You are Lucía Barrios, director of human resources at Hospital Metropolitano in Barranquilla, five months into the job. The psychosocial-risk survey says 42% of staff show signs of burnout. On Friday you present the first phase of a COP 2,000 million programme to the board, and in March the Ministry of Labour inspectors arrive.
The situation
The Metropolitano is a tertiary hospital: 185 beds, about 42,000 outpatient visits and 8,500 admissions a year, and 600 staff (320 clinical, 180 administrative and 100 in general services). It bills close to COP 86,000 million, almost all of it to health insurers, on a thin margin.
In nursing, 24-hour shifts are routine. There are 23 vacancies nobody fills, partly because pay is below the sector, and each nurse looks after about twelve patients, twice the recommended number. Three nurses in five show burnout. Nursing turnover is 38%, against 18% in the sector: 48 resignations in twelve months. In eighteen months four doctors and six nurses broke down on duty, and the health regulator received 47 complaints about errors that an internal review largely blames on fatigue.
The finance director, Álvaro Vergara, has priced each lever per phase: each million on wellbeing costs a million; each point of extra staff, about COP 25 million; each point fewer 24-hour shifts, about COP 8 million; each hour of training per employee, about COP 6 million. A phase that costs more than what is left cannot run, and whatever the programme saves on turnover and sick leave flows back into the budget. The board wants burnout and turnover below 20% by the end of the four phases, without losing care productivity, today 78 out of 100.
Nobody agrees. The medical director, Hernando Palacio, says stress comes with the job and the urgent thing is the severe cases. The head of nursing, Yolanda Ariza, wants staff and an end to 24-hour shifts before any workshop. The occupational-health psychologist wants prevention and training for heads of service. Your team left you a draft that touches a bit of everything. It is 7:30 and Ariza is waiting with this week's roster: eleven 24-hour shifts with nobody to work them.