13 Feb 2024
Laura Woodward discusses the maths behind how investing in veterinary staff well-being can increase profits and improve patient outcomes.
Laura Woodward
Job Title
Image © duyina1990 / Adobe Stock
I read a book last year called The Happiness Advantage: The Seven Principles of Positive Psychology that Fuel Success and Performance at Work by Shawn Achor1.
Mr Achor is a happiness researcher at Harvard University and has done extensive work there, as well as at Yale University, Pfizer, KPMG and elsewhere. His research shows us that when our brains work in a positive state, they work better at work, in relationships and in life than they do when they are in a neutral, negative or stressed state.
So, happiness, along with hard work, will make us more productive, more profitable, and better vets and nurses.
Leaders are under pressure from their line managers, who are under pressure from their line managers to encourage us to reach our sales targets. They have to do this – it’s a business after all. So, we have to give accurate estimates, work up cases fully and charge appropriately.
The miscommunication occurs when the shop floor staff perceive profitability to be the only aim of the leaders and managers. It isn’t. Profitability is, however, very measurable – and, therefore, a crude indicator of the “success” of the practice.
So, what do we do with happiness; this precious, but immeasurable tool? Do we park it, never to be revisited or measured?
Happiness is a very misunderstood driver of performance, and during these crazy times when we have no time to spare, we don’t give ourselves any time to investigate it. We can’t.
But happiness can be the ethereal state that both managers and clinical staff connect on. It’s not tangible, but it’s something all humans naturally desire – and there, we have a common goal.
So, how are we going to infiltrate the workplace with happiness and how are we going to learn about happiness in ourselves to model this behavioural trait?
Happiness is different to joy. Joy is a pleasant feeling when something we like happens. It’s great and it’s transient.
Happiness is a more robust, durable way of being. It is a strong personal characteristic we can embed in ourselves if we just know how. Positive psychology shows us how.
Positive psychology helps us to see the hurdles, challenges and seemingly unsurmountable difficulties around us in our chaotic veterinary world without becoming overwhelmed by them, shutting down or spiralling.
We can have many real difficulties in our lives and our work, and simultaneously experience an overall sense of calm and optimism.
Adversity can co-exist with happiness. Resilience means we can experience true hardships, feel sadness and despair, and look these emotions in the eye, give them a name and know they are temporary.
Research by the NHS shows that compassionate leaders are better leaders. Line managers, clinical leads, and head vets and nurses are all obvious leaders. Many of us also lead from within the team. Leadership doesn’t have to appear in our job description for us to take ideas forward.
If we are focused and present, can actively listen to others, have cognitive and emotional empathy, and help others intelligently then we are directly driving up profits and improving patient outcomes2,3. Let’s look at this.
Leaders who model being present with those they lead and who stop what they’re doing to “listen with fascination”4 even though they’re under massive time pressure are more time-efficient in the long run and more effective than those who try to have conversations mid-procedure.
Mindful meditation, done regularly for even a very short time, will make being present a normal way of being for us.
Active listening involves really understanding what the other person is saying and also hearing what they’re trying to say. Often, we have to reconcile our own conflicting opinions about a situation if we are to truly see things from another person’s perspective and to walk a mile in their shoes.
Cognitive empathy means the leader understands what’s being said and can reflect this back to the other person using language that person will understand.
It isn’t always easy to understand someone else’s way of thinking – especially if we aren’t trained for this. The upside to it, though, is that if you can be truly non-judgemental and accept that your colleague feels what they feel then letting go of the perceived obligation to pass judgement on their feelings is often a weight lifted off your shoulders.
Relieving yourself of the task of making the other person feel what you’re feeling is another task you can cross off your list.
Compassionate leadership requires being able to feel the distress or frustration of those we lead without being overwhelmed by the emotion and, therefore, unable to help.
An example of empathic concern is: “I can feel your distress and I have an overwhelming need to help you out.”
Taking thoughtful and intelligent action to help the other person out is different to thinking you need to “fix” how they are feeling about their situation. It’s an important distinction to make, both for your own well-being and theirs.
In this NHS workforce study, a direct correlation exists between staff health and well-being, and patient outcomes: “The finding that burnout and poor well-being are both, in the majority of studies reviewed, associated with poorer patient safety, has significant implications for policymakers and management teams within health care settings4”.
The more positive the experiences of staff in an NHS trust, the better the outcomes for that trust5.
We haven’t done such a thorough study on our own professions. But it would be prudent to assume that the same applies to us. Poor mental well-being correlates directly to poorer patient outcomes.
I have first-hand experience of the converse, which is also true: poor patient outcomes have a massively detrimental effect on our mental well-being. This is exacerbated by our sense of shame, moral injury, embarrassment and inexperience with failure, and the repercussions from owners and also from managers if they lack empathic concern or have not been trained specifically in compassionate management.
Good mental well-being has many significant associations with owner satisfaction, patient mortality and infection rates, as well as staff absenteeism and turnover6.
The more engaged staff members are, the better the outcomes for patients and the organisation generally.
An interesting psychological study presented at the American Association of Advancement of Science focused on 44 internists ranging in age from 30 to 70 years old.
The doctors were given a list of ailments from a hypothetical patient and also given another piece of information – that the patient had been diagnosed at another hospital as having lupus.
Half of the doctors also received a bag of chocolate (to be eaten later) as thanks for their participation; the other half instead got medical journals to study ahead of time. No chocolate was dispensed to this group.
Surely the better-prepared doctors outperformed the chocolate recipients, right? Wrong.
Mr Achor said: “The doctors who are primed to be happy come to the correct diagnosis twice as fast as those who are thinking only in the medical mode.”
We know already that happiness along with hard work makes us more successful than when we are in a neutral, negative or stressed state. We probably assume that chocolate makes us happy. It is the engagement of the staff with the person or organisation who wants them to be happy that gets results7,8.
So, if we have become compassionate leaders and we now want our staff to feel happy for all the right reasons, where do we invest? And how much? Is it a Snickers bar per employee? A fridge stocked with salads? Beer money?
The University of East Anglia and RAND Europe demonstrated that, for example, investment of £80 per member of staff in mental health support can achieve net gains of £855 a year through savings from absenteeism and presenteeism.
If we can invest even half of this amount with the added bonuses of increased profits and improved patient outcomes along with better owner satisfaction then does any argument against this exist?
The cost effectiveness calculator illustrates the benefits of different types of well-being initiatives via improved employee well-being and boosts to productivity. As far as possible, the calculator gives benefits and costs in pounds and pence, allowing a direct comparison to aid decision-making.
The calculator allows you to choose from a broad range of initiatives, such as gifting books on mental well-being to each member of staff, mindfulness and meditation training, eating and health checks, fitness improvement and so on.
The calculator shows the estimated well-being effects that might arise in a workplace that offers the selected initiative. This includes the benefits per employee of improved physical or mental health and job satisfaction.
As a cohort, veterinary professionals, in my opinion, are often new to actively participating in their own mental well-being. So, I would expect the well-being effects for us to be on the highest part of the scale.
The calculator will also estimate the value to the business of any improvements to productivity that arise due to reduced absenteeism or presenteeism per employee. The user can supply their own wage information.
However, as I said already, the measurable, calculable figures are only the icing on the cake for us. Improved patient outcomes must surely be the actual cake for the business.
The calculator will provide indicative costs associated with offering each type of initiative and any net savings per worker that might be expected due to improved productivity.
The well-being and productivity benefits will depend on whether employees are aware that their employer provides these initiatives and also on how widely used they are within the organisation. The calculator allows the user to see what benefits may arise if there is greater awareness of the initiative.
If the initiative is a tangible book on veterinary-specific mental well-being, the employee will be aware of who cares about their well-being9.
Leaders and managers play a key role in creating a culture that empowers teams with the skills and resources to take ownership of their own health and well-being.
Compassion can’t be faked. By leaders using positive psychology and becoming more engaged with your team, not only will the team be more profitable and successful with patients, happier and stay longer, you will feel more satisfaction, accomplishment and optimism than ever before.
Mental Wellbeing and Positive Psychology for Veterinary Professionals is published by Wiley-Blackwell and available on Amazon. This book provides a pre-emptive, proactive, and solution-based approach to the many challenges we face as vets and VNs, with positive psychology at its core.
Written by myself, all royalties are being donated to Vetlife and to the provision of free of charge therapy for vet nurses.
