Marco Trabucchi, former full professor of Neuropsychopharmacology at the University of Rome “Tor Vergata,” a specialist in psychiatry, is scientific director of the Brescia Geriatric Research Group, president of the Italian Association of Psychogeriatrics, and a councilor of SIGG (Italian Society of Gerontology and Geriatrics).
Our report on the quality of life in health care organizations shows that health care professionals draw their energy and find their motivation in their relationships with colleagues and patients, while the real problem seems to be confrontation with the management structure. Specifically, the issue seems to be a lack of recognition from superiors, so the question I would like to ask is: Why do you think recognition is so important in the professional field?
I am talking about my personal experience. Basically, the residential facilities where I work are places where you spend 365 days a year and 24 hours a day, so the atmosphere that is created inside these facilities is fundamental at all levels; it is fundamental for the well-being of the guests who must perceive that it is not a prison but that they are precisely in a home where they are taken care of with various intensities, responding to their needs. Just as it is very important for the operators, who are inhabitants of this house, because for someone who spends 7 hours a day there, the atmosphere is very important. So it seems right to me what you say about the research you have done-it seems more than right, it seems understandable to me that the workers in the facilities say, “Of course we like the relationship with the guests, we like the relationship with each other, but often on the part of the organization there is not as much sensitivity.”
In my experience, the attention from board managements is always very strong, today it is not like 10-15 years ago: it has changed a lot because they are realizing that the atmosphere is not given by the quality of the meals or the number of medications distributed, nor by how the beds are made, but it is given by how a meaningful relationship is established with the guests, which is both caring and accompanying and loving.
Here today most managements realize that it is incumbent on them to create a pleasant living atmosphere in which tensions are kept to a minimum because this allows the operators to act with the same level of care, accuracy, and love toward the guests.
Then there are always the difficult situations, there are always the unsuitable behaviors. But in most cases today I register an atmosphere of mutual understanding. Let’s take into account the dramatic economic difficulties that the facilities are experiencing today, the dramatic difficulties in staff recruitment and staff training. Here, taking all of this into account, I believe that today we are doing everything possible to make the most of the operators and especially the OSS who are the backbone of the residences.
So in your personal experience you still find a virtuous situation from this point of view. So it comes to me to ask you what do you think is the recipe for having a healthy working environment from this point of view? Because we have found that there are often difficulties related on the one hand to the economic aspect, on the other hand to too stringent timelines, but sometimes there is really a difficulty in the interpersonal relationship, in the relationship that is lacking between doctor and manager.
First of all, we have to take into account that today a large proportion of the workers are underpaid for what they do. They are underpaid not because of individual administrations’ choice but because of external economic conditioning, national contracts and so on. So we have to have the courage to say that this is the starting point. But from here, however, we have to build positive relationships: for example, I think it is important for the facility director or the president to be present in the workplaces, to show up. Physical presence in the wards is essential to make it clear that there is a concern on the part of the various levels of the administration for the work that is done every day with the sick person; and it is always heavy, difficult, stressful work.
Then kindness in relationships is crucial: you live in a community, in a family, you meet people’s needs. Create an atmosphere of kindness, caring, rewarding protection. Grant leave when possible because behind the health professional, there is a person who may have a thousand family or personal needs. Organizing trainings to make it clear that their training and professional prowess is valued, it is not a secondary thing, so there is this whole set of things that create an atmosphere in which people work more willingly.
The last question I wanted to ask you is about our national health care system. Looking not only at the specific structure in which you work, but in general, and looking into the future, what is your vision?
I am by nature optimistic. I believe there will be a resurgence of pride on the part of professionals, particularly physicians. The time will come when politics will be kicked around. Why? Because it is incapable of doing anything, it is incapable of planning, it is incapable of organizing, it is incapable of understanding what things are important for the health of people (especially the most fragile people). And so I have great confidence in the physicians who-I am sure of it-will abandon any corporate attitude and any attitude related to self-interest and will make themselves available to the community. I see this transition, I also see it relatively soon, because when we finally get fed up with the current management capacity of politics something will have to come out. And doctors today I think are particularly sensitive to this (especially young doctors). I trust them because I can see that they want to take strong responsibilities on the organizational level as well, and if that happens we will see better times ahead for our health care system as well.
So do you think our NHS will be able to manage this increasing percentage of the elderly population as well?
We will manage it. We will manage it. We keep saying the same things about the aging population in 2050 and so on and so forth. Here we start to think that numbers, statistics are important, but our ability to think of solutions is even more important. We have gone through far more difficult times in human history, we will get through this too. As long as we have people to think about long-term solutions. Systematically thinking about the good of mankind, the good in particular of the most fragile people as the elderly are. But I am optimistic.