Nurse leaders and other hospital and health system executives can take several lessons from a regional grocery chain's unusual and unresolved management nightmare.
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There's something unprecedented going on in Massachusetts, New Hampshire, and Maine: Thousands of non-unionized employees of the Market Basket grocery store chain have walked off the job after the company's CEO, Arthur T. Demoulas, known as Artie T., was voted out by the company's board of directors.
The CEO's ouster is the latest incident in a year's-long feud between two rival factions of the family that owns the company, but employees are refusing to work for anyone but Artie T.
Under his oversight, Market Basket employees enjoyed unusually good benefits, pay, and bonuses; decades-long careers; and the opportunity to rise up the ranks of the company into management positions.
On the customer end, the store is well-known not only for its low prices, but also for its helpful, knowledgeable, and incredibly loyal staff. The store is profitable, too, raking in an estimated $4.6 billion annually.
As Market Basket's employees protest the board's action, they've also encouraged a boycott of the stores, and customers are listening. As a result, operations at the chain's 71 stores have nearly ground to a halt. Shelves are bare.
Supportive customers are shopping elsewhere, taping receipts from rival grocery stores to Market Basket's windows and emailing its board of directors demanding that they listen to their employees. Politicians are also voicing their support of the employees.
What does all this have to do with nursing? Nurse leaders and other hospital executives can take several lessons from the Market Basket dustup, from appreciating the importance of an organization's culture, to understanding the need for nurses to be on boards of directors. Here are three lessons nurse executives can learn from the grocery aisle.
1. A healthy culture creates a healthy business: Promoting a culture where everyone feels valued and respected goes a long way toward productivity and outcomes. Flexible scheduling; encouraging teamwork; and making sure nurses take breaks and have plenty time between shifts may not sound like tactical moves, but they all pay off in terms of patient care. Being part of a healthy culture where everyone is valued helps with productivity, too.
"A culture of inclusiveness breeds success," Kathie Krause, MSN, RNC, NNP-BC, NEA-BC, Vice President of Patient Care/CNO at Le Bonheur Children's Hospital, told me via email.
"Nurses are part of multi-disciplinary teams and have a strong voice as advocates. It is important that all employees feel empowered to make a difference or contribute ideas. This makes staff feel like they have purpose and meaning in their work."
On the other hand, factors like requiring nurses to work overtime; units being chronically short-staffed; and an all-too-common culture of bullying create toxic environments with high nurse turnover and unhappy employees.
"Nurses who rise to executive leadership positions develop a keen ability to work collaboratively with colleagues to maintain a workplace culture where every individual is respected and feels that their contribution is valued," Bobbie Berkowitz, PhD, RN, FAAN, Dean of Columbia University School of Nursing, told me via email.
2. What workers think, experience, and say matters: Within days, Market Basket's productivity came to a standstill because everyone up and down its supply chain—from the high school students who bag groceries, to the people who stock shelves, to the 40-year managers—stopped doing their jobs. It's a reminder that every cog in the wheel is an essential one.
I'll never forget something that Maureen White, RN, MBA, NEA-BC, FAAN, senior vice president and chief nurse executive of North Shore-LIJ Health System, told me last year: "The best ideas are not coming from the C-suite when it comes to care delivery." Instead, the best ideas are "coming from front-line staff."
Nurse managers and other leaders should always take the time to listen to everyone on staff, from the bedside nurses to the CNAs and everyone in between. They keep the place running, day in and day out, and see things that people in the c-suite don't.
"Bedside nurses know patients and know their needs," Krause said. "We have to create an environment where we listen to bedside nurses to ensure they have the tools needed to do their jobs. They will deliver excellent care and fulfill their mission of providing excellent, thoughtful care for their patients if we empower them."
On the flip side, punitive environments often prevent nurses from speaking up to make needed patient safety changes. For instance, a survey last year showed that although 90% of nurses say it's important to have a culture where nurses are not penalized for reporting errors or near misses, 59% agree that nurses often hold back reporting patient errors in fear of punishment. Most nurses (62%) say the same about reporting near-misses.
"The best nurse executives recognize that patients benefit from being treated in an environment that encourages nurses at the bedside to speak up when they see a problem or an opportunity for improvement," Berkowitz said.
3. Get nurses on boards of directors: Market Basket's board of directors has appeared tone-deaf to the public, and has seemed to underestimate the importance of the store's culture and employee loyalty. Hospital boards of directors, too, can suffer from the same kind of tone-deaf behavior when nurses aren't included in decision making.
"Nurses are trained on the care of the whole patient," Krause said. "This makes us advocates for people—our patients. Our expertise and background can give boards perspective and puts this empathetic thinking at the core of business decisions."
Still, a 2011 survey of 1,000 hospital boards found that only 6% of board members were nurses, even though nursing is the largest healthcare profession, with 3.1 million RNs in the United States.
"Nurses are experts in communicating with patients, families, and communities in a way that is culturally sensitive and inclusive—expertise that would benefit any board of directors," Berkowitz said.
Only time will tell what will happen with the Market Basket feud. But nurse executives and other members of hospital leadership can take lessons from the store's struggles today.
Alexandra Wilson Pecci is an editor for HealthLeaders.
