problem solving in healthcare examples

What is Problem-Solving in Nursing? (With Examples, Importance, & Tips to Improve)

Whether you have been a nurse for many years or you are just beginning your nursing career, chances are, you know that problem-solving skills are essential to your success. With all the skills you are expected to develop and hone as a nurse, you may wonder, “Exactly what is problem solving in nursing?” or “Why is it so important?” In this article, I will share some insight into problem-solving in nursing from my experience as a nurse. I will also tell you why I believe problem-solving skills are important and share some tips on how to improve your problem-solving skills.

What Exactly Is Problem-Solving In Nursing?

5 reasons why problem-solving is important in nursing, reason #1: good problem-solving skills reflect effective clinical judgement and critical thinking skills, reason #2: improved patient outcomes, reason #3: problem-solving skills are essential for interdisciplinary collaboration, reason #4: problem-solving skills help promote preventative care measures, reason #5: fosters opportunities for improvement, 5 steps to effective problem-solving in nursing, step #1: gather information (assessment), step #2: identify the problem (diagnosis), step #3: collaborate with your team (planning), step #4: putting your plan into action (implementation), step #5: decide if your plan was effective (evaluation), what are the most common examples of problem-solving in nursing, example #1: what to do when a medication error occurs, how to solve:, example #2: delegating tasks when shifts are short-staffed, example #3: resolving conflicts between team members, example #4: dealing with communication barriers/lack of communication, example #5: lack of essential supplies, example #6: prioritizing care to facilitate time management, example #7: preventing ethical dilemmas from hindering patient care, example #8: finding ways to reduce risks to patient safety, bonus 7 tips to improve your problem-solving skills in nursing, tip #1: enhance your clinical knowledge by becoming a lifelong learner, tip #2: practice effective communication, tip #3: encourage creative thinking and team participation, tip #4: be open-minded, tip #5: utilize your critical thinking skills, tip #6: use evidence-based practices to guide decision-making, tip #7: set a good example for other nurses to follow, my final thoughts, list of sources used for this article.

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Problem Solving in Nursing: Strategies for Your Staff

4 min read • September, 15 2023

Problem solving is in a nurse manager’s DNA. As leaders, nurse managers solve problems every day on an individual level and with their teams. Effective leaders find innovative solutions to problems and encourage their staff to nurture their own critical thinking skills and see problems as opportunities rather than obstacles.

Health care constantly evolves, so problem solving and ingenuity are skills often used out of necessity. Tackling a problem requires considering multiple options to develop a solution. Problem solving in nursing requires a solid strategy.

Nurse problem solving

Nurse managers face challenges ranging from patient care matters to maintaining staff satisfaction. Encourage your staff to develop problem-solving nursing skills to cultivate new methods of improving patient care and to promote  nurse-led innovation .

Critical thinking skills are fostered throughout a nurse’s education, training, and career. These skills help nurses make informed decisions based on facts, data, and evidence to determine the best solution to a problem.

Problem-Solving Examples in Nursing

To solve a problem, begin by identifying it. Then analyze the problem, formulate possible solutions, and determine the best course of action. Remind staff that nurses have been solving problems since Florence Nightingale invented the nurse call system.

Nurses can implement the  original nursing process  to guide patient care for problem solving in nursing. These steps include:

• Assessment . Use critical thinking skills to brainstorm and gather information.
• Diagnosis . Identify the problem and any triggers or obstacles.
• Planning . Collaborate to formulate the desired outcome based on proven methods and resources.
• Implementation . Carry out the actions identified to resolve the problem.
• Evaluation . Reflect on the results and determine if the issue was resolved.

How to Develop Problem-Solving Strategies

Staff look to nurse managers to solve a problem, even when there’s not always an obvious solution. Leaders focused on problem solving encourage their team to work collaboratively to find an answer. Core leadership skills are a good way to nurture a health care environment that supports sharing concerns and  innovation .

Here are some essentials for building a culture of innovation that encourages problem solving:

• Present problems as opportunities instead of obstacles.
• Strive to be a positive role model. Support creative thinking and staff collaboration.
• Encourage feedback and embrace new ideas.
• Respect staff knowledge and abilities.
• Match competencies with specific needs and inspire effective decision-making.
• Offer opportunities for  continual learning and career growth.
• Promote research and analysis opportunities.
• Provide support and necessary resources.
• Recognize contributions and reward efforts .

Embrace Innovation to Find Solutions

Try this exercise:

Consider an ongoing departmental issue and encourage everyone to participate in brainstorming a solution. The team will:

• Define the problem, including triggers or obstacles.
• Determine methods that worked in the past to resolve similar issues.
• Explore innovative solutions.
• Develop a plan to implement a solution and monitor and evaluate results.

Problems arise unexpectedly in the fast-paced health care environment. Nurses must be able to react using critical thinking and quick decision-making skills to implement practical solutions. By employing problem-solving strategies, nurse leaders and their staff can  improve patient outcomes  and refine their nursing skills.

Images sourced from Getty Images

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5 Whys: Finding the Root Cause

When a problem presents itself, ask "Why?" five times until you reach the root cause.

• 5 Whys tool instructions, example, and template

The key to solving a problem is to first truly understand it. Often, our focus shifts too quickly from the problem to the solution, and we try to solve a problem before comprehending its root cause. What we think is the cause, however, is sometimes just another symptom.

One way to identify the root cause of a problem is to ask “Why?” five times. When a problem presents itself, ask “Why did this happen?” Then, don’t stop at the answer to this first question. Ask “Why?” again and again until you reach the root cause.

This technique is attributed to Taiichi Ohno, father of the Toyota Production System, which revolutionized automobile manufacturing with methods now known as Lean. It’s important to note that there may be multiple root causes of a problem, and that different people who see different parts of the system may answer the questions differently. For a more comprehensive tool, please see RCA 2 : Improving Root Cause Analyses and Actions to Prevent Harm .

*NOTE: Before filling out the templates, first save the PDF files to your computer. Then open and use that version of the tool. Otherwise, your changes will not be saved.

Ask "Why?" Five Times

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Fresh Perspectives

Want to Solve Problems in Public Health? Here's How

I have many loves in family medicine. I love delivering a newborn directly into a mother's arms. I love excisional biopsies of funny looking moles. I love giving someone hope after a chronic disease diagnosis.  

What I love most, however, is community-based preventive medicine. As such, I wrangled a contract directly out of residency that is 20 percent population medicine. (Lesson No. 1: Ask for what you want. You might actually get it).

As part of this endeavor, I am pursuing a master's degree in public health. I hope to use this training to make connections in the world of public health policy; to learn how to create, implement, message and evaluate programming; and perhaps to eventually break into creation of, or participation in, policy. I will have some required coursework in, for example, biostatistics and epidemiology, but I will also have myriad electives on topics like environmental public health and behavioral economics.

Throughout the course of my program, I hope to distill the most useful-to-the-family-medicine-doc public health pearls from my classes and pass them along. This post is the first in this series. Thus far, I have taken courses on problem-solving in public health and intro to persuasive communication.

The course on problem-solving in public health taught me two things: a remarkably egalitarian way to run a meeting and a systematic approach to solving problems.

The Nominal Group Technique (NGT)

In this setup for running a meeting, start by imagining a group of eight people. During each session, one of them is the moderator, one a notetaker and one a timekeeper. The moderator's job is to decide how long each part of the session ought to take, and the timekeeper's job is to cut people off once time is reached. The notetaker … takes notes.

Each meeting uses the following series of steps, and as participants get used to the process, they get faster and more efficient.

• Clarify the purpose and goals. The moderator reminds everyone about the specific question or questions for the session, reviews time limits for each ensuing step and allows for adjustments on each of these points.
• Brainstorm solutions. Group members brainstorm answers to the session's central question, a step that can take place before the meeting.
• Share ideas in a round robin. Going around in a circle, each person briefly shares one idea, adding more brief ideas -- avoiding duplicates -- when the circle comes back around until time runs out or all ideas have been voiced. In this manner, no one dominates the discussion and everyone is heard.
• Discuss as a group. Here the group focuses on clarifying, not debating. The goal is to add salient details or reasons for a certain suggestion. This is a time to ask questions rather than make arguments. Some time can also be spent discussing criteria for voting in the next step.
• Rank the suggestions. Each group member ranks the options based on the set criteria -- perhaps voting for their three favorites, using two votes however they want, or casting one vote each -- and the group ends up with two or three leading suggestions.
• Wrap up with conclusions and assignments. Participants are assigned roles or tasks to complete before the next meeting, and a new moderator, timekeeper and notetaker are assigned.

The NGT is delightfully efficient and focused. Moreover, it imposes a thoughtful, respectful and inclusive methodology to traditionally explosive or at least controversial topics. By using this technique, you can assure all members of the group that each of their voices will be heard with equal weight, as will also be the case in the problem-solving process below.

The Problem-solving Process

Usually applied to public health problems, this series of steps offers a framework through which one can approach just about any problem that involves groups of people. Whether your problem is developing a group visit program or decreasing smoking in pregnant women, you can approach the problem with success in this way. Notably, this process works well in combination with the NGT.

• Define the problem. A good problem definition has a specific group, timeframe and outcome of interest. For example, the definition could be, "Childhood obesity rates in the United States among school-aged children have been rising since the 1970s."
• Identify indicators of the problem. If your problem is childhood obesity, your direct indicators would be things like body mass index, waist circumference or waist-to-hip ratio. Indirect indicators -- things that give you a clue your endpoint might be happening -- would be rates of childhood hypertension, diabetes or obesity-related sleep apnea. Using the NGT would lead your group to brainstorm as many direct and indirect indicators as possible, then you vote on which ones to track and change.
• Find data for the indicators. Without data, you will have a hard time convincing others to do what you want.
• Identify stakeholders. Find out who cares about the outcome. A meeting held in the NGT style would come out of brainstorming and round robin with a diverse, inclusive and thorough list of potential stakeholders. For childhood obesity, the stakeholders could be parents, students, educators, elected officials, etc. The ranking step would narrow the list to the stakeholders that your group wants to work with.
• Identify key determinants. These are the things that might make the outcome of interest more or less likely. For childhood obesity, these factors might be diet, exercise, dangerous neighborhoods that prevent exercise, food deserts, genes, obesity in parents, television watching, school lunches and poverty.
• Identify intervention strategies. Here is when you brainstorm actions to change the outcome. Some of the group's ideas might be school lunch programs, educational programs for parents, active recess or adjusting food aid programs. All ideas are welcome for discussion and ranking. At the end of the meeting, your group will have decided on an intervention strategy to pursue.
• Identify implementation strategies. It is all well and good to have an intervention, but the next step is to figure out how to get it off the ground. You need to use all the resources you have -- friends in high places, friends in low places, grants, national organizations, local fundraising, city council meetings and more.
• Evaluate. All good interventions need to be evaluated. Be sure to figure out how to do so. Is it working? Is it costing too much? Does it have any unintended benefits or consequences?

I already have used each of these techniques to great effect. By addressing problems in this step-by-step fashion, I find myself suddenly more organized, and you know what that means: more time for more projects!

Just kidding. I get to read books for fun these days and go on long runs. It is amazing.

Stewart Decker, M.D., is a family physician practicing in southern Oregon. He focuses on the intersection of public health and primary care. You can follow him on Twitter at @drstewartdecker.

The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our  Terms of Use .

Copyright © 2024 American Academy of Family Physicians. All Rights Reserved.

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Thinking your way to successful problem-solving

13 September, 2001 By NT Contributor

VOL: 97, ISSUE: 37, PAGE NO: 36

Jacqueline Wheeler, DMS, MSc, RGN, is a lecturer at Buckinghamshire Chilterns University College

Problems - some people like them, some do not think they have any, while others shy away from them as if they were the plague. Opportunities, in the form of problems, are part of your life.

The most difficult decision is deciding to tackle a problem and implement a solution, especially as it is sometimes easier to ignore its existence. Problem-solving takes time and effort, but once a problem has been addressed the nurse can feel satisfied that the issue has been resolved and is therefore less likely to re-emerge.

Nurses make clinical decisions using two different approaches. The first is the rationalist approach, which involves an analysis of a situation so that subsequent actions are rational, logical and based on knowledge and judgement. The second approach is based on a phenomenological perspective, where a fluid, flexible and dynamic approach to decision-making is required, such as when dealing with an acutely ill patient.

Types of problems

Problems come in different guises and the solver can perceive them either as a challenge or a threat. One of the most common types of problem is when the unexpected happens. As a nurse you plan and implement care for a patient based on your knowledge and experience, only to find that the patient’s reaction is totally different from that expected but without any apparent reason.

Another type of problem is an assignment where others set a goal or task. Throughout your working life you will be required to undertake duties on behalf of other people. For some this is difficult as they feel unable to control their workload. Others see it as an opportunity to develop new skills or take on additional responsibilities. Opportunities can be perceived as problems by those who fear failure.

A third type of problem is when a dilemma arises. This is when it is difficult to choose the best solution to a problem because the nurse is confronted with something that challenges his or her personal and/or professional values.

Diagnosing problems

The sooner a problem is identified and solutions devised, the better for all involved. So try to anticipate or identify problems when they occur through continuously monitoring staff performance and patient outcomes.

Listening to and observing junior staff will help you to detect work or organisational concerns, because when there are problems staff are likely to behave in an unusual or inconsistent manner.

Initial analysis

Remember that people view things differently, so what you perceive as a problem may not be one to anyone else. So before you begin thinking about what to do - whether to keep it under surveillance, contain it or find a solution - you should undertake an initial analysis. This will help you to understand the problem more clearly.

An analysis will also enable you to prioritise its importance in relation to other problems as problems do not occur one at a time.

Routine problems often need little clarification, so an initial analysis is recommended for non-routine problems only. Even then, not all problems justify the same degree of analysis. But where it is appropriate, an initial analysis will provide a basis from which to generate solutions.

Perception is also important when dealing with patients’ problems. For example, if a patient gives up reading because he or she cannot hold the book (objective), the nurse may assume it is because the patient has lost interest (subjective, one’s own view).

Generating solutions

It is essential for the problem-solver to remember that, where possible, solutions must come from those connected with the problem. If it is to be resolved, agreement must be owned by those involved as they are probably the best and only people who can resolve their differences. The manager should never feel that he or she must be on hand to deal with all disputes.

To solve a problem you need to generate solutions. However, the obvious solution may not necessarily be the best. To generate solutions, a mixture of creative and analytical thinking is needed (Bransford, 1993).

Creativity is about escaping from preconceived ideas that block the way to finding an innovative solution to a problem. An effective tool for assisting in this process is the technique of lateral thinking, which is based largely on the work of Edward de Bono, who regards thinking as a skill.

There are several ways to encourage creative decision-making. One method that works best for specific or simple problems is brainstorming. If the ground rules of confidentiality and being non-judgemental are applied, it will produce a free flow of ideas generated without fear of criticism (Rawlinson, 1986).

Time constraints and staff availability may make it difficult for all those involved in a problem to meet. In such cases an adaptation of brainstorming - where a blank piece of paper is given to those involved and each writes down four solutions to the problem - may be the answer. A similar technique is the collective notebook, where people are asked to record their thoughts and ideas about a problem for a specified period.

An alternative is where one person writes down a list of solutions in order of priority, which is then added to by others. This helps to prioritise the ideas generated. All these methods produce data that can then be analysed by the problem-solver.

When the problem affects people in different geographical areas, solutions can be generated by obtaining the opinion of experts through the use of a questionnaire, which is known as the Delphi technique (McKenna, 1994).

When an apparently insurmountable problem presents itself, it is often useful to divide it into smaller pieces. This is known as convergent thinking. Using divergent thinking - where you consider a problem in different ways to expand your view - may also help. 

A final alternative is the stepladder technique, which is time-consuming but effective if the issue is stirring up strong feelings. This requires the people involved in the problem to be organised into groups. First, two people try to solve the problem, then a third member is drawn in, to whom the solution reached by the first two is presented. All three then try to agree a solution. More people are added to the group, if necessary, in a similar way, until there is agreement of all involved. Provided the individuals are motivated to solve the problem, this technique creates ownership and commitment to implementing the agreed solution.

Analytical thinking, which follows a logical process of eliminating ideas, will enable you to narrow the range down to one feasible solution.

Although someone has to make the ultimate decision on which solution to implement, there are advantages to group decision-making: a greater number of possible solutions are generated and conflicts are resolved, resulting in decisions being reached through rational discussion.

This does, however, require the group to be functioning well or the individuals involved may feel inhibited in contributing to the decision-making. One individual may dominate the group or competition between individuals may result in the need to win taking precedence over deciding on an agreed practical solution.

As nursing becomes less bureaucratic individuals are being encouraged to put forward their own ideas, but social pressures to conform may inhibit the group. We do not solve problems and make decisions in isolation, but are influenced by the environment in which we work and the role we fulfil in that environment. If group members lack commitment and/or motivation, they may accept the first solution and pay little attention to other solutions offered.

Making a decision

There are three types of decision-making environments: certain, risk and uncertain. The certain environment, where we have sufficient information to allow us to select the best solution, is the most comfortable within which to make a decision, but it is the least often encountered.

We usually encounter the risk environment, where we lack complete certainty about the outcomes of various courses of action.

Finally, the uncertain environment is the least comfortable within which to make decisions as we are almost forced to do this blind. We are unable to forecast the possible outcomes of alternative courses of action and, therefore, have to rely heavily on creative intuition and the educated guess.

Taking this into consideration, you should not contemplate making a decision until you have all the information needed. Before you make your decision, remind yourself of the objective, reassess the priorities, consider the options and weigh up the strengths, weaknesses, opportunities and threats of each solution.

An alternative is to use the method that Thomas Edison used to solve the problem of the electric light bulb. Simply focus on your problem as you drift off to sleep, and when you wake up your subconscious mind will have presented you with the answer. But bear in mind that this is not a scientific way of solving problems - your subconscious can be unreliable.

If you are not sure about your decision, test the solution out on others who do not own the problem but may have encountered a similar dilemma. Once you have made your choice stick to it, or you may find it difficult to implement because those involved will never be sure which solution is current. They will also be reluctant to become involved in any future decision-making because of your uncertainty.

The next step is to ensure that all the people involved know what decision has been made. Where possible, brief the group and follow this up with written communication to ensure everyone knows what is expected of them. You may need to sell the decision to some, especially if they were not involved in the decision-making process or the solution chosen is not theirs.

Implementing the solution

Finally, to ensure the solution is implemented, check that the people involved know who is to do what, by when and that it has happened. Review the results of implementing your solution (see Box) and praise and thank all those involved.

- Part 1 of this series was published in last week’s issue: Wheeler, J. (2001) How to delegate your way to a better working life. Nursing Times; 97: 36, 34-35.

Next week. Part three: a step-by-step guide to effective report writing.

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By Lindsay Smylie Smith

Can you imagine the next time you are up against a problem in your organization, bringing all the stakeholders together in one room and leaving with a solution that works for everyone?

That’s exactly what staff at the North Bay Regional Health Centre (NBRHC) have done. By using creative problem solving, staff are able to take challenging situations and turn them into well-defined problems with an action plan—created by and for the stakeholders—in a short time frame. Amazingly, they are able to do all this while also creating buy-in for staff, improving patient care, patient flow, interdisciplinary teamwork and, in some cases, improving the financial well-being of the hospital.

Paul Heinrich, NBRHC President and CEO says he was first introduced to the idea of creative problem solving from Min Basadur, Founder of Basadur Applied Creativity , when Basadur spoke to a class Heinrich was taking at McMaster University. “I thought it was such a simple concept, but so powerful,” Heinrich says.

Basadur teaches creativity is a process that includes the following (in this order)—problem finding, fact finding, problem definition, idea finding, evaluation and selection, plan, acceptance and action. Most people want to jump from problem finding (step 1) to action (step 8), but skipping ahead in the process would mean missing out on identifying the cause of the problem before getting to the solution. Heinrich went on to work with Basadur to use creative problem solving at four different organizations—including NBRHC.

Heinrich admits this way of thinking and problem solving can seem too difficult from the outside. “Divergent and convergent thinking can be very challenging for adults,” he says. “We have learned there is a ‘right’ answer for everything. Over time, we have learned to be uncreative.”

It was at NBRHC that Heinrich decided to try a different approach. “Instead of relying on others to help us solve our problems,” Heinrich says, “We thought ‘why not train our own staff with these skills?’” Heinrich liked the idea of tailoring the tools and tactics specific to a health care audience, while also creating the capacity within the organization to use these methods on an ongoing basis.

So they did just that—training dozens of staff at the Health Centre in the theory of creative problem solving, encouraging them to take them back to their areas and teams, adapting them for the specific problems and audiences.

That’s exactly what two members of the organizations’ Quality Team, Karin Dreany and Kristen Vaughan, did when faced with the task of making improvements to the Health Centre’s clinical documentation processes. This complicated problem involved a number of stakeholders across numerous departments. Essentially, a lack of standardization and incomplete charts meant the Health Centre was potentially missing out on important funds to match the true costs of a patient’s stay. There were additional concerns around turnaround times and a backlog for inputting that required substantial staff overtime to keep up.

Using key elements of creative problem methodology, they tailored the quality improvement to their audience by streamlining the group process from two days to two hours . Once they had everyone in the room—including physicians, frontline administrative and clinical staff, managers and senior leaders—as a group they came up with the top five problems and together brainstormed potential solutions. Subgroups were assigned to each solution, with representatives from physicians, clinical and coding staff on each.

The result? Almost 90% of physicians have adopted the new standardized documentation practices, clinical records has eliminated their overtime, and the turnaround time for chart coding has decreased from 60 days to 23 days. Improved, timely documentation allows the health centre to accurately capture the acuity and treatment of our patients.

Another example of how creative problem solving was used with impressive results is the review of the leave of absence (LOA) process in NBRHC’s Regional Specialized Mental Health Programs.

Laurie Wardell, Director, Mental Health, explains how there was an opportunity early last year to review some of the practises with the discharge process, particularly with respect to how LOA’s were functioning. “We thought there might be a way we could improve how this was executed to help improve our patient flow, better support our patients in their transition to the community and at the same time strengthen our relationships with some of our community partners.”

To accomplish this, as with the Clinical Documentation Project, they needed to get everyone together in one room. This included the psychiatrists, front line staff, health centre leadership and community partners. Groups that weren’t able to attend the session in person were able to remotely participate by Ontario Telemedicine Network (OTN).

“Bringing everyone together and having the ability to engage everyone in the process from the very beginning was so important,” Wardell says. “Everyone had a voice and was able to understand the problem. The session helped us narrow the scope of work and clearly identify the problem we were trying to solve.”

An unexpected benefit was the impact to the relationship with community partners. “They appreciated being involved in the creative problem solving session. It increased their trust in the process and they were able to see for themselves the Health Centre’s level of support for these changes,” Wardell says.

The group was able to improve wait times by reducing the length of the leave of absences by 55%. Wardell credits the group session to the success the group has had with the process change. “Front line staff were a part of the process identifying and creating the solution to the problem – so they were ready to implement it on the units without anyone else having to create buy-in.”

Bringing everyone together in one room is arguably the most important factor in the success these projects have seen. By bringing together everyone who don’t think it can be done or should be done, and by engaging them in the problems solving and allowing them to have a voice–good things are accomplished together.

Lindsay Smylie Smith is a Communications Specialist at North Bay Regional Health Centre.

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Clinical problem solving and diagnostic decision making: selective review of the cognitive literature

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• Peer review

This article has a correction. Please see:

• Clinical problem solving and diagnostic decision making: selective review of the cognitive literature - November 02, 2006
• Arthur S Elstein , professor ([email protected]) ,
• Alan Schwarz , assistant professor of clinical decision making.
• Department of Medical Education, University of Illinois College of Medicine, Chicago, IL 60612-7309, USA
• Correspondence to: A S Elstein

This is the fourth in a series of five articles

This article reviews our current understanding of the cognitive processes involved in diagnostic reasoning in clinical medicine. It describes and analyses the psychological processes employed in identifying and solving diagnostic problems and reviews errors and pitfalls in diagnostic reasoning in the light of two particularly influential approaches: problem solving 1 , 2 , 3 and decision making. 4 , 5 , 6 , 7 , 8 Problem solving research was initially aimed at describing reasoning by expert physicians, to improve instruction of medical students and house officers. Psychological decision research has been influenced from the start by statistical models of reasoning under uncertainty, and has concentrated on identifying departures from these standards.

Summary points

Problem solving and decision making are two paradigms for psychological research on clinical reasoning, each with its own assumptions and methods

The choice of strategy for diagnostic problem solving depends on the perceived difficulty of the case and on knowledge of content as well as strategy

Final conclusions should depend both on prior belief and strength of the evidence

Conclusions reached by Bayes's theorem and clinical intuition may conflict

Because of cognitive limitations, systematic biases and errors result from employing simpler rather than more complex cognitive strategies

Evidence based medicine applies decision theory to clinical diagnosis

Problem solving

Diagnosis as selecting a hypothesis.

The earliest psychological formulation viewed diagnostic reasoning as a process of testing hypotheses. Solutions to difficult diagnostic problems were found by generating a limited number of hypotheses early in the diagnostic process and using them to guide subsequent collection of data. 1 Each hypothesis can be used to predict what additional findings ought to be present if it were true, and the diagnostic process is a guided search for these findings. Experienced physicians form hypotheses and their diagnostic plan rapidly, and the …

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Design Thinking In Healthcare: A Natural Fit in 15 examples.

Design thinking in Healthcare is an almost perfectly natural fit. On the front end of Healthcare are the nurses who are naturally empathic. A key approach necessary for successful design thinking. Their role is to intimately understand the needs and take care of the problems of their patients. Their daily approach to problem solving requires them to empathize with patients. This approach fits perfectly with the approach of design thinking in healthcare, which is to understand patients/users/customer needs before looking for solutions. However, often patients can't directly communicate their needs to the nursing staff, so nurses are trained to look for signs and use their intuition to gauge the needs of their patients.

Here is a list of the top 10 examples of the use of design thinking in Healthcare:

• 4 nursing case studies :  describing the use of design thinking in healthcare by Penn Nursing which illustrate how nurses can be really powerful collaborators and generators of solutions within Healthcare. The 4 videos describe the main attributes that nurses bring to the problem solving table.
• Scanning Facilities: The influence and problems that design thinking can help solve in Healthcare go far wider than nursing. Philips, a leading producer of healthcare equipment such as MRI and CAT scanners have used design thinking to improve the patient experience by reducing the number of scans required and the amount of sedatives that need to be administered to patients during procedures by addressing the anxiety of patients who must go through scanning procedures. Philips have also used design thinking in their healthcare division to build better relationships with their healthcare clients . Over the past 10 years, the Rotterdam Eye Hospital’s managers have  transformed their institution from the usual, grim, human-repair shop into a bright and comforting place by incorporating design thinking and design principles into their planning process.
• Caring for the aged: Design thinking in healthcare has also produced interesting results for an aged care facility in Australia as you can read in this paper  on the creation of sustainability strategies for the facility.
• Improving Healthcare systems: in a   Design thinking project in healthcare in Dubai , the Dubai Health Authority (DHA) sought to make it easier for their patients to deal with the logistics of interacting with the healthcare system and found that they didn’t just need help connecting to medical information; they needed help connecting to their loved ones as well.
• Diagnosis: Design thinking has also been used to improve the treatment and management of diseases such as Diabetes and Alzheimer’s.  The Alzheimer’s Association asked used design thinking to respond to the question "how might we diagnose the disease earlier?". In Denmark design thinking was used in the development and testing of a mobile application to support diabetes self-management for people with newly diagnosed type 2 diabetes.
• Underpinning results with research (a study of 24 projects): The USA Center for Disease Control (CDC) did an extensive study to understand how applying design thinking in healthcare could enhance innovation, efficiency, and effectiveness by increasing focus on patient and provider needs. The objective of this review was to determine how design thinking has been used in health care and whether it is effective. Twenty-four studies using Design Thinking were included across 19 physical health conditions, 2 mental health conditions, and 3 systems processes. Twelve were successful, 11 reported mixed success, and one was not successful. In addition, 4 studies comparing Design Thinking interventions to traditional interventions showed greater satisfaction, usability, and effectiveness.
• Improving hygiene:  In another design thinking in healthcare project , Northwestern University graduates Mert Iseri and Yuri Malina spent weeks observing staff at North Shore University Health System. The challenge is to get staff to wash their hands. Experts agree that simply improving staff  hand-washing habits could prevent needless infections. While hospitals have plenty of communal sinks and hand-sanitizing dispensers, time-strapped caregivers simply don’t use them, and hand washing monitoring is still done manually with pen and paper. To figure out why compliance is so low, they noticed  medical staff wiped their hands on their scrubs , which led to an important insight for brainstorming possible solutions and ultimately the creation of a new product and corporation,  SwipeSense.
• Improving the effectiveness of medication: IDEO worked on a project to help with the accurate dispensing and taking of pills , a major reason that medicine is not as effective and it was designed to be.
• Hospital utilization and reduced infection rates: One US healthcare provider , for example, scoured multiple sources of patient and operational data, from interviews to medical records to motion-tracking cameras. As a result, it redesigned the way care was delivered, reconfiguring hospital layout to minimize cross-infection and reduce length of stay by 10 percent.
• Mayo Clinic : One of the first Healthcare Facilities to use Design Thinking in Healthcare in the early 2000's. Design Thinking had delivered myriad small improvements through its center for Innovation (CFI), but could it deliver transformational improvements. Read more in this  Yale University case study
• Memorial Hospital of South Bend, Indiana : The hospital wanted to create the best cardio vascular experience for patients.
• Chief Andrew Isaac Health Clinic :  develop a new and specialized outpatient clinic by understanding the living habits of native people and thus understand their culture, their sense of community and expectations.
• Kaiser Permanente : Nurse Knowledge exchange used design thinking to eliminate the gap in care between nurse shift changes
• Whittington Hospital, UK : used design thinking to help them reduce waiting times and increase patient satisfaction
• Rotterdam Eye Hospital : transforming the hospital from long dreary corridors, impersonal waiting rooms, the smell of disinfectant
• Driving Earlier Diagnosis and Care for Alzheimer’s Disease : only 50% of those living with Alzheimer's have been diagnosed.
•   The Design Institute for Health :  The first-of-its-kind institute was founded in 2015 as a unique collaboration between the Dell Medical School and the College of Fine Arts at the University of Texas at Austin. The institute explores new ways that design can improve healthcare and they believe that the opportunities are endless. Read this interview .
• Reducing missed medical appointments . Each year approximately  3.6 million people  miss or put off medical appointments due to transportation issues. Design thinking, putting yourself in the shoes of the patient and seeing the problems from their perspective, something that does not happen in exit surveys, proved to be the clue to how to improve no shows.
• Public Health : saving lives at a global scale
• Tim Brown, IDEO talks about the role of design thinking in Healthcare through a number of examples of design thinking project work around the world in one of his TEDTalks.

Read more about the effectiveness of design thinking in healthcare in projects on this site at the Mayo Clinic, Memorial Hospital of South Bend, Indiana, Chief Andrew Isaac Health Clinic, Kaiser Permanente and the Whittington Hospital which all provide additional ideas on the types of problems you can use design thinking to help you solve.

For a full index of all The Design Thinking Association articles on design thinking in healthcare, visit our Healthcare sector page

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The influencing factors of clinical nurses’ problem solving dilemma: a qualitative study

a Department of Nursing, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China

b Tongji University School of Medicine, Shanghai, China

c Beijing Tiantan Hospital, Capital Medical University, Beijing, China

Problem solving has been defined as “a goal-directed sequence of cognitive and affective operations as well as behavioural responses to adapting to internal or external demands or challenges. Studies have shown that some nurses lack rational thinking and decision-making ability to identify patients’ health problems and make clinical judgements, and have poor cognition and response to some clinical problems, easy to fall into problem-solving dilemma. This study aimed to understand the influencing factors of clinical nurses’ problem solving dilemma, to provide a basis for developing training strategies and improving the ability of clinical nurses in problem solving.

A qualitative research was conducted using in-depth interviews from August 2020 to December 2020. A total of 14 participants from a tertiary hospital in Shanghai, China were recruited through purposive sampling combined with a maximum variation strategy. Data were analysed with the conventional content analysis method.

Three themes and seven subthemes were extracted: nurse’s own factors (differences in knowledge structure and thinking, differences in professional values, poor strain capacity); improper nursing management (low sense of organizational support, contradiction between large workload and insufficient manpower allocation); patient factors (the concept of emphasizing medicine and neglecting to nurse, individual differences of patients).

The influencing factors of clinical nurses’ problem-solving dilemma are diverse. Hospital managers and nursing educators should pay attention to the problem-solving of clinical nurses, carry out a series of training and counselling of nurses by using the method of situational simulation, optimize the nursing management mode, learn to use new media technology to improve the credibility of nurses to provide guarantee for effective problem-solving of clinical nurses.

Introduction

Nursing education in China can be divided into two main levels: vocational education and higher education. Vocational education includes technical secondary schools and junior colleges, while higher education includes undergraduate, master’s and doctoral education. Vocational education aims at training students to master basic nursing service skills and to be able to take the post to engage in daily nursing work (Sun & Zong, 2017 ). Higher nursing education started late, and undergraduate education has always followed the “three-stage” education model of clinical medicine (basic medical courses, specialized courses and clinical practice). Most courses are centred on subject knowledge, and all clinical practice takes the form of centralized practice (Li, 2012 ). The training goal of nursing postgraduates is gradually expanding from academic master to professional master. The curriculum mainly includes classroom teaching and clinical practice. The classroom teaching contents include public courses (political theory, foreign languages, etc.), professional basic courses (advanced health assessment, pharmacotherapy, pathophysiology, evidence-based nursing, medical statistics or clinical epidemiology), specialized courses (advanced nursing practice theory) and Academic activities . The goal of nursing doctoral training is to cultivate high-level nursing research talents, focusing on the cultivation of scientific research ability rather than clinical practice ability. The curriculum includes ideology and politics, basic theory, research methods, specialized courses, development frontier, scientific writing, etc (Luo et al., 2018 ). There are some problems in the training mode and curriculum, such as theory and practice are out of touch, traditional lecture-based classroom teaching makes students passively accept knowledge, students attach importance to theory over practice, knowledge input to ability output, professional study to humanities knowledge. Nursing students receive no theoretical and/or practical training in problem solving before entering the clinical setting, so there is not a starting point for these nurses to clinical dilemmas in their professional life.

With the development of medicine, people pay more attention to health and have higher requirements for nursing service ability (Yang, Ning, et al., 2018). The National Nursing Development Plan (National Development and Reform Commission, 2017 ) points out that it is necessary to strengthen the construction of nurse teams, establish nurse training mechanisms and improve the professional quality and service ability of nurses. However, in the face of increasingly complex and changeable clinical environment, nurses are still lacking in problem-solving thinking and ability, and often fall into the dilemma of problem solving (Li et al., 2020 ).

Typical decision theory approaches to the identification of problem solving in nursing have viewed the process as a series of decision formulations that include: decisions about what observations should be made in the patient situation; decisions about deriving meaning from the data observed (clinical inferences); and decisions regarding the selection of action to be taken that will be of optimal benefit to the patient (McGuire, 1985 ). Information processing theory describes problem solving as an interaction between the information processing system (the problem-solver) and a task environment, which can be analysed as two simultaneously occurring sub-processes of “understanding” and “search” (VanLehn, 1989 ). Individuals collect the stimulus that poses the problem in the understanding process, forming the internal representation of the problem, transforming the problem stimulus into the initial information needed in the search process, and then producing mental information structures for the understanding of the problem, which making individuals distinguish the nature of the problem and clarify the goal of the problem. The mental information structures drive the search process that enables the individual to find or calculate the solution to the problem. This process starts with the nurse identifying the clinical problem and continues until the decision is made to resolve the problem (Taylor, 2000 ). Clinical problem solving requires nurses to have a variety of cognitive strategies, which involves nurses’ knowledge, experience, and memory process. Nurses must recognize the current problem and use all available knowledge and experience to transform the problem into their internal problem representation, and then set goals and search for strategies that can achieve the goal (Mayer & Wittrock, 1992 ). In today’s complex clinical environment, nurses need to be able to solve problems accurately, thoroughly, and quickly. Nurses who can solve problems efficiently have fewer medical errors (Babaei et al., 2018 ), and the level of nursing skills and empathy are higher (Ay et al., 2020 ; Bayindir Çevik & Olgun, 2015 ). To cultivate nurses’ problem solving thinking and ability, it is necessary to better understand the influencing factors of problem solving dilemma. However, these cannot be obtained by observing nurses’ behaviour in their work, and cannot be obtained through quantitative research either. Exploring the thinking process involved in nurses’ work through qualitative interviews is an effective way to understand the influencing factors of nurses’ problem solving. Given this, this study used qualitative research methods to deeply analyse the influencing factors of clinical front-line nurses’ problem solving dilemma, to provide a basis for making relevant strategies to cultivate nurses’ thinking and ability of problem solving.

Study design

A qualitative study based on in-depth interviews was conducted to obtain influencing factors of nurses’ problem-solving dilemma.

Settings and participants

Purposive sampling combined with a maximum variation strategy was used to identify and select information-rich participants related to the research phenomenon. Maximum variation was achieved in terms of participants’ gender, education level, professional title, marital status, seniority, and administrative office, respectively. The study was conducted between August 2020 to December 2020 in a tertiary hospital in Shanghai, China. The inclusion criteria were a nurse practicing certificate of the People’s Republic of China and within the valid registration period; having been engaged in clinical nursing work for at least 1 year and still engaged in clinical nursing work; clear language expression, able to clearly describe the solution and feelings of clinical problem solving; informed consent to this study and voluntary participation. The exclusion criterion were on leave during the study period (personal leave, maternity leave, sick leave, etc.); out for further study or came to the hospital for further study; confirmed or suspected mental illness and psychotropic medicine users. Purposive sampling continued until thematic saturation was reached during data analysis.

Data collection

Face-to-face, a semi-structured interview was used to collect information. All interviews were conducted in the lounge to ensure quiet and undisturbed by a female postgraduate nursing student with the guidance of her master tutor. Initially, an interview guide was developed based on literature review and expert consultation including about five predetermined questions: What thorny problems have you encountered in clinical work or have a great impact on you? How did you solve it? Why take such a solution? What is the biggest difficulty encountered in the process of problem solving? How does it affect you? How do you feel in the process of problem solving? Before the interview, the consent of the interviewee was obtained and then the researcher fully explains to the interviewees and starts with a friendly chat to allay the interviewees’ worries. During the interview, the researcher listened carefully and responded in time, always maintaining a neutral attitude, without any inducement or hint, if necessary, giving encouragement and praise to support the expression of the interviewees, and to record the interviewees’ facial expressions, physical movements and emotional responses in time. At the same time, a recording pen was used to ensure that the interview content was recorded accurately and without omission. The interview time for each person was 30 to 40 minutes.

Data analysis

After each interview, the researcher wrote an interview diary in time to reflect on the interview process and transcribed the interview content into words within 24 hours, then the researcher made a return visit by phone the next day to confirm that the information is correct. The seven-step method of Colaizzi’s phenomenological analysis method ( Table I ) was adopted to analyse the collected data(Colaizzi, 1978 ). Two researchers collated the original data, independently coded, summarized this information as themes, and organized a research group meeting once a week to discuss and reach a consensus.

7 steps of Colaizzi’s phenomenological analysis method.

Ethical considerations

This study was approved by the Ethics Committee of the Shanghai Pulmonary Hospital, Affiliated to Tongji University, project number: K16-252. Before the interview, the researcher explained the purpose and significance of the study to each interviewee in detail and obtained the informed consent of them on a voluntary basis and all of the interviewees signed informed consent forms. To protect the privacy of each interviewee, their names are replaced by numbers (e.g., N1, N2), and the original materials and transcribed text materials involved are kept by the first author himself, and all materials are destroyed after the completion of the study.

There was no new point of view when the 13th nurse was interviewed, and there was still no new point of view when one more nurse was interviewed, the interview was over, 14 nurses were interviewed. Three themes and seven subthemes were extracted. The characteristics of the participants ( N = 14) are provided in Table II .

Participant characteristics (N = 14).

Nurses’ own factors

Differences in knowledge structure and thinking.

Differences in the structure of prior knowledge and way of thinking will affect nurses’ processing of clinical data, thus affecting their clinical decision-making. The nurses made a wrong judgement of the condition because of the solidified thinking that postoperative nausea and vomiting symptoms were side effects of narcotic drugs and the lack of overall control and understanding of the patient’s condition.

There was a patient who came back after surgery with nausea and vomiting, the first thing that went through my mind, is the drug side effects, so I didn’t pay much attention, as is often the case, the most common cause of postoperative nausea and vomiting is anesthetic drug side effects, but later found to be cerebral infarction, this kind of situation I find it hard to recognize.

Differences in professional values

Professional values of nurses are accepted codes of conduct internalized by nursing professionals through training and learning (Pan, 2016 ). Negative professional values are easy to lead to problem solving dilemma. Some nurses think nursing is just a service.

The work is difficult to do, everything is the nurse’s fault, the nurse must apologize and put up with the patient’s scolding, nursing is a service industry, sometimes I am really wronged.” There are also nurses who believe that nursing work can reflect their personal value, and solving problems successfully will bring them a sense of achievement.

Although the nursing work is very intense, I live a full life every day. I feel a sense of accomplishment and pride that I can solve the problems of patients and discharge them smoothly through my work.

Poor strain capacity

Nursing work is patient-centred holistic nursing, the current clinical situation is complex and changeable, requiring nurses must have good strain capacity, and can “be anxious about what the patient needs, think what the patient thinks, and solve the patient’s difficulties.”

All patients are self-centered, and they don’t care whether you (the nurse) are busy or not. For example, once I gave oral medicine to a patient, a patient in the same ward was in a hurry and asked me to help him call his son. I was busy handing out the medicine and did not help. As a result, the patient was very dissatisfied and complained to the head nurse.

The 20-bed patient went through the discharge formalities but was still lying in the hospital bed. when the new patient arrived and she didn’t leave, I went to urge her to leave the hospital, she suddenly got angry and scolded me, I don’t know what to do.

Improper nursing management

Low sense of organizational support.

Organizational support is an important resource for clinical nurses in the process of problem solving (Poghosyan et al., 2020 ). Low sense of organizational support will hinder nurses’ problem solving.

The style of leadership and the atmosphere of the department are very important. in a department I rotated before, the leader was too strict to listen to your explanation, and the atmosphere of the department was not good. I couldn’t find help when I encountered problems. When I have a conflict with a patient, the leader will only criticize me, which makes me feel helpless.

Sometimes there will be a conflict with patients due to the bed turnover problem, and the patient will not listen to your explanation and turn around to complain, the nurse will be responsible for such things. In severe cases, even violent incidents will be encountered and the personal safety can not be guaranteed.

Insufficient allocation of manpower

Although the total number of nurses has increased substantially, there is still a shortage of human resources under the rapidly increasing workload (Guo et al., 2021 ).

When I was on the night shift and I encountered the critical moment of rescuing patients, I had to call an anesthesiologist, a doctor on duty, a nurse on duty simultaneously, an observation of the patient’s condition to prevent accidents was needed, I also have to race against time to give the patient ECG monitoring and oxygen inhalation. When the doctor came, he also criticized me that the first-aid equipment was not in place (crying).

According to the normal nurse-patient ratio, each nurse takes care of eight patients, and now there are not only eight patients, but also with extra beds and a fast turnover, and sometimes a nurse is responsible for more than 12 patients

Patient factors

The concept of emphasizing medicine and neglecting to nurse.

There is a deviation in society’s cognition of the profession of nurses, which believes that nurses are the “legs” of doctors, and nurses’ work is to help doctors run errands, give injections and give fluids. This concept not only leads to nurses’ lack of due respect, but also hinders nurses’ professional identity, and has a great negative impact on nurses’ problem-solving (Gao et al., 2015 ).

The patient did not dare to tell the doctor something he was not satisfied with, but complained directly to the nurse. For example, if the patient did not want to do some tests, he would scold the nurse. The nurse explained to him that he would not listen. But when the doctor came, he smiled and refused to admit that he cursed nurses, and he would frame the nurse. 90% of the patients would be willing to listen to the doctor.

Sometimes the patient says he was not feeling well, and I know the patient’s condition. I will give her some reasonable explanations, but the patient does not accept it. She is satisfied only when the doctor come to see her. In the final analysis, the patient just don’t believe us. No matter how much I explain to her, it is not as effective as the doctor’s glance at her.

Individual differences of patients

There are differences in patients’ personality characteristics, cultural background, views on nurses and state of an illness, these individual differences are also the reasons for nurses’ problem-solving dilemma (Chan et al., 2018 ).

Some cancer patients are in a period of anger, and it is very difficult to communicate with him. When I see him angry and lose his temper, I will not talk to him and just leave.”

Patients have different cultural levels and different social backgrounds. Sometimes I can’t talk too deeply. If patients are a little more educated, it will be easier for us to communicate with them, and some patients can’t understand anything we say.”

Multiple factors affecting clinical nurses’ problem-solving dilemma

The reasons for nurses’ failure in problem solving are mainly in the process of understanding the problem, the search process driven by the psychological information structure, and the problem or loss of balance in the process of implementing the plan. In the process, the three factors of nurses, management and patients all played an important role. Nurses’ knowledge structure and thinking loopholes led to the deviation of nurses’ internal representation of the problem (Jonassen, 2005 ). Poor professional values and low sense of organizational support can lead to nurses’ negative orientation and attitude towards problems (Poghosyan et al., 2020 ; X. Wang et al., 2018 ). The manpower allocation of nurses, patients’ emphasis on medical treatment over nursing care, and individual differences mainly increase the complexity and difficulty of nurses’ problem-solving task environment as external factors. The three factors work together on the problem-solving of clinical nurses, which leads to the dilemma of problem-solving.

Implementing situational simulation training to improve the comprehensive quality of nurses

At present, the overall quality and ability of nurses cannot meet the requirements of systematic, effective and rapid problem-solving. It is necessary to strengthen the construction of nurses to improve nurses’ problem-solving ability. Some studies have shown that situational simulation class can improve students’ knowledge, experience, psychological quality and other abilities (Mohammad, 2020 ). It is suggested that nursing educators should explore targeted situational simulation teaching and strengthen the relationship between classroom teaching and clinical practice through situational simulation, and to build a novel, perfect and clinical knowledge network for nurses. Secondly, emergency situational simulation teaching should be carried out to enable nurses to experience emergency situations from different angles, so as to improve their thinking, skills and timeliness in dealing with emergencies (Zhang et al., 2019 ). The content of professional values training should also be added to the situational simulation class in order to cultivate nurses’ positive, accessible and stable professional values and promote their positive orientation and attitude when facing problems (Skeriene, 2019 ).

Optimize nursing management and improve nurses’ working experience

Through interviews, it is found that nursing management factors have caused nurses’ problem-solving dilemma to a certain extent, which needs to be optimized according to the specific problems existing in nursing management to help nurses deal with the problems and solve the dilemma effectively. The total number of registered nurses in China exceeded 4.7 million in 2021, an increase of 1.46 million from 3.24 million in 2015, an increase of 45% (Deng et al., 2019 ]. However, there is still a large workload and underallocation of manpower, which may be due to the unreasonable distribution of human resources between time periods and departments. Hospitals and nursing managers can use the hospital information system to evaluate the nursing workload, and allocate nursing human resources reasonably according to the evaluation results (H. Yang et al., 2019 ), so as to avoid nurses falling into the dilemma of problem solving due to long-term overloaded work. In addition, it is necessary to create a harmonious departmental atmosphere for nurses, create a supportive departmental environment (Aghaei et al., 2020 ), and strictly ensure the safety of nurses’ practice and put an end to the occurrence of violence. Timely and strong organizational support can reduce the painful feelings of nurses caused by adverse events (Stone, 2020 ). and help them to solve problems actively.

Using new media to improve the image and credibility of nurses

There is a bias in social cognition of the profession of nurses, and some negative media reports mislead patients, resulting in social stereotypes of nurses (L. Q. Wang et al., 2021 ). It is necessary to make full use of new media to objectively introduce the nursing profession to the public, publicize outstanding nursing figures and typical deeds, make the public realize the important role of nurses in health care, and create an atmosphere of understanding and supporting nurses in the whole society to enhance the image and credibility of nurses and help nurses deal with problems and solve difficulties effectively (Falkenstrom, 2017 ).

Limitations and strengths of the study

The limitation is that the transferability of this study’s results may be limited as a result of including a small number of participants and the participants all worked in the same hospital in Shanghai. More participants in different cities and hospitals could have increased the variety of the descriptions and experiences. The strength is that the use of purposive sampling facilitated inclusion of participants from a range of demographic groups. The use of maximum variation strategy facilitated that the participants covered different gender, education level, professional title, marital status, seniority and department, which helped to increase the representativeness of sample.

Implications for practice

This study provides an in-depth exploration of the problem solving dilemmas of clinical nurses in China and provides valuable insights into the continuing education of nurses. These insights shine a light on areas that warrant further investigation and need to be improved in continuing education of nurses. It is of great significance to improve nurses’ problem-solving ability, improve nurses’ professional quality, effectively solve patients’ medical treatment and health problems, and improve patients’ experience of seeking medical treatment.

Through the semi-structured interview, it is found that the problem-solving dilemma of clinical nurses is affected by many factors. Nurses themselves should be confident, self-improvement, constantly learning and enterprising to improve their own ability, and be good at using new media to improve nurses’ image and credibility. Hospitals, nursing administrators and nursing educators should take corresponding measures to improve the knowledge structure of nurses, cultivate nurses’ positive professional values and adaptability, and give full organizational support to nurses. optimize the allocation of nursing human resources to provide a strong guarantee for nurses to deal with problems solving dilemma.

Biographies

Yu Mei Li : associate chief nurse, master degree, master supervisor, engaged in nursing of tumor patients.

Yifan Luo : nurse, master degree, engaged in clinical nursing.

Funding Statement

This work was supported by the Graduate Education Research and Reform Education Management program of Tongji University [2021YXGL09].

Disclosure statement

No potential conflict of interest was reported by the author(s).

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A3 Methodology

Purpose  A3 problem solving is part of the Lean management approach to quality improvement (QI). However, few tools are available to assess A3 problem-solving skills. The authors sought to develop an assessment tool for problem-solving A3s with an accompanying self-instruction package and to test agreement in assessments made by individuals who teach A3 problem solving.

Methods  After reviewing relevant literature, the authors developed an A3 assessment tool and self-instruction package over five improvement cycles. Lean experts and individuals from two institutions with QI proficiency and experience teaching QI provided iterative feedback on the materials. Tests of inter-rater agreement were conducted in cycles 3, 4 and 5. The final assessment tool was tested in a study involving 12 raters assessing 23 items on six A3s that were modified to enable testing a range of scores.

Results  The intraclass correlation coefficient (ICC) for overall assessment of an A3 (rater’s mean on 23 items per A3 compared across 12 raters and 6 A3s) was 0.89 (95% CI 0.75 to 0.98), indicating excellent reliability. For the 20 items with appreciable variation in scores across A3s, ICCs ranged from 0.41 to 0.97, indicating fair to excellent reliability. Raters from two institutions scored items similarly (mean ratings of 2.10 and 2.13, p=0.57). Physicians provided marginally higher ratings than QI professionals (mean ratings of 2.17 and 2.00, p=0.003). Raters averaged completing the self-instruction package in 1.5 hours, then rated six A3s in 2.0 hours.

Conclusion  This study provides evidence of the reliability of a tool to assess healthcare QI project proposals that use the A3 problem-solving approach. The tool also demonstrated evidence of measurement, content and construct validity. QI educators and practitioners can use the free online materials to assess learners’ A3s, provide formative and summative feedback on QI project proposals and enhance their teaching.

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5 Alarming Administrative Problems in Healthcare and How to Solve Them

Discover 5 healthcare industry challenges in 2024. From managing crises to enhancing data security, learn how experts are tackling these critical issues.

As we emerge from the shadows of the COVID-19 pandemic, the healthcare industry stands at a crucial crossroads. The past years have not only tested our resilience but have also brought to light a spectrum of administrative challenges that continue to shape our healthcare system today. From the intense pressures once faced by frontline workers to systemic issues that have long simmered beneath the surface, the pandemic has left an indelible mark, reshaping our approach to healthcare management.

Now, in this post-pandemic era, we seize the opportunity to transform challenges into catalysts for change. We reached out to l eading experts in the healthcare field to answer a critical question: What are some of the top problems related to healthcare and hospital management? (Because management performance is our domain.)

What you're about to read is a compilation of their responses, along with some insights we’ve gained after partnering with healthcare organizations over the years to improve their operations. In no way is this intended to be an article on how to solve healthcare problems, but rather a way to contribute more voices to the conversation to make things better.

1. Lack Of Real-time Situation Management

In an era where healthcare crises have evolved from rare occurrences to frequent challenges, the ability to manage situations in real-time has become indispensable. The past years, marked by public health emergencies like COVID-19, have underscored this reality more than ever. Terry Zysk, CEO of LiveProcess , highlights a crucial aspect of modern healthcare management: using real-time data analysis to understand how an event is unfolding, and reacting to it accordingly . This approach is critical in understanding and responding to unfolding events, ensuring that vital healthcare resources reach where they are needed most, precisely when they are needed.

The crux of the issue lies in the limitations of current healthcare management systems. Many hospitals cannot provide real-time metrics essential for swift and effective decision-making. Imagine the impact of knowing the availability of beds in a facility at any given moment or pinpointing the exact location of critical supplies during emergencies.

To bridge this gap, several software products have been built to help gather real-time metrics, including situation management-specific platforms like LiveProcess.

‍ClearPoint is another option that takes a more holistic view of situation management from a strategy perspective. This software has been used by many organizations to automatically track and report on healthcare metrics, including number of cases, response rates, quantity of resources, etc. You can use that data to respond appropriately to crises and make sure those decisions continue to support your overall strategy.

Wondering what metrics other healthcare organizations are tracking to improve performance? Download this free list of 108 healthcare KPIs to help get your facility on the right track.

2. ineffective internal communication.

Communication among and within healthcare institutions—and even with other external stakeholders—continues to be a challenge. The stakes are high: studies reveal that hospitals lose a staggering $12 billion annually due to poor communication, often due to aging technologies, silos between departments, and other issues. Poor internal communication has even been linked with the quality of patient care , highlighting an urgent need for a robust communication framework.

For hospitals, there is a need to communicate with both internal and external audiences about things like safety precautions, test availability, PPE supplies, etc. However, the challenge of internal communication transcends beyond crises. In the day-to-day rhythm of healthcare operations, the ability to seamlessly share information and data across departments is fundamental. It empowers teams, fosters collaboration, and propels strategic initiatives forward.

ClearPoint makes communication and knowledge-sharing simpler and more organized. It provides transparency around your organization’s direction and mission and encourages all employees to take ownership of projects, increasing employee engagement. It can also help you communicate with outside stakeholders using external dashboards that convey crucial information, similar to the one for a municipality shown below.

3. Lack Of System Interoperability

Another major challenge identified by several healthcare providers is the lack of interoperability across health technology systems. Susan G. Bornstein , MD, MPH points out that, without a national healthcare database in place, “medical providers in one office or healthcare system are precluded from seeing a patient's information in another system to the detriment of the patient. For example, a patient may forget some of their medication allergies, what tests they had performed, exactly what surgery was done when, who they saw for what—all of which is critical information for rendering the current episode of care.”

Echoing this sentiment, Kristy Dalechek of Haven Healthcare Advocates agrees that interoperability issues make it harder to identify patients’ medical problems and their solutions . “Electronic health records were supposed to be the answer, but our healthcare system is even more fragmented now. Even if all of your doctors and specialists are in the same network and use the same EHR, they may not have your entire health record and history.”

This lack of system interoperability is a barrier to elevating healthcare quality and efficiency. It's a puzzle that, if solved, could streamline care delivery and reduce costs significantly. Forward-thinking solutions are on the horizon, with emerging technologies like machine learning and blockchain offering glimmers of hope, though their practical applications have yet to be determined.

The journey to achieving true interoperability in healthcare is complex, but the vision is clear: a future where every piece of medical information is just a click away, ensuring that every patient receives the most informed and holistic care possible.

4. Information Overload

Picture this: hospital workers, administrators, and clinicians drowning in an ocean of test results, patient records, and administrative data. The scenario is all too common – sifting through hundreds of pages, analyzing tens of thousands of data points, all in the quest for that crucial piece of information. This is the reality of information overload in healthcare , a challenge as critical as any medical condition.

Whether that information is generated by medical devices or lab tests, or used for patient care or administrative purposes, data overload is undeniably a problem across all types of healthcare organizations. The key to unlocking the power of this data lies in technology – smart, intuitive, and efficient.

Healthcare organizations should look for advanced solutions that support:

• Easy Information Gathering —Look for software that automatically imports data from multiple sources and departments and brings it together in one place. The fewer tools you need to interact with, the better.
• Real-Time Data Updates —When someone in another department or division updates a data point, all users should be able to see the change happen in real time. That way, everyone’s working with the same information.
• Clear Data Visualization —Visualizing data makes it easier to consume, so look for a tool that has a variety of chart and graph options.
• Simple Reporting —The days of manual, time-consuming reporting are over. The future belongs to software solutions that automate report generation and distribution, saving precious time and resources.

If you’re looking for a solution that makes sense of your organization’s data about performance improvement, check out ClearPoint. If you need a tech solution to address other data challenges—like managing patient information, for example—you might be better off searching for software that addresses those technology issues in healthcare more specifically.

5. Data Security

Another challenge mentioned by multiple respondents was data security. A startling statistic brings this into sharp focus: from 2009 to 2020, an astonishing 70% of the U.S. population was impacted by healthcare data breaches—a trend that isn’t likely to go away.

Compared to other industries, the healthcare industry is relatively unprepared for cyber attack s. Raymond Dacillo, Director of Operations at C-Care Health Services , paints a concerning picture: “due to limited funding and budgetary constraints, many healthcare providers have become increasingly easy targets for attackers, who exploit their vulnerabilities.”

The rapid adoption of digital health initiatives, such as telehealth services, has inadvertently widened the attack surface, making data breaches more frequent and severe. As more healthcare functions continue to move online, it’s essential to ensure these processes are protected.

Dacillo believes the healthcare industry needs government funding to strengthen its IT resources. However, there's also an immediate need for healthcare organizations to take proactive steps. Key measures include:

• Educating Healthcare Staff : Empowering healthcare professionals with knowledge and best practices in data security is the first line of defense against breaches.
• Restricting Data Access : Implementing stringent access controls ensures that sensitive data is only available to authorized personnel.
• Implementing Data Usage Controls : Monitoring and regulating how data is used within the organization can significantly reduce the risk of internal breaches.

These practices are essential strategies in safeguarding the lifeblood of healthcare – patient data. You can read about some essential data security practices here.

How Strategy Management Software Can Help Revolutionize Hospital Operations

From real-time situation management to data security, the hurdles faced by healthcare organizations are multifaceted. However, the solution may lie in a powerful ally: strategy management software . Among the leaders in this technology is ClearPoint Strategy, a tool designed to empower healthcare organizations to navigate and thrive amidst these complexities.

ClearPoint Strategy also enhances hospital performance in several key areas:

• Hospital Star Ratings: ClearPoint Strategy helps improve ratings by aligning hospital operations with key performance areas like patient care and satisfaction.
• Revenue Cycle Management: The software streamlines billing and administrative processes, enhancing financial health through efficient revenue management.
• Value-Based Pricing: It aids in implementing value-based pricing by analyzing patient outcomes and aligning pricing strategies with care quality.
• Quality Improvement: ClearPoint Strategy supports systematic quality improvement by facilitating data-driven decision-making and tracking performance improvements.
• HEDIS Measures: The tool assists in tracking and improving healthcare quality and effectiveness, aligning hospital performance with HEDIS standards.

Read our blog on 5 Strategy Management Software Use Cases in Healthcare for a comprehensive exploration of how healthcare project management software, particularly ClearPoint Strategy, can revolutionize hospital operations and patient care.

Optimize Your Healthcare Operations in 2024: Book a ClearPoint Demo Now!

Certainly, the healthcare landscape is riddled with more challenges than we've explored today. But every problem presents an opportunity for a solution. If your organization is grappling with issues in strategic planning, reporting, or project management, we're here to assist. Book a demo and connect with us for a tailored approach that not only addresses your specific healthcare challenges but also propels you toward achieving and surpassing your goals.

Let's collaborate to turn these challenges into milestones of success for your organization!

Ted Jackson

Ted is a Founder and Managing Partner of ClearPoint Strategy and leads the sales and marketing teams.

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Problem solving in health services organizations

Affiliation.

• 1 College of Business Administration, University of Akron, OH, USA.
• PMID: 10158720
• DOI: 10.1080/00185868.1996.11736053

Health services organization managers at all levels are constantly confronted with problems. Conditions encountered that initiate the need for problem solving are opportunity, threat, crisis, deviation, and improvement. A general problem-solving model presenting an orderly process by which managers can approach this important task is described. An example of the model applied to the current strategic climate is presented.

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• Electronic managed care: the utilization of information technology in a managed care environment. Kiel JM. Kiel JM. Health Care Manag (Frederick). 2003 Jan-Mar;22(1):16-20. doi: 10.1097/00126450-200301000-00003. Health Care Manag (Frederick). 2003. PMID: 12688607
• Applied research as a problem-solving tool: strengthening the interface between health management and research. Brownlee AT. Brownlee AT. J Health Adm Educ. 1986 Winter;4(1):31-44. J Health Adm Educ. 1986. PMID: 10276336
• Managed care and total quality management: a necessary integration. Phoon J, Corder K, Barter M. Phoon J, et al. J Nurs Care Qual. 1996 Jan;10(2):25-32. doi: 10.1097/00001786-199601000-00005. J Nurs Care Qual. 1996. PMID: 8562986 Review.
• Patrolling the turbulent borderland: managerial strategies for a changing health care environment. Burns M, Mauet AR. Burns M, et al. Health Care Manage Rev. 1989 Winter;14(1):7-12. doi: 10.1097/00004010-198901410-00002. Health Care Manage Rev. 1989. PMID: 2647671 Review.
• Analyzing the health care environment: "You can't hit what you can't see". Ginter PM, Duncan WJ, Richardson WD, Swayne LE. Ginter PM, et al. Health Care Manage Rev. 1991 Fall;16(4):35-48. Health Care Manage Rev. 1991. PMID: 1743962
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Innovations in Teamwork for Health Care

Don’t leave teaming up to chance. Create better teamwork through science.

In this course, experts from Harvard Business School and the T.H. Chan School of Public Health teach learners to implement a strategy for organizational teamwork in health care.

What You'll Learn

Health care is a team effort. From the front desk administrators to the nurses, doctors, insurers, and even the patients and their families, there are many people involved in an individual’s care. To deliver quality care in today’s fast-paced environment, practitioners and caregivers must go beyond medical problem-solving and rely on effective collaboration and communication skills.

While other businesses may organize around a functional area or project, allowing team members to learn each other's working styles and strengths over time, health care workers often find themselves in ad hoc scenarios, coordinating with near-strangers on life and death situations. As a leader, how do you encourage trust and meet shared goals when teams are formed quickly? How do you strengthen flexibility and collaboration even as team membership and structures fluctuate across departments? 

In Innovations in Teamwork for Health Care, leaders in the field of organizational behavior and teamwork, Amy Edmondson, Professor at Harvard Business School, and Michaela Kerrissey, Assistant Professor at the Harvard T.H. Chan School of Public Health, share their latest research and present their concept of "teaming" as it relates to the health care and life science industries.

In this course, you will explore the complexities of collaboration in dynamic cross-functional teams and its impact on quality of care. You will examine the theory of teaming – where individuals join together to lend their expertise – to appreciate what enables effective teamwork and why teamwork fails; articulate the importance of psychological safety and a joint problem-solving orientation; understand the particular needs of time-limited teams; and rethink the role of hierarchy and leadership in the context of teaming.

You’ll hear firsthand from experts with experience inside and outside the health care industry, from CEO and President of the Cleveland Clinic, Tomislav Mihaljevic, to Andres Sougarret, the engineer who led the miraculous rescue of 33 Chilean miners in 2011. 

Ultimately, this course provides you with the tools needed to implement effective teaming strategies for patient-centered care and provides your organization with a framework to empower robust communication, improve efficiency, and elevate patient safety.

The course will be delivered via  HBS Online’s course platform  and immerse learners in real-world examples from experts at industry-leading organizations. By the end of the course, participants will be able to:

• Explore the science of teamwork, focusing on the psychological and sociological aspects of teaming, collaboration, and defining effective outcomes.
• Understand the complexity of building trust in ad hoc teams, including how to define purpose, build trust, and navigate interpersonal risks to reach common goals.
• Apply communication strategies that encourage psychological safety and create a safe space for all to contribute.
• Understand the value in adopting a model of joint problem-solving for patient care.
• Identify the distinct needs of time-limited project teams and how to incorporate effective and transparent feedback loops.
• Ensure accountability and identify leaders, breaking down hierarchy and encouraging the right person to step up at the right time.
• Implement a PDSA (Plan, Do, Study, and Act) framework for your organization.

Continuing Education Credits

In support of improving patient care, Harvard Medical School is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education.

The Harvard Medical School designates this enduring material for a maximum of 20 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Harvard Medical School is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

This activity is approved for 20.00 contact hours. Contact hours are awarded commensurate with participation and completion of the online evaluation and attendance attestation. We suggest claiming your hours within 30 days of the activity date, after this time, the attendance attestation will still be required to claim your hours. 

Groups of 10 or more receive Amy Edmondson's latest book!

A free, hard copy of right kind of wrong: the science of failing well for each participant. .

Your Instructors

Amy C. Edmondson  is the Novartis Professor of Leadership and Management at Harvard Business School, a chair established to support the study of human interactions that lead to the creation of successful enterprises that contribute to the betterment of society. She has pioneered the concept of psychological safety for over 20 years and was recognized in 2021 as #1 on the Thinkers50 global ranking of management thinkers. 

She is the author of Teaming: How Organizations Learn, Innovate, and Compete in the Knowledge Economy (2012), The Fearless Organization: Creating Psychological Safety in the Workplace for Learning, Innovation, and Growth (2018), and Right Kind of Wrong: The Science of Failing Well (2023).

Michaela Kerrissey  is an Assistant Professor of Management at the Harvard T.H. Chan School of Public Health. She conducts research on how teams and organizations innovate, integrate, and perform, with a focus on health care.   Dr. Kerrissey has authored over 30 publications on these topics and has won numerous best-paper awards, such as from the Academy of Management. She designed the Management Science for a New Era course at Harvard’s School of Public Health. In 2023, she was listed on Thinkers50 Radar, a global listing of top management thinkers.

Real World Case Studies

Affiliations are listed for identification purposes only.

Tomislav Mihaljevic, MD

Learn from the President and CEO of the Cleveland Clinic about how to implement joint problem solving in complex care organizations.

Maya Rupert

Hear from a top political strategist and campaign manager about how she leads within a teaming structure.

Trishan Panch, MD, MPH

Learn from Harvard faculty and founder of Wellframe about the importance of team learning.

Available Discounts and Benefits for Groups and Individuals

Experience Harvard Online by utilizing our wide variety of discount programs for individuals and groups. 

Past participant discounts.

Learners who have enrolled in at least one qualifying Harvard Online program hosted on the HBS Online platform are eligible to receive a 30% discount on this course, regardless of completion or certificate status in the first purchased program. Past Participant Discounts are automatically applied to the Program Fee upon time of payment.  Learn more here .

Learners who have earned a verified certificate for a HarvardX course hosted on the  edX platform  are eligible to receive a 30% discount on this course using a discount code. Discounts are not available after you've submitted payment, so if you think you are eligible for a discount on a registration, please check your email for a code or contact us .

Nonprofit, Government, Military, and Education Discounts

For this course we offer a 30% discount for learners who work in the nonprofit, government, military, or education fields. 

Eligibility is determined by a prospective learner’s email address, ending in .org, .gov, .mil, or .edu. Interested learners can apply below for the discount and, if eligible, will receive a promo code to enter when completing payment information to enroll in a Harvard Online program. Click here to apply for these discounts.

Gather your team to experience Innovations in Teamwork for Health Care and other Harvard Online courses to enjoy the benefits of learning together: 

• Single invoicing for groups of 10 or more
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Learn more and enroll your team ! 

Course Syllabus

Learning requirements: There are no prerequisites required to enroll in this course. In order to earn a Certificate of Completion from Harvard Online and Harvard Business School Online, participants must thoughtfully complete all 5 modules, including satisfactory completion of the associated assignments, by stated deadlines.

Download Full Syllabus

• Study the Mining Accident Rescue and Cleveland Clinic cases.
• Understand the concept of teaming and how it can be applied to the health care industry.
• Brainstorm how to organize with a team to rescue 33 trapped miners.
• Analyze the problems solved and new challenges created by organizational structures that were implemented to facilitate teamwork at the Cleveland Clinic.
• Outline and analyze an individualized teaming breakdown for your organization. 
• Study the NASA and Google cases on psychological safety.
• Collaborate with team members and leadership to create a space of psychological safety. 
• Identify the indicators of psychological safety in a group. Analyze data from Project Aristotle’s study of teams at Google.
• Consider how past experiences can affect current feelings of psychological safety.
• Study the Cleveland Clinic ,  Boehringer Ingelheim , and  Cincinnati Children’s Hospital Medical Center cases.
• Implement a joint problem-solving orientation in which team members view problems as shared and solutions as requiring collaboration.
• Match different types of diversity in the workplace with the interpersonal boundaries that they imply.
• Articulate what you bring to a team and what you might need from others.
• Walk down the ladder of inference to get to the root of a problem.
• Study the  Virginia Mason Medical Center and  Institute for Healthcare Improvement cases.
• Cultivate an organization where team learning is valued and mobilized for improved performance.  
• Identify different kinds of work on the process knowledge spectrum.
• Brainstorm how a nursing team could learn from an accidental morphine overdose.
• Study the cases of Julio Castro's Presidential Campaign and Wellframe . 
• Practice leadership skills that include coaching, enabling, and ensuring that the right voices are present or represented within the team structure. 
• Build a leadership workshop for your team using the concepts addressed in this course.
• Practice asking meaningful questions as a way to encourage input and express authentic humility.
• Learn the difference between confirmatory and exploratory responses.

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Addressing employee burnout: Are you solving the right problem?

The COVID-19 pandemic has accelerated and exacerbated long-standing corporate challenges to employee health and well-being , and in particular employee mental health. 1 When used in this article, “mental health” is a term inclusive of positive mental health and the full range of mental, substance use, and neurological conditions. This has resulted in reports of rapidly rising rates of burnout 2 When used in this article, “burnout” and “burnout symptoms” refer to work-driven burnout symptoms (per sidebar “What is burnout?”). around the world (see sidebar “What is burnout?”).

About the authors

This article is a collaborative effort by Jacqueline Brassey , Erica Coe , Martin Dewhurst, Kana Enomoto , Renata Giarola, Brad Herbig, and Barbara Jeffery , representing the views of the McKinsey Health Institute.

Many employers have responded by investing more into mental health and well-being than ever before. Across the globe, four in five HR leaders report that mental health and well-being is a top priority for their organization. 3 McKinsey Health Institute Employee Mental Health and Wellbeing Survey, 2022: n (employee) = 14,509; n (HR decision maker) = 1,389. Many companies offer a host of wellness benefits such as yoga, meditation app subscriptions, well-being days, and trainings on time management and productivity. In fact, it is estimated that nine in ten organizations around the world offer some form of wellness program. 4 Charlotte Lieberman, “What wellness programs don’t do for workers,” Harvard Business Review , August 14, 2019.

As laudable as these efforts are, we have found that many employers focus on individual-level interventions that remediate symptoms, rather than resolve the causes of employee burnout. 5 Anna-Lisa Eilerts et al., “Evidence of workplace interventions—A systematic review of systematic reviews,” International Journal of Environmental Research and Public Health , 2019, Volume 16, Number 19. Employing these types of interventions may lead employers to overestimate the impact of their wellness programs and benefits 6 Katherine Baicker et al., “Effect of a workplace wellness program on employee health and economic outcomes: A randomized clinical trial,” JAMA , 2019, Volume 321, Number 15; erratum published in JAMA , April 17, 2019. and to underestimate the critical role of the workplace in reducing burnout and supporting employee mental health and well-being. 7 Pascale M. Le Blanc, et al., “Burnout interventions: An overview and illustration,” in Jonathan R. B. Halbesleben’s Handbook of Stress and Burnout in Health Care , New York, NY: Nova Science Publishers, 2008; Peyman Adibi et al., “Interventions for physician burnout: A systematic review of systematic reviews,” International Journal of Preventive Medicine , July 2018, Volume 9, Number 1.

What is burnout?

According to the World Health Organization, burnout is an occupational phenomenon. It is driven by a chronic imbalance between job demands 1 Job demands are physical, social, or organizational aspects of the job that require sustained physical or mental effort and are therefore associated with certain physiological and psychological costs—for example, work overload and expectations, interpersonal conflict, and job insecurity. Job resources are those physical, social, or organizational aspects of the job that may do any of the following: (a) be functional in achieving work goals; (b) reduce job demands and the associated physiological and psychological costs; (c) stimulate personal growth and development such as feedback, job control, social support (Wilmar B. Schaufeli and Toon W. Taris, “A critical review of the job demands-resources model: Implications for improving work and health,” from Georg F. Bauer and Oliver Hämmig’s Bridging Occupational, Organizational and Public Health: A Transdisciplinary Approach , first edition, Dordrecht, Netherlands: Springer, 2014). (for example, workload pressure and poor working environment) and job resources (for example, job autonomy and supportive work relationships). It is characterized by extreme tiredness, reduced ability to regulate cognitive and emotional processes, and mental distancing. Burnout has been demonstrated to be correlated with anxiety and depression, a potential predictor of broader mental health challenges. 2 Previous meta-analytic findings demonstrate moderate positive correlations of burnout with anxiety and depression—suggesting that anxiety and depression are related to burnout but represent different constructs (Katerina Georganta et al., “The relationship between burnout, depression, and anxiety: A systematic review and meta-analysis,” Frontiers in Psychology , March 2019, Volume 10, Article 284). When used in this article, burnout does not imply a clinical condition.

Research shows that, when asked about aspects of their jobs that undermine their mental health and well-being, 8 Paula Davis, Beating Burnout at Work: Why Teams Hold the Secret to Well-Being and Resilience , Philadelphia, PA: Wharton School Press, 2021. employees frequently cite the feeling of always being on call, unfair treatment, unreasonable workload, low autonomy, and lack of social support. 9 Jennifer Moss, The Burnout Epidemic: The Rise of Chronic Stress and How We Can Fix It , Boston, MA: Harvard Business Review Press, 2021. Those are not challenges likely to be reversed with wellness programs. In fact, decades of research suggest that interventions targeting only individuals are far less likely to have a sustainable impact on employee health than systemic solutions, including organizational-level interventions. 10 Hanno Hoven et al., “Effects of organisational-level interventions at work on employees’ health: A systematic review,” BMC Public Health , 2014, Volume 14, Number 135.

Since many employers aren’t employing a systemic approach, many have weaker improvements in burnout and employee mental health and well-being than they would expect, given their investments.

Organizations pay a high price for failure to address workplace factors 11 Gunnar Aronsson et al., “A systematic review including meta-analysis of work environment and burnout symptoms,” BMC Public Health , 2017, Volume 17, Article 264. that strongly correlate with burnout, 12 Sangeeta Agrawal and Ben Wigert, “Employee burnout, part 1: The 5 main causes,” Gallup, July 12, 2018. such as toxic behavior. 13 The high cost of a toxic workplace culture: How culture impacts the workforce — and the bottom line , Society for Human Resource Management, September 2019. A growing body of evidence, including our research in this report, sheds light on how burnout and its correlates may lead to costly organizational issues such as attrition. 14 Caio Brighenti et al., “Why every leader needs to worry about toxic culture,” MIT Sloan Management Review, March 16, 2022. Unprecedented levels of employee turnover—a global phenomenon we describe as the Great Attrition —make these costs more visible. Hidden costs to employers also include absenteeism, lower engagement, and decreased productivity. 15 Eric Garton, “Employee burnout is a problem with the company, not the person,” Harvard Business Review , April 6, 2017.

The McKinsey Health Institute: Join us!

The McKinsey Health Institute (MHI) is an enduring, non-profit-generating global entity within McKinsey. MHI strives to catalyze actions across continents, sectors, and communities to achieve material improvements in health, empowering people to lead their best possible lives. MHI is fostering a strong network of organizations committed to this aspiration, including employers globally who are committed to supporting the health of their workforce and broader communities.

MHI has a near-term focus on the urgent priority of mental health, with launch of a flagship initiative around employee mental health and well-being. By convening leading employers, MHI aims to collect global data, synthesize insights, and drive innovation at scale. Through collaboration, we can truly make a difference, learn together, and co-create solutions for workplaces to become enablers of health—in a way that is good for business, for employees, and for the communities in which they live.

To stay updated about MHI’s initiative on employee mental health and well-being sign up at McKinsey.com/mhi/contact-us .

In this article, we discuss findings of a recent McKinsey Health Institute (MHI)  (see sidebar “The McKinsey Health Institute: Join us!”) global survey that sheds light on frequently overlooked workplace factors underlying employee mental health and well-being in organizations around the world. We conclude by teeing up eight questions for reflection along with recommendations on how organizations can address employee mental-health and well-being challenges by taking a systemic approach focused on changing the causes rather than the symptoms of poor outcomes. While there is no well-established playbook, we suggest employers can and should respond through interventions focused on prevention rather than remediation.

We are seeing persistent burnout challenges around the world

To better understand the disconnection between employer efforts and rising employee mental-health and well-being challenges (something we have observed  since the start of the pandemic ), between February and April 2022 we conducted a global survey of nearly 15,000 employees and 1,000 HR decision makers in 15 countries. 16 Argentina, Australia, Brazil, China, Egypt, France, Germany, India, Japan, Mexico, South Africa, Switzerland, Turkey, the United Kingdom, and the United States. The combined population of the selected countries correspond to approximately 70 percent of the global total.

The workplace dimensions assessed in our survey included toxic workplace behavior, sustainable work, inclusivity and belonging, supportive growth environment, freedom from stigma, organizational commitment, leadership accountability, and access to resources. 17 The associations of all these factors with employee health and well-being have been extensively explored in the academic literature. That literature heavily informed the development of our survey instrument. We have psychometrically validated this survey across 15 countries including its cross-cultural factorial equivalence. For certain outcome measures we collaborated with academic experts who kindly offered us their validated scales including the Burnout Assessment Tool (BAT), the Distress Screener, and the Adaptability Scale referenced below. Those dimensions were analyzed against four work-related outcomes—intent to leave, work engagement, job satisfaction, and organization advocacy—as well as four employee mental-health outcomes—symptoms of anxiety, burnout, depression, and distress. 18 Instruments used were the Burnout Assessment Tool (Steffie Desart et al., User manual - Burnout assessment tool [BAT ] , - Version 2.0, July 2020) (burnout symptoms); Distress Screener (4DSQ; JR Anema et al., “Validation study of a distress screener,” Journal of Occupational Rehabilitation , 2009, Volume 19) (distress); GAD-2 assessment (Priyanka Bhandari et al., “Using Generalized Anxiety Disorder-2 [GAD-2] and GAD-7 in a primary care setting,” Cureus , May 20, 2021, Volume 12, Number 5) (anxiety symptoms); and the PHQ-2 assessment (Patient Health Questionnaire [PHQ-9 & PHQ-2], American Psychological Association) (depression symptoms). Individual adaptability was also assessed 19 In this article, “adaptability” refers to the “affective adaptability” which is one sub-dimension of The Adaptability Scale instrument (Michel Meulders and Karen van Dam, “The adaptability scale: Development, internal consistency, and initial validity evidence,” European Journal of Psychological Assessment , 2020, Volume 37, Number 2). (see sidebar “What we measured”).

What we measured

Workplace factors assessed in our survey included:

• Toxic workplace behavior: Employees experience interpersonal behavior that leads them to feel unvalued, belittled, or unsafe, such as unfair or demeaning treatment, noninclusive behavior, sabotaging, cutthroat competition, abusive management, and unethical behavior from leaders or coworkers.
• Inclusivity and belonging: Organization systems, leaders, and peers foster a welcoming and fair environment for all employees to be themselves, find connection, and meaningfully contribute.
• Sustainable work: Organization and leaders promote work that enables a healthy balance between work and personal life, including a manageable workload and work schedule.
• Supportive growth environment: Managers care about employee opinions, well-being, and satisfaction and provide support and enable opportunities for growth.
• Freedom from stigma and discrimination: Freedom from the level of shame, prejudice, or discrimination employees perceive toward people with mental-health or substance-use conditions.
• Organizational accountability: Organization gathers feedback, tracks KPIs, aligns incentives, and measures progress against employee health goals.
• Leadership commitment: Leaders consider employee mental health a top priority, publicly committing to a clear strategy to improve employee mental health.
• Access to resources: Organization offers easy-to-use and accessible resources that fit individual employee needs related to mental health. 1 Including adaptability and resilience-related learning and development resources.

Health outcomes assessed in our survey included:

• Burnout symptoms: An employee’s experience of extreme tiredness, reduced ability to regulate cognitive and emotional processes, and mental distancing (Burnout Assessment Tool). 2 Burnout Assessment Tool, Steffie Desart et al., “User manual - Burnout assessment tool (BAT), - Version 2.0,” July 2020.
• Distress: An employee experiencing a negative stress response, often involving negative affect and physiological reactivity (4DSQ Distress Screener). 3 Distress screener, 4DSQ; JR Anema et al., “Validation study of a distress screener,” Journal of Occupational Rehabilitation , 2009, Volume 19.
• Depression symptoms: An employee having little interest or pleasure in doing things, and feeling down, depressed, or hopeless (PHQ-2 Screener). 4 Kurt Kroenke et al., “The patient health questionnaire-2: Validity of a two-item depression screener,” Medical Care , November 2003, Volume 41, Issue 11.
• Anxiety symptoms: An employee’s feelings of nervousness, anxiousness, or being on edge, and not being able to stop or control worrying (GAD-2 Screener). 5 Kurt Kroenke et al., “Anxiety disorders in primary care: Prevalence, impairment, comorbidity, and detection,” Annals of Internal Medicine , March 6, 2007, Volume 146, Issue 5.

Work-related outcomes assessed in our survey included:

• Intent to leave: An employee’s desire to leave the organization in which they are currently employed in the next three to six months.
• Work engagement: An employee’s positive motivational state of high energy combined with high levels of dedication and a strong focus on work.
• Organizational advocacy: An employee’s willingness to recommend or endorse their organization as a place to work to friends and relatives.
• Work satisfaction: An employee’s level of contentment or satisfaction with their current job.

Our survey pointed to a persistent disconnection between how employees and employers perceive mental health and well-being in organizations. We see an average 22 percent gap between employer and employee perceptions—with employers consistently rating workplace dimensions associated with mental health and well-being more favorably than employees. 20 Our survey did not link employers and employees’ responses. Therefore, these numbers are indicative of a potential gap that could be found within companies.

In this report—the first of a broader series on employee mental health from the McKinsey Health Institute—we will focus on burnout, its workplace correlates, and implications for leaders. On average, one in four employees surveyed report experiencing burnout symptoms. 21 Represents global average of respondents experiencing burnout symptoms (per items from Burnout Assessment Tool) sometimes, often, or always. These high rates were observed around the world and among various demographics (Exhibit 1), 22 Our survey findings demonstrate small but statistically significant differences between men and women, with women reporting higher rates of burnout symptoms (along with symptoms of distress, depression, and anxiety). Differences between demographic variables across countries will be discussed in our future publications. and are consistent with global trends. 23 Ashley Abramson, “Burnout and stress are everywhere,” Monitor on Psychology , January 1, 2022, Volume 53, Number 1.

So, what is behind pervasive burnout challenges worldwide? Our research suggests that employers are overlooking the role of the workplace in burnout and underinvesting in systemic solutions.

Employers tend to overlook the role of the workplace in driving employee mental health and well-being, engagement, and performance

In all 15 countries and across all dimensions assessed, toxic workplace behavior was the biggest predictor of burnout symptoms and intent to leave by a large margin 24 Measured as a function of predictive power of the dimensions assessed; predictive power was estimated based on share of outcome variability associated with each dimension; based on regression models applied to cross-sectional data (that is, measured at one point in time), rather than longitudinal data (that is, measured over time); causal relationships have not been established. —predicting more than 60 percent of the total global variance. For positive outcomes (including work engagement, job satisfaction, and organization advocacy), the impact of factors assessed was more distributed—with inclusivity and belonging, supportive growth environment, sustainable work, and freedom from stigma predicting most outcomes (Exhibit 2).

In all 15 countries and across all dimensions assessed, toxic workplace behavior had the biggest impact predicting burnout symptoms and intent to leave by a large margin.

The danger of toxic workplace behavior—and its impact on burnout and attrition

Across the 15 countries in the survey, toxic workplace behavior is the single largest predictor of negative employee outcomes, including burnout symptoms (see sidebar “What is toxic workplace behavior?”). One in four employees report experiencing high rates of toxic behavior at work. At a global level, high rates were observed across countries, demographic groups—including gender, organizational tenure, age, virtual/in-person work, manager and nonmanager roles—and industries. 25 Differences between demographic variables across countries will be discussed in our future articles.

What is toxic workplace behavior?

Toxic workplace behavior is interpersonal behavior that leads to employees feeling unvalued, belittled, or unsafe, such as unfair or demeaning treatment, non-inclusive behavior, sabotaging, cutthroat competition, abusive management, and unethical behavior from leaders or coworkers. Selected questions from this dimension include agreement with the statements “My manager ridicules me,” “I work with people who belittle my ideas,” and “My manager puts me down in front of others.”

Toxic workplace behaviors are a major cost for employers—they are heavily implicated in burnout, which correlates with intent to leave and ultimately drives attrition. In our survey, employees who report experiencing high levels of toxic behavior 26 “High” represents individuals in the top quartile of responses and “low” represents individuals in the bottom quartile of responses. at work are eight times more likely to experience burnout symptoms (Exhibit 3). In turn, respondents experiencing burnout symptoms were six times more likely to report they intend to leave their employers in the next three to six months (consistent with recent data pointing to toxic culture as the single largest predictor of resignation during the Great Attrition, ten times more predictive than compensation alone 27 Charles Sull et al., “Toxic culture is driving the Great Resignation,” MIT Sloan Management Review, January 11, 2022. and associated with meaningful organizational costs 28 Rasmus Hougaard, “To stop the Great Resignation, we must fight dehumanization at work,” Potential Project, 2022. ). The opportunity for employers is clear. Studies show that intent to leave may correlate with two- to three-times higher 29 Bryan Bohman et al., “Estimating institutional physician turnover attributable to self-reported burnout and associated financial burden: A case study,” BMC Health Services Research , November 27, 2018, Volume 18, Number 1. rates of attrition; conservative estimates of the cost of replacing employees range from one-half to two times their annual salary. Even without accounting for costs associated with burnout—including organizational commitment 30 Michael Leiter and Christina Maslach, “The impact of interpersonal environment on burnout and organizational commitment,” Journal of Organizational Behavior , October 1988, Volume 9, Number 4. and higher rates of sick leave and absenteeism 31 Arnold B. Bakker et al., “Present but sick: A three-wave study on job demands, presenteeism and burnout,” Career Development International , 2009, Volume 14, Number 1. —the business case for addressing it is compelling. The alternative—not addressing it—can lead to a downward spiral in individual and organizational performance. 32 Arnold B. Bakker et al., “Present but sick: A three-wave study on job demands, presenteeism and burnout,” Career Development International , 2009, Volume 14, Number 1.

Individuals’ resilience and adaptability skills may help but do not compensate for the impact of a toxic workplace

Toxic behavior is not an easy challenge to address. Some employers may believe the solution is simply training people to become more resilient.

There is merit in investing in adaptability and resiliency skill building . Research indicates that employees who are more adaptable tend to have an edge in managing change and adversity. 33 Karen van Dam, “Employee adaptability to change at work: A multidimensional, resource-based framework,” from The Psychology of Organizational Change: Viewing Change from the Employee’s Perspective , Cambridge, England: Cambridge University Press, 2013; Jacqueline Brassey et al., Advancing Authentic Confidence Through Emotional Flexibility: An Evidence-Based Playbook of Insights, Practices and Tools to Shape Your Future , second edition, Morrisville, NC: Lulu Press, 2019; B+B Vakmedianet B.V. Zeist, Netherlands (to be published Q3 2022). We see that edge reflected in our survey findings: adaptability acts as a buffer 34 Estimated buffering effect illustrated in Exhibit 4. to the impact of damaging workplace factors (such as toxic behaviors), while magnifying the benefit of supportive workplace factors (such as a supportive growth environment) (Exhibit 4). In a recent study, employees engaging in adaptability training experienced three times more improvement in leadership dimensions and seven times more improvement in self-reported well-being than those in the control group. 35 McKinsey’s People and Organization Performance - Adaptability Learning Program; multirater surveys showed improvements in adaptability outcomes, including performance in role, sustainment of well-being, successfully adapting to unplanned circumstances and change, optimism, development of new knowledge and skills; well-being results were based on self-reported progress as a result of the program.

However, employers who see building resilience and adaptability skills in individuals as the sole solution to toxic behavior and burnout challenges are misguided. Here is why.

Individual skills cannot compensate for unsupportive workplace factors. When it comes to the effect of individual skills, leaders should be particularly cautious not to misinterpret “favorable” outcomes (for example, buffered impact of toxic behaviors across more adaptable employees) as absence of underlying workplace issues that should be addressed. 36 Tomas Chamorro-Premuzic, “To prevent burnout, hire better bosses,” Harvard Business Review , August 23, 2019.

Also, while more adaptable employees are better equipped to work in poor environments, they are less likely to tolerate them. In our survey, employees with high adaptability were 60 percent more likely to report intent to leave their organization if they experienced high levels of toxic behavior at work than those with low adaptability (which may possibly relate to a higher level of self-confidence 37 Brassey et al. found that as a result of a learning program, employees who developed emotional flexibility skills, a concept related to affective adaptability but also strongly linked to connecting with purpose, developed a higher self-confidence over time; Jacqueline Brassey et al., “Emotional flexibility and general self-efficacy: A pilot training intervention study with knowledge workers,” PLOS ONE , October 14, 2020, Volume 15, Number 10. ). Therefore, relying on improving employee adaptability without addressing broader workplace factors puts employers at an even higher risk of losing some of its most resilient, adaptable employees.

Employees with high adaptability were 60 percent more likely to report intent to leave their organization if they experienced high levels of toxic behavior at work than those with low adaptability.

What this means for employers: Why organizations should take a systemic approach to improving employee mental health and well-being

We often think of employee mental health, well-being, and burnout as a personal problem. That’s why most companies have responded to symptoms by offering resources focused on individuals such as wellness programs.

However, the findings in our global survey and research are clear. Burnout is experienced by individuals, but the most powerful drivers of burnout are systemic organizational imbalances across job demands and job resources. So, employers can and should view high rates of burnout as a powerful warning sign that the organization—not the individuals in the workforce—needs to undergo meaningful systematic change.

Employers can and should view high rates of burnout as a powerful warning sign that the organization—not the individuals in the workforce—needs to undergo meaningful systematic change.

Taking a systemic approach means addressing both toxic workplace behavior and redesigning work to be inclusive, sustainable, and supportive of individual learning and growth, including leader and employee adaptability skills. It means rethinking organizational systems, processes, and incentives to redesign work, job expectations, and team environments.

As an employer, you can’t “yoga” your way out of these challenges. Employers who try to improve burnout without addressing toxic behavior are likely to fail. Our survey shows that improving all other organization factors assessed (without addressing toxic behavior) does not meaningfully improve reported levels of burnout symptoms. Yet, when toxic behavior levels are low, each additional intervention contributes to reducing negative outcomes and increasing positive ones.

The interactive graphic shows the estimated interplay between the drivers and outcomes, based on our survey data (Exhibit 5).

Taking a preventative, systemic approach—focused on addressing the roots of the problem (as opposed to remediating symptoms)—is hard. But the upside for employers is a far greater ability to attract and retain valuable talent over time.

The good news: Although there are no silver bullets, there are opportunities for leaders to drive material change

We see a parallel between the evolution of global supply chains and talent. Many companies optimized supply chains for “just in time” delivery, and talent was optimized to drive operational efficiency and effectiveness. As supply chains come under increasing pressure, many companies recognize the need to redesign and optimize supply chains for resilience and sustainability, and the need to take an end-to-end approach to the solutions. The same principles apply to talent.

We acknowledge that the factors associated with improving employee mental health and well-being (including organizational-, team-, and individual-level factors) are numerous and complex. And taking a whole-systems approach is not easy.

Would you like to learn more about the McKinsey Health Institute ?

Despite the growing momentum toward better employee mental health and well-being (across business and academic communities), we’re still early on the journey. We don’t yet have sufficient evidence to conclude which interventions work most effectively—or a complete understanding of why they work and how they affect return on investment.

That said, efforts to mobilize the organization to rethink work—in ways that are compatible with both employee and employer goals—are likely to pay off in the long term. To help spark that conversation in your organization, we offer eight targeted questions and example strategies with the potential to address some of the burnout-related challenges discussed in this article.

Do we treat employee mental health and well-being as a strategic priority?

This is fundamental to success. When a large organization achieved a 7 percent reduction in employee burnout rates (compared with an 11 percent increase in the national average within the industry over the same period), the CEO believed that leadership and sustained attention from the highest level of the organization were the “key to making progress.” 38 John H. Noseworthy and Tait D Shanafelt, “Executive leadership and physician well‐being: Nine organizational strategies to promote engagement and reduce burnout,” Mayo Clinic Proceedings , January 2017, Volume 92, Number 1. Senior executives recognized employee mental health and well-being as a strategic priority. Executives publicly acknowledged the issues and listened to employee needs through a wide range of formats—including town halls, workshops, and employee interviews (our research suggests that leaders are not listening to their people  nearly enough). They prioritized issues and defined clear, time-bound measurable goals around them—with a standardized measure of burnout being given equal importance to other key performance metrics (financial metrics, safety/quality, employee turnover, and customer satisfaction). Although anonymous at the level of the individual, results were aggregated at division/department level to allow executive leadership to focus attention and resources where they were most needed. 39 Liselotte Dyrbye et al., “Physician burnout: Contributors, consequences and solutions,” Journal of Internal Medicine , 2018, Volume 283, Number 6. This example highlights how CEOs have the ability to create meaningful change through listening to employees and prioritizing strategies to reduce burnout.

Do we effectively address toxic behaviors?

Eliminating toxic workplace behavior is not an easy task. Organizations that tackle toxic behavior effectively deploy a set of integrated work practices  to confront the problem, 40 Robert I. Sutton, The No Asshole Rule: Building a Civilized Workplace and Surviving One That Isn’t , first edition, New York, NY: Business Plus, 2010. and see treatment of others as an integral part of assessing an employee’s performance. Manifestations of toxic behavior 41 “Why every leader,” 2022. are flagged, repeat offenders either change or leave, and leaders take time  to become aware of the impact their behavior has on others. If you lead part of an organization, looking at your own behaviors, and what you tolerate in your own organization, is a good place to start. 42 “ Author Talks: How to handle your work jerk ,” March 29, 2022.

Leaders with higher self-regulation may be better, less toxic leaders

Research shows that leaders’ development of self-regulation increases followers’ ratings of their effectiveness and is associated with higher team financial performance as well as a higher final team grade compared with a control group. The benefits of self-regulation also improved leaders’ development of task-relevant competencies. 1 Robin Martin and JooBee Yeow, “The role of self-regulation in developing leaders: A longitudinal field experiment,” Leadership Quarterly , October 2013, Volume 24, Number 5. Furthermore, building employees’ resilience and adaptability  skills leads to a higher sense of agency and self-efficacy, 2 Jacqueline Brassey et al., “Emotional flexibility and general self-efficacy: A pilot training intervention study with knowledge workers,” PLOS ONE , October 14, 2020, Volume 15, Number 10; and Jacqueline Brassey et al., Advancing Authentic Confidence Through Emotional Flexibility: An Evidence-Based Playbook of Insights, Practices and Tools to Shape Your Future , second edition, Morrisville, NC: Lulu Press, 2019; B+B Vakmedianet B.V. Zeist, Netherlands (to be published Q3 2022). which is related to reduced burnout and improved performance. 3 Charles Benight et al., “Associations between job burnout and self-efficacy: A meta-analysis,” Anxiety, Stress, & Coping , 2016, Volume 29, Issue 4; and Alex Stajkovic, “Self-efficacy and work-related performance: A meta-analysis,” Psychological Bulletin , 1998, Volume 124, Number 2.

Another component of eliminating toxic behavior is cultivating supportive, psychologically safe work environments , where toxic behaviors are less likely to spread  across the organization. 43 Annie McKee, “Neutralize your toxic boss,” Harvard Business Review , September 24, 2008. Effective leaders know that emotional contagion 44 John T. Cacioppo et al., Emotional Contagion , Cambridge, England: Cambridge University Press, 1994. may go both ways: displaying vulnerability and compassion  fuels more compassionate teams; displaying toxic behavior fuels more toxic teams. 45 Michael Housman and Dylan Minor, Toxic workers , Harvard Business School working paper, No. 16-057, October 2015 (revised November 2015). There are two caveats: toxic behavior may not be intentional—particularly if individuals are not equipped to respond with calm  and compassion under pressure—and regardless of intent, toxic behavior spreads faster and wider than good behavior. 46 “To prevent burnout,” 2019. To prevent unintentional dissemination of toxic behaviors, role modeling from adaptable , self-regulating, compassionate leaders may help (see sidebar “Leaders with higher self-regulation may be better, less toxic leaders”).

Do we create inclusive work environments?

Most leaders recognize the established associations between performance and inclusion , but inclusion does not happen by accident . Inclusion is a multifaceted construct that must be addressed comprehensively and proactively. Most companies define inclusion too narrowly and thus address it too narrowly as well. Over the past three years, we’ve broadened our perspective  on how to create truly inclusive workplaces and developed a modern inclusion model . The model includes 17 practices (based on frequency of desired behaviors) and six outcomes (based on perceptions of effectiveness). Each practice falls into one of three relationships that shape workplace inclusion: organizational systems, leaders, and peers/teammates.

The 17 inclusive-workplace practices , when done consistently well, drive workplace inclusion and equity for all employees by providing clarity into actions that matter. For example, among employees working in hybrid models , work–life support was the top practice employees desired improvements on—with nearly half of employees recommending prioritizing policies that support flexibility—including extended parental leave, flexible hours, and work-from-home policies.

A truly inclusive workplace implements systems that minimize conscious and unconscious bias , allowing employees to express themselves and connect with each other. It also features leaders who not only advocate for team members and treat them impartially but also uphold and support all organizational systems and practices . For example, one employer defined data-driven targets for the representation and advancement of diverse talent across dimensions (beyond gender and ethnicity) and role types (executive, management, technical, board)—leveraging powerful analytics to track progress and foster transparency along the way.

Do we enable individual growth?

Evidence suggests that individual growth, learning, and development programs are effective 47 Arnold B. Bakker and Evangelia Demerouti, “Towards a model of work engagement,” Career Development International , 2008, Volume 13, Issue 3. ways to combat burnout and to retain and engage employees, and therefore are important for addressing growing talent and skills shortages within organizations. Employers who “double down” on talent redeployment, mobility, reskilling, and upskilling tend to see improvement across a range of financial, organizational, and employee experience metrics. In a recent study of extensive employee data, offering lateral career opportunities was two-and-half times more predictive of employee retention than compensation, and 12 times more predictive than promotions 48 “Why every leader,” 2022. —signaling an opportunity for leaders to support employee desires to learn, explore, and grow way beyond traditional career progression.

Investing in your employees’ capabilities can drive financial returns, is often cheaper than hiring, and signals to employees that they are valued and have an important role in the organization.

Do we promote sustainable work?

Promoting sustainable work goes beyond managing workload. It’s about enabling employees to have a sense of control and predictability, flexibility, and sufficient time for daily recovery. It’s also about leading with compassion and empathy 49 “It’s time to eliminate bad bosses. They are harmful and expensive,” Potential Project, The Human Leader, April 2022. —tailoring interventions based on where, when, and how work can be done , and how different groups are more likely to (re)establish socio-emotional ties  after a long period of isolation and loss of social cohesion .

One technology company is using real-time data on employee preferences to rapidly test and iterate solutions that work for specific groups around return-to-office options. To find solutions that work for your employees, consider adopting a test-and-learn  mindset. This approach can help the organization make progress while adapting as context evolves (a hallmark of more productive  organizations).

Are we holding leaders accountable?

Many organizations consider people leadership criteria in their performance management. Yet, there is substantial room to grow when it comes to employers providing transparency around employee mental-health and well-being objectives and metrics. 50 Workplace Mental Health Blogs , One Mind, “Fix performance management by aligning it with employee mental health,” blog entry by Daryl Tol, March 2, 2022; Garett Slettebak, “Measuring progress on workplace mental health”, One Mind at Work, March 24, 2022.

Organizations that are doing this well have set clear expectations for managers to lead in a way that is supportive of employee mental health and well-being. 51 Taylor Adams et al., Mind the workplace: Work health survey 2021 , Mental Health America, 2021. They offer training to help managers identify, proactively ask about, and listen to employees’ mental-health and well-being needs. They also introduce mental-health “pulse” checks and incorporate relevant questions into the broader employee satisfaction surveys, to establish a baseline and track trends in how employees are feeling. Discussion on employee mental health and well-being can be incorporated into regular leadership meetings, including concerns, risks, and potential actions.

To encourage leaders to lead by example and increase their accountability, some employers embed employee mental-health support into leaders’ reviews based on anonymous upward feedback from their teams. Finally, some companies are exploring if they can go even further and tie incentives to short- and long-term employee mental-health and well-being objectives.

Are we effectively tackling stigma?

As noted in a previous McKinsey article , the majority of employers and employees acknowledge the presence of stigma 52 In the context of employee mental health, stigma is defined as a level of shame, prejudice, or discrimination toward people with mental-health or substance-use conditions. in their workplaces. Stigma has been shown to have real costs to workforce productivity, often exacerbating underlying conditions because of people being afraid to seek help for mental-health needs and driving down an employee’s self-worth and engagement.

We see several actions that organizations are taking to eliminate stigma. 53 Erica Coe, Jenny Cordina, Kana Enomoto, and Nikhil Seshan, “ Overcoming stigma: Three strategies toward better mental health in the workplace ,” July 23, 2021. Leading by example can make a difference, with senior leaders stepping forward to describe personal struggles with mental health, using nonstigmatizing language. 54 Evelien Brouwers et al., “To disclose or not to disclose: A multi-stakeholder focus group study on mental health issues in the work environment. Journal of Occupational Rehabilitation , 2020, Volume 30, Number 1. Leaders showing vulnerability helps to remove shame and promote a psychologically safe culture. 55 Global thriving at work framework , MindForward Alliance, 2020.

Stigma can also be reduced by companies prioritizing mental wellness as critical for peak performance instead of rewarding overwork at the expense of rest and renewal—rewarding an “athlete” mindset instead of overemphasizing a “hero.” This can begin to shift perception of signs of burnout or other mental-health needs as being indicative of a moral failing. Finally, creating a dedicated role to support employee mental health and well-being and appointing a senior leader, such as chief wellness officer, will increase awareness and show commitment.

Do our resources serve employee needs?

Leaders should evaluate whether mental-health and well-being resources are at parity with physical-health benefits and how frequently they are being used by employees. An increasing number of employers have expanded access to mental-health services 56 Charles Ingoglia, “Now more than ever, employers must provide mental health support for employees,” National Council for Mental Wellbeing, May 4, 2022. ; however, research  shows that almost 70 percent of employees find it challenging to access those services.

In a previous survey , 45 percent of respondents who had left their jobs cited the need to take care of family as an influential factor in their decision (with a similar proportion of respondents who are considering quitting also citing the demands of family care). Expanding childcare, nursing services, or other home- and family-focused benefits could help keep such employees from leaving and show that you value them. Patagonia, long the standard-bearer for progressive workplace policies, retains nearly 100 percent of its new mothers with on-site childcare and other benefits for parents.

Never in history have organizations around the world devoted so much attention and capital to improving employee mental health and well-being. It is lamentable that these investments are not always providing a good return regarding improved outcomes. Employers that take the time to understand the problem at hand—and pursue a preventative, systemic approach focused on causes instead of symptoms—should see material improvements in outcomes and succeed in attracting and retaining valuable talent. More broadly, employers globally have an opportunity to play a pivotal role in helping people achieve material improvements in health. With collaboration and shared commitment, employers can make a meaningful difference in the lives of their employees and the communities they live in.

The McKinsey Health Institute (MHI) is collaborating with leading organizations around the world to achieve material improvements in health—adding years to life and life to years. As part of that, MHI is focused on improving employee mental health and well-being at scale—in a way that is good for business, for employees, and for the communities they live in.

To stay updated about MHI’s initiative on employee mental health and well-being, sign up at McKinsey.com/mhi/contact-us .

Jacqueline Brassey is a director of research science in McKinsey’s Luxemburg office, Erica Coe is a partner in the Atlanta office, Martin Dewhurst is a senior partner in the London office, Kana Enomoto is a senior expert in the Washington, DC, office, and Barbara Jeffery is a partner in the London office; they are all leaders with McKinsey Health Institute (MHI). Renata Giarola , in the Southern California office, and Brad Herbig , in the Philadelphia office, are consultants with MHI.

The authors wish to thank Yueyang Chen, Elena Chit, Aaron de Smet, Soheil Eshghi, Lars Hartenstein, Tom Latkovic, David Mendelsohn, Roxy Merkand, Isidora Mitic, Bill Schaninger, Wilmar Schaufeli, Jeris Stueland, Berend Terluin, Karen van Dam, and Marieke van Hoffen for their contributions to this article.

This article was edited by Allan Gold, a senior editorial advisor in Washington, DC, and Elizabeth Newman, an executive editor in the Chicago office.

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Home — Essay Samples — Nursing & Health — Nursing Practice — Characteristics of a Good Nurse Sample

Characteristics of a Good Nurse Sample

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Compassion: the heart of nursing, critical thinking and problem-solving skills, effective communication: building trust and collaboration, adaptability and flexibility: thriving in a dynamic environment.

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