How to Strengthen Your Own and Others’ Morale

Abstract

Morale is a measure of job satisfaction, personal well-being, quality of interactions, and activity level of individuals that work together. Faculty of all ranks and roles may contribute through the general principles of active engagement in the leadership aspects of their assignments, support for everyone around them, transparency in their decisions and policies, and attention to the balance between direction and autonomy they provide to those they supervise. Specific issues to be addressed include the quality of their supervision and mentorship, how work expectations are handled, the importance of social activities, and how complaints and problems are corrected.

Appendix: Best Practices

Case Study #1

Dr. Beth Davidson, a 2nd-year resident on a busy inpatient service, was in constant conflict with Linda, an experienced nurse on the service. Frustrated and angry by a recent caustic e-mail exchange, she sought out her attending to ask for help quashing the nurse. “Look at this sarcastic comment. You need to call her on the carpet for the way she is treating me.” Dr. Rhoades, who had experienced a few of these communications himself in past years, chose a different approach. “Beth, I want you to take care of this yourself. You are responsible for the smooth operation of your team and who is at fault is less important than who will take the lead in fixing the problem. I will be interested to see how you handle it.” A few days later, Dr. Davidson returned and excitedly reported, “I really had to bite my tongue, but I sat down with Linda and asked her to talk with me. She had some hard things to say about me and I did not agree with a lot of them, but I can see her point now. In the end, the only real change I needed to make was to give her a head’s up before I wrote orders for her patients. I had no idea that was the problem.”

Case Study #2

Dr. Wilkins was both excited and intimidated by his new role as program director. He loved teaching and had good relations with the residents he supervised. He quickly found, however, that the regulatory requirements of a residency program were daunting, especially with an accreditation site visit on the horizon. He soon found himself lost in administrative details and making decisions based on what looked good for the program rather than what was good for the residents. When the site visitor came, the files were in great shape, but the residents were not. They were all too anxious to share their dissatisfaction with the site visitor. “We never hear from Dr. Wilkins unless we are behind on our documentation, we have no idea how we are doing as residents, and no one seems to notice that we are here unless something goes wrong.” Most of them said they were unhappy with the program and several wished they had gone elsewhere. The primary citations in the accreditation report were for poor engagement of the program director and low resident morale. In an effort to understand what was happening, Dr. Wilkins spent time over the next few weeks visiting residents on their clinical services, meeting with them after their lectures, and inviting them to his office for informal chats. Within a short time, before he implemented any other changes, morale was already improving.

Case Study #3

Dr. French was considering her options as she approached residency graduation. Always interested in community outreach and underserved populations, she hoped to find an outpatient position that would allow her to develop new clinic models to provide this service. Dr. Parker was the chair of a prominent research-oriented department that struggled to retain clinical staff, especially in its outpatient operation. With that in mind, he told Dr. French, “We have an opening in our outpatient clinic that we would like you to fill. With your interest in outreach, you should be able to do the work with no problem.” Across town, Dr. Gage had a similar opening in a more modest department. After meeting with Dr. French to discuss her career interests, she said, “With your interest in outreach, a good place to start would be our outpatient clinic. With the experience you gain there, you will be well equipped to take the next step.” Wanting an academic career, not just an academic job, Dr. French chose to forego prestige in favor of upward mobility and accepted Dr. Gage’s offer.

Case Study #4

Dr. Norris enjoyed having medical students on his inpatient service. He found the opportunity to chat with them and hear their thinking about cases to be especially enjoyable. Dorothy, a third-year student, was anxious about the rotation. She had always been a bit awkward in social situations, and she found discussions in rounds especially trying. She tried to make up for this by studying hard and staying on top of every issue with her patients. Dr. Norris quickly noticed that Dorothy was not jumping in to answer questions and assumed that she was poorly prepared. Preferring the livelier interactions with the other students, Dr. Norris stopped calling on Dorothy, who experienced relief to be out of the limelight. Not having heard that anything was wrong, Dorothy was taken aback to receive an evaluation that said she had a poor fund of knowledge and seemed disengaged from clinical care. Her evaluation of Dr. Norris complained that she was never told there was a problem or given the opportunity to improve things. Taking this evaluation to heart, Dr. Norris began to give feedback promptly and frequently, and soon noticed a sharp improvement in students’ performance and his own evaluations.

Case Study #5

Dr. Logan had worked hard to ensure that recent changes in ACGME work hours did not disrupt her residents’ educational experience or clinical care. Her plan to create a senior resident night float and limit PGY-1 residents to the inpatient day shift seemed the perfect arrangement to stay within the guidelines. She was taken aback, then, to learn that both the interns and the senior residents felt overburdened and unhappy with the experience. Her initial response was anger at their complaints, and she planned to confront them with work-hour reports to show how much less they were working than previous classes. Instead, what she heard when she met with them changed her mind. They pointed out that most admissions to the inpatient unit came in late in the afternoon and were directed to the night float, placing most of the assessment and planning for new patients in the hands of the senior residents and leaving the interns to implement the plans the following day. Consequently, the senior residents felt like they were “on call every night” and the interns felt overwhelmed by “scut work” of little educational value. They did not want fewer hours but more direct involvement with the new patients and suggested a rotating “short-call” assignment alongside the senior residents. This would allow them to perform more patient assessments and plans and would change the senior residents’ role to teacher and supervisor. Dr. Logan made a few phone calls to affected faculty and implemented the change the following month. The residents commented that the responsiveness of their training director to their concerns was as important to them as the change in job description.

Case Study #6

Dr. Carter was a popular and capable third-year resident, with a roguish disdain for meaningless bureaucracy. Though attentive to his patients, he was openly defiant about treatment plans, billing forms, and insurance reviews. Despite repeated reminders and warnings, he refused to complete this paperwork until a major payor threatened to terminate its relationship with the clinic because of noncompliance with these requirements. The program director, Dr. Walters, was finally forced to convene a disciplinary hearing. Morale ­plummeted as Dr. Carter stirred up his colleagues over the issue. Bound by confidentiality rules regarding the hearing, Dr. Walters could not share the details of the case but arranged a meeting of the residency class to explain the rationale for the documentation requirements, the procedures that had been followed before the hearing, who was on the hearing committee, and the mechanics of the disciplinary process. One member of the class commented afterward, “Dr. Walters did not really tell us anything about Dr. Carter’s case, but we felt a lot better knowing what was going on behind the scenes.”