distance from the big cities, it had encountered significant difficulty in attracting employees and new recruits to the hospital. Over the last ten years, the dental department had been tarnished by indictments of poor work performance, negative workplace culture and inadequate conflict resolution by the departmental management. The dental department had a multidisciplinary team with a hierarchical system that hindered open communication.5
Conflict in the workplace is an “undesirable dynamic process [arising] amongst parties from perceived disagreements and interference with the parties’ goals, [resulting] in negative emotional reactions”.1 Studies indicate that within the clinical environment interpersonal conflict is a routine feature for nurses.4 This is also evident in the dental nursing staff, affecting workplace professional behaviour and causing poor on-the-job performance. With respect to the hierarchical nature of this workplace, the dental nurses alluded to various reasons for conflict such as feeling unfairly treated, a lack of communication, disagreements, and feelings of animosity.15
Staff dissatisfaction, poor workplace attendance rate and high turnover are symptoms that can be attributed to a negative teamwork culture resulting from poor conflict management and resolution.19 As a new dental clinician working in the department, I saw this myself and observed the change in staff numbers over a period of 12 months. Staff instability and poor retention of clinicians and nurses in the dental department had a crippling effect on the provision of healthcare services to the patients.
Such a system resulted in many patients not being seen and being provided with vouchers to visit external service providers. In addition to poor patient management, this also led to a noteworthy financial impact.19 The dental department was then curtailed with funding and budget allocations, resulting in the provision of under-resourced services. With a lack of adequately experienced staff and a high staff changeover rate, it placed additional responsibility on the existing and new staff, such as me, to address the experience gap caused by staff absenteeism.6 Not only did this affect the attitude of the staff, but it also hampered the experiential learning and observing that is needed to nurture the workplace environment.5
Unresolved conflicts within staff brought on a negative teamwork culture and dysfunctional clinicians. Research suggests that a berating dentist will cause team spirit and staff morale to suffer, resulting in a dysfunctional team with increased staff turnover. At such a point, communication between the staff is so poor that they tend to withhold information.13 Ultimately, the dental practitioner loses staff support and may become isolated, resulting in disinterest in the workplace and leading to ineffective continuity of care.10 This reflects my experiences of my first dental job where team members were performing poorly and looking for work elsewhere. The efficiency of the dental department was compromised because of the negative climate in the workplace, which influenced staff and their behaviour.10
Contributing factors
Several factors can be attributed to a disruptive team such as low job satisfaction, inadequate problem solving, and lack of support, but one key stressor for a clinician-nursing environment such as dentistry is workload.8 Given that I was at a rural hospital, which was the only one providing oral health services in the region, the patient load was so high that it resulted in excessive workload. This could be “conceptualized as physical exertion, patient ‘dependency’, complex patient care and the amount of time spent in patient care”.12 Studies suggest that when nursing staff perceive their workload to be high, they feel angry, distressed and cynical.7 This also results in burnout as evidenced in my workplace.18
The cultural climate of a team contributes to the conflict at work. Adjustment of staff to conflict in teams “is mainly a function of clear leadership about conflict in groups and the nurtured robustness to tolerate differences”.5 In our dental setting, staff were inundated with workload, which was made worse by poorly informed changing shift rosters. New casual staff members were brought in and trialled; however, there wasn’t clear communication regarding this, with extra load being placed on the nursing staff and clinician to assist in training on the busiest of days. In addition, the team didn’t have an ‘avenue’ to vent their frustrations. Such an environment where the staff concerns were not heard, coupled with poor communication and an extensive workload, led to an arena of disinterest, negative workplace culture and conflicts.
During all of this I was undertaking postgraduate studies on the side in health management. This was very helpful to me as I could learn the patterns in human behaviour within the workplace and apply the strategies to build a stronger team. Effective organisational management and workplace governance requires influence, processes, power distribution that aids behavioural accountability and clear norms for dealing with any arising issues. My dental department needed a supportive voicing system whereby staff could express their viewpoints and changes could be facilitated accordingly.19
Strategies to address the issue
I approached my manager to undertake a subtle management role aiming to create a functionally strong team. In order to perform at a high level within a team, effective staff engagement is important. Organisations and workplaces need managers and leaders who can cultivate commitment and enhance enthusiasm amongst staff members by utilising personality traits and behavioural characteristics such as vision enhancement, constructive influence and charisma. By using effort and talent in a meaningful way, organisational goals can be achieved. Those who can embrace this skill are known as transformational leaders and aim to empower team members to attain goals such as the provision of better services, social problem solving and higher productivity.2
We employed Bass’ categorisation of transformational leadership into four domains for my workplace:
Idealised influence – forming a standpoint that displayed insight and self-confidence within the presence of staff, eg organising regular meetings where staff feedback could be given not only about how their hard work was valued, but also regarding updates on upcoming departmental changes. Additionally, this platform could be used for discussing concerns and sharing ideas to better the department’s functions, demonstrating respect for staff ideas and suggestions. Research suggests validating staff for a job well done bolsters their self-esteem and overall morale.16
Inspirational motivation – introduction of a mentoring based approach for nurses and clinicians to assist them in achieving personnel goals including leadership development and succession planning.17 The senior nurses worked with the trainee nurses, supervising them prior to the trainee nurse working independently. For complex clinical cases, junior dentists had an opportunity to witness the senior clinicians performing a procedure and ask for support when needed. Such a system ensured delegation of adequate responsibility to staff members, which led to effective sustenance of clinical protocols.
Intellectual stimulation – this results in creativity and implementation of innovative techniques. We implemented this by providing staff with continuing professional development opportunities and resources that further their skills. Some of the initiatives included sponsored attendance at professional learning events and offering task based incentives.6
Individualised consideration – giving attention to each staff member and treating him or her in the best way for his or her needs.9 Staff members that have an issue or concern should be able to raise it with the manager in charge or the respective department lead. Prior to discussion of the issue, the leader should look at best and worst case scenarios, then effectively listen to both sides before presenting their side assertively and making it a win-win situation for all. This should be followed by a summary of the discussion.15 Such a system was executed and encouraged at my workplace, which was reassuring to employees, as they knew their concerns were heard and valued, and that their position was being respected.
Conclusion
I didn’t want to run away from challenges. As a young dentist, I didn’t want to leave my job due to the toxic environment, but rather assist in changing my workplace culture. I learnt that a transformational leadership approach that values authenticity, respect, openness and positive regard for staff members, was the most effective for preventing conflict and restoring interest in the dental team. This created a wonderful opportunity for learning, adjustment and growth; enhancing teamwork, reducing negative workplace culture and strengthening staff retention.
Learning points
1. Be the change you want to see – leading by example is one of the most positive things a clinician can do to improve a practice culture.
2. Opening discussion and removing hierarchical barriers empowers positive collegiate interactions and promotes best patient care.
3. Supporting colleagues through difficult times and being sensitive to their challenges and needs will help create a healthy work environment.
References
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2. Bass, B M & Avolio, B J 1997. Full range leadership development: manual for the multifactor leadership questionnaire, Palo Alto, USA, Mind Garden Inc.
3. Bass, B M, Avolio, B J, Jung, D I & Berson, Y 2003. Predicting unit performance by assessing transformational and transactional leadership. J Appl Psychol, 88.
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15. Robert, R W, Cynthia, D M & Robert, R S 2013. Conflict on the treatment floor: an investigation of interpersonal conflict experienced by nurses. Journal of Research in Nursing, 19, 26-37.
16. Schalk, D, Bijl, M, Halfens, R, Hollands, L & Cummings, G 2010. Interventions aimed at improving the nursing work environment: a systematic review. Implement Sci, 5.
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19. Wilkinson, A, Townsend, K, Graham, T & Muurlink, O 2015. Fatal consequences: an analysis of the failed employee voice system at the Bundaberg Hospital. Asia Pacific Journal of Human Resources, 53, 265-280.