Culture, management and the impact on safety

October 13, 2020
by Sean Ruck, Contributing Editor
Cheryl Turner is the director of global education and training at Legion Healthcare Partners. She’s also a radiation therapist with more than 30 years’ experience and holds a doctorate in education. In other words, she’s had the opportunity to see a lot of the good and not so good that can happen in oncology and healthcare in general.

Turner has extensively researched some of those problems, with that research highlighting things like strong and weak management, positive and negative work cultures, employee burnout and how those factors impact each other.

Each of those issues can have a very direct impact on staff and patient safety and while the solutions are clear, being able to incorporate and implement sustainable solutions can be difficult.

When it comes to those managing radiation oncology departments, many have experience either as radiation therapists or some other connection to the radiologic sciences. Other managers come from outside the profession, some with healthcare-related experience and others with none, Turner says.

So that’s a good start. The people directly managing those on the front lines are able to empathize and mentor. However, the buck doesn’t stop with them, and in fact, it’s those keeping their eyes on the bucks — the finance directors one or two levels further up — that may be managing some aspects that prove to be difficult in managing, without having a similar frame of reference.

It’s for that reason that an effective radiation oncology manager doesn’t just have the clinical knowledge and experience regarding the work their staff does, but also has strong communication skills, the ability to adapt, integrity, the ability to absorb and translate orders from on high and a little bit of professional and personal fortitude. All those attributes serve well for working with staff, but they potentially pay off in even greater ways when interacting with the upper tier leadership.

“At the end of the day, your main goal is to provide high-quality, safe patient care,” says Turner. “To do that, you need to take care of your employees and have the strength of character to not just stand up for your patients, but your providers/staff as well.”

While Turner is a strong advocate for formal education, she isn’t adamant about it being required in order to be a good leader. Just as having a certain management title doesn’t directly translate to an individual being good at that work, having a degree doesn’t necessarily make someone an expert in that field. “There are some very good leaders who may have a bachelor’s degree, but also 20 years’ experience. That experience has given them a very important education in being a leader. It’s probably as important if not more important than the formal education in many cases.”

Mentors are also important, but maybe not how you’d think. Yes, a great leader can develop a great leader, but Turner points out that a poor leader can potentially develop a great leader too. “If they recognize all the things being done wrong and figure out solutions, the new leader can really shine,” she says.

Cheryl Turner
So how does leadership matter when it comes to safety? A good leader and effective culture mean when an employee sees something, they’ll be more likely to say something. If they see shortcuts that shouldn’t happen, or a co-worker who’s not pulling their weight, or even if they identify a mistake they’ve made, having the encouragement and being given the voice to raise the issue can prevent small problems from becoming big problems. And when the work you’re doing involves the potential to deliver lethal doses of radiation to a patient, big problems are the last thing you want for the patient, staff, and institution.

The idea that a mistake can be lethal is something Turner says absolutely contributes to employee stress and burnout. “When you realize you’re the last thing standing between a patient and a mistake, it can be overwhelming at times. That’s compounded by the challenge of having all kinds of things going on around you and work to keep track of that doesn’t necessarily tie directly to the care you’re providing for the patient.”

Again, the solutions for employee stress are clear: good management and good culture. The nuances are where the hang-up is. It requires caring for employees in a way that healthcare, by and large, isn’t configured to handle today. Employees are often overworked because departments are understaffed. “I had someone, when I did my research, who said she was working 12 to 14-hour shifts. She said it wasn’t the physical time — she could manage that. It was everything she had to keep straight in her head during that whole time. If you’re working with 100 patients in a 14 hour shift, think how much information you have in your head.”

Turner says she doesn’t expect things to change anytime soon, but one thing she would like to see is just the acknowledgement that therapists and radiographers and others in the profession are also subject to burnout, similar to that which has been so widely covered among nurses and physicians.