Flourishing in Difficult Times

By Jo Manion and Thomas Muha

Follow six steps to create a healthy work environment.


Jo Manion	Thomas Muha

Surviving is difficult enough during tough times, so how does a health care organization manage not only to survive, but to thrive? Recent research has provided the answer: Flourishing is possible only when leaders work in partnership with a vibrant, engaged workforce.

It sounds so easy, yet during difficult times, stress levels are high and people are hardwired to respond by fighting, fleeing or freezing. None of these reactions creates a positive work environment. One strategy that has proven effective—increasing staff resiliency and producing optimal outcomes when they are needed the most—is a performance improvement methodology based on the principles of positive psychology.

This model was developed by psychologist Thomas Muha and has been demonstrated to produce astonishing results in our high-paced, challenging industry. Developed through independent research completed in a Solucient 100 hospital in the Northeast, Muha uncovered six principles that have been validated by the latest empirical research findings in positive psychology. To make them easy for leaders to remember and use, Muha created the acronym PROPEL: passion, relationships, optimism, proactivity, energy and legacy.

PROPEL in the Workplace

The six principles were tested at a four-unit nursing department in a major academic medical institution. Learning to use the PROPEL principles helped a nurse manager and her staff transform the units into some of the facility's top performers. This performance has been sustained for more than two years.

When the nurse manager assumed responsibility for the almost 200 FTE perinatal department, she found that the most negative members of the staff had become very powerful. Morale had plummeted as rules of professional conduct and basic human courtesy were routinely ignored. An environment of toxicity was prevalent. Even the "good" nurses were infected. Night staff members were sleeping during their shift; day staff nurses took extended lunch breaks. A culture of blaming and hostility toward management existed. Staff nurse satisfaction levels were at 1 percent and new employee turnover close to 100 percent.

After almost two years in the position, the manager was ready to resign. At that point, the organization enlisted a coach, and thus began the turnaround.

By learning the six key positive psychology principles, the manager and her assistant nurse managers were able to start dealing with the problem. They began by expanding their team of formal leaders to include the informal positive leaders within the department. They identified the top 20 percent of performers—those who were willing to help change the culture in the department. This larger group became the team that started the transformation.

Step by Step

Passion. To begin implementing the model, the manager and her team of top performers began to work on increasing their passion, the first of the six positive psychology principles. Passion is created when people become clear about what they value most in life, then put those priorities into a vision of how they want their life to be. The leadership team members aligned their visions for the future workplace and developed concrete, constructive steps to reach that vision.

Relationships. Next, the team focused on enhancing relationships. Positive psychology research has revealed that relationships must have between four and six positive exchanges to every negative interaction to be considered healthy and constructive.

If the ratio drops below 3:1, people become more inclined toward self-absorbed advocacy than collaboration. When people reach a ratio of 2:1 (common in many workplaces), they become so dissatisfied that they often sever their relationship with the other person. At 1:1 and below, relationships are usually classified as pathological and characterized by active attempts to sabotage the system or the other person.

The team members were taught how to increase and maintain a high positive-to-negative ratio in their interactions.

Optimism. Numerous studies from positive psychology have found that people who explain their problems as temporary, specific and situational remain optimistic in their thinking. They also believe that the good things in life—such as their character strengths—are permanent, pervasive and personal. Because of these thinking processes, they seek (and usually find) solutions to their problems. Pessimists think in just the opposite manner and have far higher levels of anger, anxiety and depression, all of which contribute to blaming and defensiveness.

The team members were taught to examine their thinking styles and replace pessimistic thinking patterns with hopeful and energy-producing approaches. They discovered that, by changing their thinking, they were able to agree on solutions much more quickly and painlessly.

Proactivity. An optimistic approach provides the foundation for the fourth principle. Proactive people are willing to implement those optimistic possibilities they think may solve their problems and help them create positive outcomes. Reactive people, on the other hand, are controlled by their negative emotions, which limits their response repertoire to fight, flight or freeze. The departmental leaders were coached consistently to consider their next action in light of the strengths they possessed that would enable them to bring their vision to fruition. This allowed them to stay focused on the possibilities for being successful rather than feeling immobilized by overwhelming challenges.

Energy. Transformation requires positive energy. There are four sources of energy renewal: physical, emotional, mental and spiritual. Members of the team were coached to consistently enhance their energy by establishing healthy routines for taking care of themselves, such as exercising regularly, eating a nutritious diet and sleeping well. They also focused on their attitudes and their emotional intelligence, learning how to manage their own emotions and developing solid skills of relationship management.

Legacy. Legacy is creating meaning in our lives. The leaders in this study were encouraged to enhance the well-being of others, which made a magnificent difference in their workplace.

Empowering the Employees

As the manager, the assistant managers and the top performers implemented the six positive psychology principles, it became clear that anything was possible now they were working together. Eventually, the coaching sessions expanded to include the entire staff. All employees began to see that they were a necessary and integral part of the solution. They began accepting responsibility for the quality of the work environment, and their perceptions changed. The more empowered they felt, the more respect they developed for their leaders and for themselves.

As a result, the department was able to move from the lowest level of functioning (relative to other departments in the organization) to some of the highest ratings on multiple surveys—including the Gallup Staff Survey, the Press Ganey Patient Survey, the Rand Patient Safety Survey and the NDNQI Magnet Survey. The staff is now given top ratings for friendliness and courtesy by 98.9 percent of patients. Staff satisfaction levels have jumped from 1 percent to 85 percent. Staff engagement scores went from 3 percent to 84 percent.

RN-RN interaction scores increased by 36 percent, and RN-MD interaction scores improved by 23 percent. The turnover of new RNs improved by 80 percent. The impact on the financial picture was startling as well. The use of agency nurses decreased by 95 percent, and the use of sick time and family medical leave was reduced by 75 percent. Overall, the total cost containment at the end of the year was $816,000.

More importantly, the manager and her staff now love coming to work. Staff job enjoyment levels improved by 50 percent. The feelings of camaraderie that they developed have led to a tremendous improvement in teamwork and support between staff members. The manager and her staff have been recognized throughout the organization for the remarkable results they have achieved and are justly proud of their success.

When the six PROPEL principles are integrated into the culture of a hospital—even during challenging and difficult times—they have been proven effective in creating a positive, flourishing work environment with highly engaged staff. During tumultuous times like these, it is more important than ever to have a staff motivated to provide the best patient care possible.

Jo Manion, Ph.D., R.N., N.E.A.-B.C., F.A.A.N., is a speaker, author and senior management consultant based in Oviedo, Fla. Thomas Muha, Ph.D., a psychologist in Annapolis, Md., offers professional coaching services through PROPEL Performance in Annapolis.

Dr. Manion's latest book, The Engaged Workforce: Proven Strategies to Build a Positive Health Care Workplace, may be ordered from the American Hospital Association at www.HealthForumOnlineStore.com.

This article 1st appeared on December 7, 2009 in HHN Magazine online site.

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