How Many $100 Bananas Does your Organization Have?

Aug. 13, 2010
A hospital patient asks for a banana. The nurse calls the dietary manager, who says, “not without a doctor’s order.” After talking to two nearby managers who commiserate with her, the nurse mentions it to a senior VP, who was passing through the unit. The senior VP intervenes and the patient, unhappy about the long wait, finally receives the banana.

The cost of that banana exceeded $100. This wasted money, due to miscommunication and failure to integrate department systems, is an example of why medical care costs have escalated. It also typifies why workplace costs in general have increased.

Similar situations occur in many health care facilities and workplaces across the country. Patients or employees experience unnecessary delays and nurses (or managers) are forced to waste time and money because they are unable to satisfy patient (or employee) needs. They need quick and accurate action from others, but often encounter obstacles and delays.

Suppose, instead of asking for a banana, the patient experienced an emergency? Delayed responses can harm patients and can create hazardous situations for employees. The National Patient Safety Foundation attributes the medical error crisis to an inability to overcome systems problems, exacerbated by the growing complexity in health care systems, which requires improved communication and cooperation among health care professionals. Sound familiar? The same could be said of many workplaces in the United States.

Frontline employees need greater power, increased mutual respect and adequate communication to overcome these systems problems. A lack of courtesy and respect can chip away at a person’s sense of self, destroying his or her energy level and motivation. Organizations that provide supportive environments where staff can perform at their best attract and retain the best people. Positive relationships among employees generate energy and raise productivity. In the healthcare setting, clinicians who can make decisions at the patient level save management time and increase patient satisfaction.

Whether you are a safety manager or a nurse, you can save money, improve patient or employee satisfaction and reduce errors by using the following seven tips:

Empower your frontline staff to solve problems on the spot, then support them. When frontline staff hesitates to make the independent decisions related to critical thinking, it’s because they have been reprimanded for doing so in the past. They have learned to wait for specific directions from their managers rather than functioning as autonomous professionals fully capable of delivering high-quality work. Since their experiences have taught them that waiting is safer than taking a stand; this ingrained habit is difficult to break. The best way to slowly change this habit is to build trust by giving your staff consistent support. Don’t let your chain of command become a ball and chain that keeps frontline staff from solving problems on the spot.

Build trust. When your staff trusts each other, they save time and money, because people who trust others can act quickly and decisively. How do you build trust? By respecting yourself and others. You build it by being a role model, by courteous communication and by sensitivity to the needs of others. Staff members pay attention when you seek them out and ask for their input, and begin to trust you when you make consistent decisions according to what is right rather than what is easy.

Build a positive work environment. Organizations that provide environments where employees can perform at their best attract and retain the best people. Long-term strategies such as effective communication and staff-friendly cultures enable organizations to achieve the best results. A positive culture promotes employees’ understanding of organizational values so that they can make the right clinical decisions.

Insist that staff collaborate instead of compete. Everybody is able to accomplish more when departments work together. Good communication and collaboration save time and money and increase productivity. For instance, the ER staff repeatedly works with the lab, radiology, pharmacy, blood bank, the OR and clinical units. If each of these interactions is a struggle, patient safety becomes compromised and costs begin to soar. The same is true of any workplace department that effectively must work with other departments.

Brainstorm about the opportunities that lie beyond the challenges. Dedicate a portion of your staff meetings to list current challenges. Then talk about ways to transform these challenges into opportunities.

Communicate respectfully. As the $100 banana illustrates, poor communication is expensive. Healthcare organizations often use the SBAR model to improve communication. This model structures communication as follows: situation, background, assessment and recommendations. The intent was that the SBAR-structured communication would improve communication especially during crises. SBAR works well in positive work environments, but not when power struggles are occurring in negative work environments. Even good tools are rendered ineffective when staff manage to find new ways to sabotage one another in negative cultures.

Solve the root causes of problem. If the work environment prevents employees from solving the root causes of any problems that they encounter, then the best your frontline staff can do is create temporary fixes day after day. This wastes huge amounts of staff time, costing significant amounts of money.

Smarter workplace practices assist people in working together. Using conceptual communication and leadership approaches enables you to leverage scarce resources and to do more with less. More than helping to maximize the work process, using these tips will address the bottom line for managers: the dollar difference between the present level of staff productivity and full professional capacity are the number of $100 bananas you can save.

About the author: June Fabre, MBA, RN-BC, is author of “Smart Nursing: Nurse Retention and Patient Safety Improvement Strategies,” and owner of Smart Healthcare LLC. She has worked as a clinical nurse, educator and manager in many specialties such as medical surgical, psychiatry, home care, long-term care, ambulatory care and managed care. Through Smart Healthcare LLC, June develops and presents education programs that improve communication, raise productivity without burnout and promote team performance. “Smart Nursing” assists nurses and managers in how to work together, using conceptual, communication, and leadership approaches. The seven core values of Smart Nursing are caring, respect, simplicity, flexibility, integrity, professional culture and communication. June is a speaker, trainer, coach and author. You can contact her at (603) 320-3469, [email protected], or at

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