ATTITUDE ADJUSTMENT The perioperative crew at the University of Pittsburgh Medical Center quickly realized a happy staff translates into happy patients.

When our surgery center staff grumbled more than they grinned and turmoil led to turnover, we examined our workplace culture. We launched a program designed to boost staff morale and stem the tide of valuable staff members looking for work elsewhere. Here are the program's key elements that made our staff realize they had the power to make the changes they wanted to see happen.

1Air the grievances
Creating a cultural identity can seem like an amorphous task that is potentially boundless in scope. Where to begin? Establish a baseline of your workplace culture by having every member of your staff complete a brief survey designed to reveal their thoughts on different aspects of their day-to-day experiences (outpatientsurgery.net/resources/forms). For example, our survey asked employees to let us know if they agreed with statements like these:

• The work environment is pleasant, clean and organized.
• Nurses, physicians and other staff members work as a high-functioning team.
• Leaders support professional development.
• There are an adequate number of experienced staff to care for patients.

Determine which questions scored the lowest and focus your initial efforts on addressing those issues. For us, that meant assuring staff members that managers welcome their ideas for process improvement and that we'll implement those suggestions that make good sense.

2Create a behavioral charter
Put down in writing the expectations you and your staff have for how everyone in the facility must act on a daily basis. Gather staff members in a meeting room to discuss what they believe are the root causes of the issues that matter most to them. Involve representatives from every position within your facility and invite individuals who are known to give their fair and honest opinions of what really goes on away from the watchful eyes of management. Organize the trends staff members share into common themes and create focus groups to discuss the issues and possible solutions. We had groups discuss ways to optimize the surgical team's interactions with anesthesia providers and how to best standardize and document clinical performances, among other hot-button topics.

3Chart the progress
Create a temperature gauge chart — the kind you see used to track the progress of fundraising efforts — that outlines the timeline of the program's goals and notes the months you plan on achieving specific goals on your journey to a better workplace. Our gauge chart showed that we kicked off the improvement program by standardizing the pre- and post-op nursing care modules in January 2015, hired 2 additional clinical positions to relieve stress on overworked staff in February, created the behavioral charter in March and so on. We colored in the gauge's segments as we met each goal until the "mercury" reached April 2016, the month we pledged to complete the follow-up staff survey to measure improvements to our workplace culture. Hang the chart in a prominent area of the department. The visual tool will remind staff of the efforts and progress you're making to improve the workplace morale based on the recommendations they made.

4Walk in their shoes
Lesia Very, MSN, RN, director of the ambulatory surgery center, says team cohesion can have a direct impact on the quality of patient care your team provides. She believes in bringing her team together by listening to their concerns on a daily basis, finding out what matters most to them and keeping the lines of communication wide open. If you don't know what's bothering your staff, you can't resolve whatever issues they're facing, says Ms. Very, who's at work at 4:30 a.m., when the first nurses arrive, and who always fills in as a circulator or scrub tech when the OR team is short-staffed.

Ms. Very also revamped the surgery center's unit-based council, which had devolved into constant gripe sessions. She restored the gathering's intended purpose: a forum where team leaders could voice common issues and develop shared solutions to make the surgical department better.

CLEAR EXPECTATIONS
Create a Pact of Professionalism

CLEANLINESS IS HAPPINESS It's the little things, like tidying up the staff lounge, that add up to make a big difference in staff morale.

Don't leave dirty dishes in the break room sink. That's just one of the elements listed on the behavioral charter every staff member at the University of Pittsburgh Medical Center's surgery center must sign as a condition of employment. The charter, which is based on the health system's core values — listening to and caring for patients, health plan members, fellow employees, physicians and the community — also notes other ways to be a good teammate, including:

Front desk workers must always make eye contact and introduce themselves to patients and their family members during the check-in process.

Perioperative staff should ensure patient care areas are clean and uncluttered, including being free of extra supplies and trash. They must secure patients' personal belongings in labeled bags, place the bags in lockers and keep privacy doors to pre- and post-op rooms closed to decrease patients' exposure to excess noise and unnecessary disturbances.

All staff members should put things in their proper places, restock supply areas as needed, empty trash cans when full and wipe up spills in the break room. They must also be conscientious users of social media and maintain staff confidentiality when posting on the various platforms.

— Daniel Cook

The place to be
Whoever's in charge of your workplace improvement project must have the communication skills needed to serve as the liaison between the frontline staff and their managers. She must ensure the program maintains momentum and continues to progress toward the final goal. Change won't happen overnight. Our journey took close to 2 years — and it continues today. The ongoing efforts have paid off. No staff members left in 2016 and our ASC recently achieved the highest patient satisfaction score in our health system's ambulatory care areas. OSM