1. Section Editor(s): Raso, Rosanne MS, RN, NEA-BC

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No, I'm not asking about the chicken or the egg, but rather patients or staff. At a time when patient experience scores rule the C-suite-and when patient-centeredness is a national movement-it seems logical that patients come first. Who can argue with that premise? It's our purpose. However, we may put forth another foundational element of the puzzle: your staff members come first, too.

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Staff engagement is popular in the nursing literature-how to measure it, the negative effects of its absence, what elements are needed to have it, and how it correlates to our patients' experience. Are we truly committed to positive work environments? Or are we still turning our heads away from dysfunction, systems issues, and disrespect, thinking they're too hard to change? The failure to push forward with a staff engagement agenda does trickle down and can result in increased turnover, absenteeism, errors, and, of course, a poor patient experience. On the positive side, engaged staff members have purpose, are less stressed, and are at their best-another one of our goals as leaders.


In fact, it seems that the principles driving both staff engagement and the patient experience are similar. Avoiding blame and improving systems are basic examples of successful leadership. What about effective communication and responsiveness? We can't have a positive work environment or a great patient experience without these building blocks.


As a leader, you show that you care, listen, acknowledge, recognize, value, and respect your staff. Isn't that the same message we drive home to staff members about their relationships with patients? Our staff members want to feel valued, and our patients want to feel like they're a real person to us with individual needs. It's all about acknowledgment of people as people no matter the angle, either the patient or staff perspective.


Another fundamental element is developing collaborative relationships at all levels. We teach it to new managers as a key to success, and we teach it to our staff in working with patients and families. Relationship building is central to patient care and leadership. Again, it works for patients as it does for staff.


Patients can tell when staff members are dissatisfied. Invest in your staff. Commit to them. Get them the resources they need to do the job. Truly make patient-centered decisions and systems. Unmet patient needs tend to focus on information, listening, and caring. It wouldn't surprise me if staff needs are similar. Research tells us that they also need growth, respect, and recognition.


So it's all connected. We can't fall into the trap of only focusing on patients. Sustainable change in your patients' experience won't occur without an engaged workforce. If we focus on staff and organizational values, then patients and families will feel the positive effects in a real and substantial way. Of course, this assumes that the entire organization is behind patient-centeredness.


Maybe it is the chicken or the egg conundrum. Without staff engagement and true purpose, we won't see an extraordinary patient experience; with engagement, it's almost guaranteed. We can't focus on one without the other and we must use equivalent strategies to promote success. So let's make the environment special for our patients and our staff, using the same principles for both and never losing sight of either one.


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