Prioritizing well-being at the institutional level
Self-care can only do so much for individuals in a toxic environment
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Jeremiah Grissett was hired last year as counselor and wellness coordinator at Oklahoma State University College of Veterinary Medicine. He’s already gotten a counseling program set up for students. He’s now working with a team lead by Dr. Margi Gilmour, associate dean for student and academic affairs, to create a better environment for everyone at the veterinary teaching hospital.
“There’s so much stress for everyone over there. There’s stress for veterinarians in general, but faculty have to teach, do research, and maintain client care. It’s difficult for them,” Grissett said. “It’s also not just a typical teaching position—you teach students as they come through on rotations. And students are growing and stretching during that time. It’s long hours and difficult work.”
Grissett, the hospital director, and others in leadership have formed a team to approach culture change through a strategic plan. They will send a survey at the beginning of this semester to figure out what faculty, staff, and residents want to see changed.
He attended the session “Developing a Strategic Organizational Plan for Wellbeing” during the 2019 Veterinary Wellbeing Summit, held Nov. 17-19 in Rosemont, Illinois, to get ideas for how to make a plan happen.
The speaker for the session, Makenzie Peterson, well-being program director at Cornell University College of Veterinary Medicine, said working toward better well-being for all requires culture change. That’s because individual efforts can’t take root if the culture isn’t open to them in the first place.
“Culture eats strategy for breakfast. There’s the stuff we (organizations) put on our marketing materials, and then there’s the boots-on-the-ground experience—that’s culture. And it is a monster,” she said.
And while intimidating, culture change is necessary for many parts of the profession, Peterson said, citing results from the Merck Animal Health Veterinary Wellbeing Study, which showed that overall only 40% of veterinarians would recommend the profession. And of those with serious psychological distress, only 17% would recommend the profession (J Am Vet Med Assoc 2018;252:1231-1238).
“We’re not doing well-being to be nice anymore; it’s not a fluffy luxury. We’re doing it to save lives at this point. We want everyone who participates in veterinary medicine to be in the profession as long as they want to be—not as long as they can stand it,” Peterson said.
She outlined the following five steps to create a culture of well-being at any workplace.
1. Establish enough leadership buy-in.
Studies have shown that well-being programs reduce health costs and lead to higher engagement, improved productivity, higher retention, easier recruiting, reduced absenteeism, better company culture, and higher job satisfaction.
2. Conduct a needs assessment.
The needs assessment can look at resource allocation; the current culture, including values, and the hidden culture; and what is currently being offered for well-being as well as whether employees are happy with those offerings. Conduct a survey open to all members and departments. Collecting demographics is a good idea, too.
The second part of this step is data analysis. Identify stress points for the community, whether those are individual factors such as skills or competencies, systemic factors such as organizational communication or processes, or external factors such as clients, the economy, or industry trends. Also, look at capacity to see what well-being offerings can feasibly be made available and what can be outsourced or done as a partnership.
“The essence of strategy is determining what not to do,” Peterson said. “What national and community organization can you partner with to fill in the gaps?”
Finally, assign people or ask for volunteers in the organization for a further deep dive to develop suggested solutions based on the needs assessment.
We’re not doing well-being to be nice anymore; it’s not a fluffy luxury. We’re doing it to save lives at this point. We want everyone who participates in veterinary medicine to be in the profession as long as they want to be—not as long as they can stand it.
Makenzie Peterson, well-being program director, Cornell University College of Veterinary Medicine
3. Choose your own adventure.
Based on the needs assessment data, leaders should determine which change management and well-being approaches they’d like to take.
The three top models for organizational culture change are the Lewin Change Management Model, meant for large shifts and deep analysis; the McKinsey 7S Model, which is good for small organizations to analyze how coherent or in sync an organization is; and Kotter’s Theory, a top-down approach that generates momentum and drive toward change. This last option helps implement either of the first two models, Peterson said.
Culture change should touch everything from recruiting, hiring, and orientation to performance evaluations, staff training, and support.
As for drafting the well-being approach, Peterson recommends designing the program for the marginalized, the people who have to navigate the most barriers and need the most support. This way, the program will automatically cover those who need less support.
Further, let the needs assessment be a road map, have defined roles and responsibilities for action steps, and don’t subscribe to the thinking that you have to offer it all. Don’t offer gym memberships when people can’t even take a lunch break or programming that people don’t want or won’t use.
Above all else, “we need to see modeled behavior to have culture change,” especially leadership modeling behavior that promotes well-being, Peterson said. “Maybe being the best team player is going home and taking care of yourself instead of staying 12 hours when you only needed to be there eight hours.”
4. Conduct a stakeholder assessment.
Who are the stakeholders? Are they donors, leadership, veterinarians, technicians, staff, clients, students, or alumni?
Once the groups are determined, sort them by who is supportive, on the fence, unsupportive, and unknown. Consider what the groups value and who influences them.
5. Address barriers to change.
Barriers to change can involve closed attitudes, not accounting for differences among departments or divisions, unclear culture goals, bias or stigma, poor communication strategy around changes, or lack of employee engagement, expertise, or data.
To manage resistance is to expect it and plan for it. Addressing resistance formally, identifying the root causes of resistance, and being able to answer “What’s in it for me?” can all go a long way, Peterson said.
Grissett, the wellness coordinator at Oklahoma State’s veterinary college, encounters resistance to change frequently in his work as a licensed therapist. When a client is resistant, he takes a step back and reassesses.
“The process of feedback with a client is the same as what we might go through with the teaching hospital,” he said. “If we encounter that (resistance to change), we’ll make sure we have a core group, not necessarily the ones heading up the initiative, but the ones guiding it, that will be open to feedback, which will be vital for us so we can address and move forward with changes in the most effective way possible.”
When there is resistance, he said, it’s important to not push through, but to think of why there is resistance. Is it an obstacle to go around? Is there another way to get through it better? Or do we need to rethink the plan in general because it’s not going to work?
“You can learn a lot from resistance; you just have to listen to it,” Grissett said.