This chapter is about the spiritual environment management tool, which includes spirituality at work and spiritual practices. This management tool is divided into two steps: diagnostic of the worker’s perceptions about spirituality at work (first step) and spiritual practices design (second step). By meaning, spirituality at work can help healthcare managers to build effective teamwork in medicine. Spirituality at work has a multidimensional and measurable nature and is aligned with the three principles of the World Health Organization, based on two arguments: the new approach should be preventive and should promote partnership. This fact allows the managers as well the human resource department to classify the organizational environment on the next spiritual issues in the first step: meaningful work; opportunities for inner life; the sense of community; alignment with the organization’s value; emotional balance and inner peace. The reduction of medical errors to improve patient safety require the performance of multistep tasks of the great complexity of healthcare professionals, and this chapter pretends to show how the spiritual environment management tool can contribute with the “all working together” goal through a multi-disciplinary care team.
- spiritual environment
- management tool
The purpose of this chapter is to contribute with the concern of this book: the need for a multi-disciplinary care Team - all working together - to help coordinate and optimize the care of patients with complex medical problems.
Can the development of a spiritual environment to help with this concern? This chapter pretends to answer this question and to demonstrate how can spiritual environment as a management tool to help healthcare professionals.
It’s very important to contextualize this concept to help us understand how its implementation can contribute to the effective creation of teamwork in healthcare.
Spirituality at work approach is aligned with the principles of different international organizations , and the academic evidence shows us, that this approach is useful as a management tool, guiding healthcare practitioners.
The world can be defined as an organization’s society, and the scientific community has the responsibility to explain the power and the role of organizations for the achievement of the well-being of the society as a whole.
Spirituality at work has a multidimensional nature, and is aligned with the next three principles of the World Health Organization:
The work should be performed in a safe and healthy environment
The work conditions should be consistent with the well-being and human dignity
The work should provide individual achievement and service for the whole society
The ‘60s represent a decade in which emerges the consciousness of the negative impacts of the organizational practices on the workers’ health and well-being. Attending to this fact, the World Health Organization, appealed to define new perspectives that inspire a positive organizational behavior based on two arguments: these new perspectives should be preventive; and the new human resources policies should promote authenticity, trust, and partnership.
The World Health Organization refers precisely both globalization and technological advance as the two big drivers in the labor world transformation, opening opportunities for a dangerous global competition, looking for financial results in detriment of fundamental human rights and well being.
The new developing technologies and the internet came to show that the line that separates professional and private life became almost invisible and work-life balance became questioned. The stress from this new reality during the XXI century influences negatively the workers’ physical and mental health causing absenteeism, low motivational levels, satisfaction and creativity decrease, and organizational productivity and competitiveness reduction. In other words, we are facing conditions that are globally a concern to us all, that represent serious social and financial costs.
Currently, we are facing with weakened economy healthcare and a rapidly changing and increasingly high-tech environment, which requires healthcare workers more contact with screens than with patients . The same authors claim that during these times of high burnout and low engagement levels, the healthcare workers feel the need to bring their whole selves to the work. Please, take note of the previous expression: “whole selves to the work”!
Work environments with a superior spiritual environment have higher individual and organizational outcomes, both within and outside of the healthcare industry [1, 2, 3]. So, we are facing the moment to establish the connection between the spiritual environment and the need for a multi-disciplinary care Team - all working together - to help coordinate and optimize the care of patients with complex medical problems.
Exist a connection between spirituality and organization, which is easily established after a deep analysis of the spirituality at work concept and its impacts on the improvement of attitudes and individual performance at work (Figure 1), as we will see next. To establish this connection and answering all inheriting concerns related to conceptualization and measurement, a dialog was established between spirituality and science, accepting the Maslow’s idea :
“I want to demonstrate that spiritual values have naturalistic meaning, that they are not the exclusive possession of organizational churches, that they are well within the jurisdiction of a suitable enlarged science, and that, therefore they are the general responsibility of all mankind”.
This responsibility mentioned in the previous paragraph has been assumed in social sciences by several authors, where the search for the “naturalistic meaning” is guided by organizational excellence, looking for an organizational purpose or humanitarian aid [4, 5].
The presence of spirituality at work is related to several concerns that should be familiar to leaders, as values and integrity, as the contribution to society, as to take care and support, and as being true . The same authors refer that spirituality at work is both organizational and individual concerns. That is, the leaders need to value the spirituality in their own lives to develop this approach as an organizational management tool, and they will play a role differentiator inside organizations where they belong.
So, spiritual leadership is about creating meaning and value for people, in work life, family life, or community life, as a person who inspires others, promoting higher levels of workforce engagement with their jobs and organizations .
The spiritual leadership is related to workplace spiritual intelligence attribute, and both can improve lower levels of job stress, higher levels of workforce engagement, that is greater motivation to improve performance .
If the hottest buzz  is about the triple bottom line (3 P), a commitment with people, planet, and profit, this buzz should be aligned with another triple bottom line (3 E): employees, environment, and economic.
We need, together, think and act about the importance of both 3 P and 3 E.
So, the humankind needs an evolution more healthy. If we need a more healthy planet/environment, if we need a solid profit/economy, we need healthy people/employees too. And the work, in this complex world, can play a vital role, through a spirit-team-at-work.
So, can we survive without the wealth professionals? Can the world survive without them? We need them. The world needs you! And, we must not forget: you are employees and human beings first!
We can state that health professionals have the mission to supports the pains of humanity. Which is not easy! It is here that spirituality at work emerges as a management tool, as suggested by several authors [1, 2, 7] described in the next section.
2. Teamwork and spiritual environment
This section brings us to a series of doubts and questions which will be addressed in the next subsections:
What defines spirituality at work?
How to create a spiritual environment?
Does spirituality at work contribute to improving the workers’ well-being and to create effective teamwork?
2.1 Spirituality at work concept
In the year 2000 spirituality at work met a shift mark, with the research developed by the authors Ashmos and Duchon  setting the conceptual frontiers and measurement, therefore enabling the research of the spiritual impacts on workers´ attitudes and work-related outcomes. Their initial investigation was published in the Journal of Management Inquiry, based on previous theoretical developments, their conceptualization and measurement inspired most of the subsequent investigations. Spirituality at work has been explored as a multidimensional concept, mainly due to the work of the authors mentioned above. They have been considered the first authors to produce a serious approach to spirituality at work [9, 10, 11, 12, 13].
Spirituality at work is not about religion  conversion or about getting people to accept a specific belief system [1, 3, 15] and “has taken many forms”  (p.80). It is primarily identified with an open mind and involves connectedness  and with the connection between others and the workplace environment, and it is related to self-actualization .
Spirituality at work is the recognition that workers perform work with meaning and purpose, for them and society as a whole, including a strong sense of enjoyment at work. The workers can find an opportunity at work to express many aspects of one’s being, not just the ability to perform physical or intellectual tasks, and they feel work as a source of spiritual growth and connection with coworkers.
In the organizational level spirituality at work is the link between personal values and the organization’s mission and purpose, and the source of employee’s emotional balance and inner peace. When organizations introduce spirituality at work, it means that they take care of both the mind and spirit of their employees, finding a more holistic picture of the human being . Returning to Maslow’s theory of needs, self-actualization and self-transcendence imply the valence of the individual mind and spirit involved in the work component.
If Maslow created the roots and produced the seminal work that showed the importance and gave rise to the spirituality concept on the organizational field, the authors Ashmos and Duchon developed the basic boundaries of the concept and its measurement, giving place to the most significant developments in this field.
The next figure (Figure 1) show us the fundamental words which be part of a spiritual environment. The spiritual environment includes five dimensions and spiritual practices. The same figure includes spirituality at work impacts: job resourcefulness (ability and imagination to solve; intelligence), organizational affective commitment (family feeling), individual productivity (effectiveness), and job performance (quality, relative capacity).
The previous figure (Figure 1) shows spirituality at work as a multidimensional concept defined by the next five dimensions:
Meaningful work involves a deep sense of meaning and purpose in one’s work, for workers and society as a whole including the sense of contribution to the community (items related to work that coincides with personal life values and is helpful for the community) and sense of enjoyment at work (items related to a sense of joy and pleasure at work).
The work can be a way to understand the meaning of life.
Meaningful work happens when people experience a deep sense of meaning when they perform their work. People have an intrinsic drive and motivation to learn and find meaning in their work and to be a member of a group, where they feel valued for their contribution to the group’s performance .
Opportunities for inner life is about finding an opportunity at work to express many aspects of one’s being.
Opportunities for inner life measures the degree to which organizations respect the spiritual values of the workers  and was identified by the authors Ashmos and Duchon  as spiritual identity: “an opportunity at work to express many aspects of one’s being, not merely the ability to perform physical or intellectual tasks” (p.136).
Spirituality at work begins by acknowledging that people have an inner and outer life, and inner life exists when workers find their inner strengths and use them to perform their tasks at work.
A sense of community or sense of connection between workers is a human goal at work because although money is important it is not the most important goal for most people. A sense of community is described as the feeling of connectedness that workers develop with other coworkers.
This concept captures the degree to which employees feel the existence of teamwork connects them as a family in the organization to which they belong, as well as the perception that the supervisors do their best to encourage the presence of effective work.
A sense of community is described as the feeling of connectedness that workers develop with other coworkers , and success can be described using terms such as being connected and balanced.
The sense of connection is a feeling far beyond oneself, with a genuine sense of community arising from the presence of affections .
Spirituality at work is related to the teamwork concept, once the sense of connection is better understood when we realize meaningful work, and colleagues take the place of family and social groups.
Alignment with the organization’s values is about the personal values and the organization’s mission and purpose .
This dimension captures the gap between the workers’ perceptions and attitudes and the values of their organizations.
Alignment with the organization’s values measures aspects related to the leader’s interests, particularly if there are concerns beyond financial issues. Issues as the perceptions about the organization’s future, the way that workers inner life and peace are respected, and finally, the leadership’s attitudes to society. These issues are fundamental to create effective teamwork.
Emotional balance and inner peace capture the emotional balance and inner peace at an individual level when workers perform meaningful work, as explained above. This dimension reinforces the coherence of the overall spirituality at work concept and covers these aspects already anticipated by Maslow [3, 15, 17], and to enrich the traditional approaches of spirituality at work and reinforce the overall coherence of the concept, currently based on four dimensions: inner life, meaningful work, sense of community and values alignment. Emotional balance and inner peace are related to the importance of the happiness that can be felt through work, allowing to find a feeling of inner peace and emotional balance when something goes wrong . With this dimension, we can create a clear connection between the individual and organizational levels, since employees with higher welfare and better life balance are stronger and more persevering .
2.2 The link between spirituality at work and teamwork
Through analysis of Maslow’s Theory of Needs, a reason was found to establish a link between spirituality at work and organizations . So to begin the understanding about this link, we need to remember the following question, built by Maslow on September 14, 1967, in San Francisco, where he delivered a public lecture titled “The farther reaches of human nature”:
“What are the moments which give you … the greatest satisfaction? What are the moments of reward which make your work and your life worthwhile?”
The answer to the previous question can be contextualized through the updated version of the Maslow’s hierarchy, that includes the next six motivational levels :
Physiological (survival needs) – seeks to obtain basic needs to survive
Safety needs – seeks security
Belongingness and love needs – seeks affiliation with a group
Esteem needs – seeks esteem trough recognition or achievement
Self-actualization – seeks fulfillment of personal potential
Self-transcendence – seeks to a cause beyond the self and to experience communion beyond the boundaries of the self through peak experience
Maslow’s studies created the foundations of the spirituality at work concept, identifying the dimensions to the self-actualization and self-transcendence : unique self, peak experience and transcendence, spirituality and meaning, and esthetic-creative element.
Maslow gave an additional contribution to helping the launch in 1969 of the Journal of Transpersonal Psychology, and several other specialists found there a good opportunity to clarify the spirituality at work concept and the role of spirituality may have in the organizational context, in the management, and leadership fields .
This new approach contributes to a natural commitment to actions related to justice, trust, beauty, order, simplicity, meaning, and purpose . It is important to note that self-actualizing people are committed with themselves and with the well-being of their groups and community  when they are committed whit these intangible being-values .
Many academic studies give us insights about how a spiritual environment can help organizations increase their performance and improve the link between workers, between workers and the organization. And, both the self-actualization need and the self-transcendence need, are related to spirituality, and more specifically, related to spirituality inside organizations.
As Maslow explained a self-actualizing person can transcend to individual concerns when he/her being feels actualizing. And these individual concerns are related to intrinsic willingness to serve others, devotion to an ideal, or involvement with a cause as social justice. The self-transcendence person can become relatively egoless. So, to be self-actualizing is not enough for a full description of the human being.
This description of the human being leads us to the words of Chattopadhyay : good people management is more important than all other factors since organizations need to create a work environment that helps them attract, keep and motivate the workers. Dr. (Prof) Debaprasad Chattopadhyay reinforces the idea stating that “the creation of challenge and meaningfulness for employees has become a priority” and “how individuals within organizations can maintain inner and outer balance is an important issue” (p.75).
A multi-disciplinary care team - all working together - to help coordinate and optimize the care of patients with complex medical problems, as mentioned before, meaning effective teamwork, that can reduce medical errors, improving patient safety, requires good people in the management. The presence of spirituality at work can help, since can represent the link between the concern of this book with the words of Dr. (Prof) Debaprasad Chattopadhyay.
How spirituality can help health professionals? Spirituality at work can help them by making organizations socially responsible  what includes: the impacts on the environment, the impacts on the community, and the possibility to create a better world. Once, spirituality at work look at people not only as human resources but as whole human beings, including their spiritual needs  helping workers “become a spiritual being on a human journey”  p.747. And, spiritual leadership is about identifying and affirming shared core values, vision, and purpose with meaning for everybody; meaningful work and community .
3. Spiritual environment implementation
The Institute of Medicine (IOM) identified six key measures to improve the overall quality of the healthcare system: safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity . The balanced pursuit of these six key measures is not easy with the current challenges facing by healthcare organizations, as well as other organizations belonging to other industries.
Rational common interests and rational individual interests conflict  frequently, and this issue does not promote effective teamwork.
The academic research shows us some evidence which justified the relationship between teamwork and patient safety : investigations about the factors contributing to critical incidents and adverse events have shown that teamwork plays an important role in the causation and prevention of adverse events; some studies focusing on healthcare providers’ perceptions of teamwork demonstrated that staff’s perceptions of teamwork and attitudes toward safety-relevant team behavior were related to the quality and safety of patient care, and perceptions of teamwork and leadership style are associated with staff well-being, which may impact clinician’ ability to provide safe patient care; observational studies on teamwork behaviors related to high clinical performance have identified patterns of communication, coordination, and leadership that support effective teamwork.
The creation and implementation of a spiritual environment may be one strategic imperative of the new millennium, once “people with heart” are “good people management”, and good people management is more important than other organizational factors . A spiritual environment includes spiritual practices and spirituality at work , as we can see in Figure 1, and in this subsection, we will address the implementation.
In the introduction of this chapter, was asked to note the expression “whole selves to the work”. This expression helps us to understand the importance of the spiritual environment for healthcare professionals, to bring their whole selves to their organizations where they belong.
The spiritual environment as a management tool can have a positive impact on the development of a care team, with the natural meaning of this concept as claimed by Maslow. Even as create an environment where workers may find meaning in their lives, resilience to overcome obstacles upon fulfilling a fundamental human need .
A solid healthcare system requires a healthy work environment, with the compassion feeling between workers as between workers and patients, so the workers need to perform their tasks where the expression “whole selves to the work” is a priority. And we cannot forget: they support all the pain of the humankind. They represent the hope for those who suffer from the most varied pathologies.
The author Pfeffer  (p.32) noted four dimensions that workers seek in the workplace:
A kind of work that permits to learn and develop a sense of competence and mastery
Meaningful work that provides some feeling of purpose
A sense of connection and positive social relations with their coworkers
The ability to live an integrated life, so that one’s work role and other roles are not inherently in conflict and so that a person’s work role does not conflict with his or her essential nature and who the person is as a human being
True spiritual leadership enables workers to find these four dimensions, through a training program about a shared spiritual environment, which includes both spiritual practices and spirituality at work concept.
The first step should be diagnostic and measure the level of spirituality at work through the five dimensions previously described, which include 22 questions. This first step allows us to know the organization about the presence of spirituality at work. That is, it allows us to answer the question:
Have the healthcare professionals the recognition that they have an inner life that nourishes and is nourished by meaningful work that takes place in a community context, with a sense of alignment between individual and organizational values with a sense of emotional balance and inner peace?
After the diagnostic, the next step (second step) should be the development of spiritual practices to implement a spiritual environment.
The implementation of spiritual programs in the workplace can have results at the individual level contributing to the multi-disciplinary care team. Corporate programs and spiritual practices should be custom-designed and adapted to the individuality, values, and perspectives of the workers .
Academic studies identified a set of spiritual practices: fitness relaxation practice, meditation, reiki, health programs, hygiene and food education, yoga, pilates, dance, diversity support programs, and music .
All these spiritual practices benefit health and well-being and are reported in various investigations in the areas of psychology and health. These different practices may contribute to the development of a sense of community within the team, alignment with organizational values, meaningful work, opportunities for the inner life, and emotional balance and inner peace. And this impacts explained why the practices mentioned called by “spiritual practices” can contribute with the goal “all working together”.
In the introductory chapter “Medical Error and Associated Harm - The Critical Role of Team Communication and Coordination” of the book “Vignettes in Patient Safety” the authors claim that “the focus on patient safety has its genesis in the combined desire and duty to “do the right thing” in conjunction with the realization that there is an unacceptably high prevalence of avoidable adverse events, we must all join forces and make the effort to meaningfully contribute at the personal, team, and institutional levels” . We find here words and issues which by natural meaning are connected with the spiritual management tool, supporting the link between spirituality at work concept and effective teamwork.
Many researchers emphasize the importance of spirituality at work within organizations, and this growing interest among academics, managers, and the general public . This approach can be seen as a new paradigm change inside the academic context and management thinking.
In recent years, research using diverse methodological approaches has led to significant progress in teamwork research in healthcare . This chapter explained the spiritual environment management tool concept and how can contributes to the creation of a multi-disciplinary care team - all working together - to help coordinate and optimize the care of patients with complex medical problems.
To achieve collective prosperity through work, the International Labor Organization considers fundamental values as freedom, human dignity, social justice, security, and non-discrimination. The spiritual environment is aligned with these values as well as principles of the World Health Organization.
Spiritual environment, can play a fundamental role in healthcare organizations since spirituality at work is definable and measurable, and the inclusion provides intrinsic and extrinsic reasons as organizational affective commitment, job resourcefulness , and organizational performance [9, 28].
Attending the spirituality at work concept, a spiritual environment is created when the companies respect cultural diversity and personal values of workers by implementing employee development programs, employee participation in the decision, and healthy employer-employee relations . The implementation of spiritual programs can boost results at the individual level, such as self-efficacy, greater willingness to cooperate, grow, learn, and adapt to challenges [1, 25, 27].
The spiritual practices should respond to organizational and individual concerns as explained in Subsection 2.2. To create a spiritual environment a greater consensus is required to move the whole organization.
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