Healing Ecosystem Component 1 – Does Structure Measurably Impact Wellbeing?
In our last blog post, we explored why and how focusing on structural elements of the workplace could enhance healing and human thriving. But is there evidence that doing so actually makes a difference?
Most of us think of structures as physical buildings or organizational hierarchy – but structures show up as policies, systems, programs, schedules, or any other decision, rule, constraint, or tool that impacts how work is organized and executed. Even an agenda for a meeting is a form of structure.
A good example of reimagining structure to enhance wellbeing comes from the institution where I did my training to become a doctor: University of California, San Francisco (UCSF). In some of UCSF’s primary care clinics, they were faced with a conundrum. Many clinicians reported both a high degree of burnout (nearly 60%) and stress in their work (about 85%), and an overwhelming daily workload seemed the cause. In this circumstance, most of us might feel inclined to leap to an assumption: hiring more people or redistributing the work to other departments are the most logical ways to reduce burnout and stress. Instead, the team at UCSF looked at some of their workplace structures, and sought to change them in an effort to move from high stress/high burnout toward a more healing workplace environment.
Specifically, the team changed the rules and permissions for handling phone calls from patients and other clinicians, to allow up to 50% of the calls to be resolved on the “first touch” rather than pass them along to multiple people. They also changed the structure for how electronic messages sent to the clinic via the electronic health record were reviewed, triaged, and resolved. They created more time in the daily clinic schedule to account for all the activities that occurred in the clinic, not only the doctors’ face-to-face time with patients, and they rearranged how patients, clinicians, and other care team members (nurses and medical assistants) interacted and moved through the clinic across the day.
Some might call these process changes, and in a way they are. However, processes are informed by structures, and in many cases the more prudent way to improve wellbeing is to focus on the structural elements, not only the steps in the workflow itself. By using this mindset, the UCSF clinic team reduced the clinicians’ reported burnout by nearly half and reduced stress at work by a third.
Even more impressive and important is that they achieved these gains without asking the workforce to take better care of themselves, imploring leaders to lead differently, or focusing on team climate and dynamics. Simply attending to ways in which they could improve the structures designed for daily work was enough to make a difference in wellbeing metrics. In doing so, they shifted their workplace down the spectrum, away from a place of great distress and toward a healing ecosystem.
In our next blog post, we’ll turn to organizational and team climate – another important lever for cultivating healing ecosystems in our workplaces.