Primary versus tertiary interventions: nursing case study

In this week’s blog, we’ve taken a perspective on primary versus tertiary intervention strategies. Often, management and leaders at work only begin to feel the strain of staff leaving, money shortages and management issues when the ‘backs are already at the wall’. Secondary and tertiary means are often used in an attempt to ease the strain on employees. Even a primary intervention of using extra, or agency, staff to fill gaps is often seen as a ‘quick fix’. However, unless there is a willingness to tackle the primary causes of stress, the sustainability of this adjunct approach is not good in a longer-term plan.

We’ve taken a stance this week to look at a good personification of this issue – with a lack of nurses in the private and public sector. Below is a case-study on the management of such issues in the workplace, but without truly addressing the primary issues arising from the shortage of healthcare specialists.

In Britain the shortage of nurses has reached disastrous levels, with some large bodies like the RCN calling the disaster a ‘national emergency’. This news comes as university applications for nursing degrees are at an all-time low, with almost 17,000 less applications in 2018. Clearly, there is a disconnect between the ambitious career and the reality of the jobs – with some major causes of stress relevant to nurses including emotional trauma, poor pay and long hours. But it doesn’t end there – a lack of cohesion with team members can occur due to the coming and going of agency staff, alongside changes in roles for care team members. In careers like this, the impact of the job on the staff’s life often causes poor mental health and self-neglect, leading to a new flurry of secondary and tertiary interventions such as health promotion for weight control and exercise, or counselling for those already at the point of burnout - but does it work?

Something seen often in healthcare companies is the strategy of taking on agency staff to give a brief relief of pressure to staff. But the issue isn’t always addressed by employing more staff – indeed, this can confound the issue by taking vital resources away from sorting out the direction of issues towards more training and ‘rehabilitation’ of old working practices. A solution we have used to great effect here at Working Well involves working at three levels within an organisation to identify the systemic, team and individual issues in order to create a strategy that not only provides management solutions for each level, but engages employees in the process. This approach tackles issues from systemic through individual, providing a more holistic overview of the challenges and allowing a greater harmony between management and employees all working towards sustainable resilience, engagement and performance.

In building resilient cultures, working across all three layers of an organisation is imperative. By obtaining an overview of an organisation, management are able to focus on what is working well and not so well in each area of the business, emphasise learning opportunities for other departments, as well as local teams and managers greater autonomy in their working processes to make necessary improvements. A primary intervention can integrate staff, and with their own autonomy may develop a better sense of belonging to their team, where their efforts are valued and recognised. This directly leads on to staff feeling more appreciated and thus more likely to willingly offer their discretionary effort, once again, something which tends to fade when dissatisfaction, frustration or stress occur. Indeed, it is these discretionary efforts which are often key to excellence within a business, but often the first thing to stop when the pressure is on.

At Working Well, our consultancy service supports leaders and managers in the development of effective long-term wellbeing strategies, alongside upskilling management to create sustainable high-performance teams. Often seen in times of financial pressure, a knee-jerk mechanism to save money is to lay-off staff. However, this can cause issues across the business in relation to staff insecurities, lack of trust and ultimately a lack of engagement – impacting the bottom line negatively. We always advise addressing the root cause of stress or imbalance in teams, but as with our nursing example – it is never as simple as a primary intervention.

Truly, a working strategy requires all levels of intervention to adequately address issues of stress and disengagement, to enable changes in a timely fashion, in response to business demands. Furthermore, constant training and counselling of employees is often a mask and often delays the inevitable – too big a demand with too little staff resulting in poor performance, burnout and reduced services. Indeed, archaic mechanisms may be in place which, in some organisations, can be resistant to change, or may never change at all. In the context of interventions, the ‘clip-on’ of secondary and tertiary interventions may be the only options, but instead should be used as part of a wider strategy to create a sustainable, high-performance culture.