title: Monitoring the health of the work environment with a daily assessment tool: the REAL - Relative Environment Assessment Lens - indicator.
abstract: BACKGROUND
  Evidence shows that the health of the work environment impacts staff satisfaction, interdisciplinary communication, and patient outcomes. Utilising the American Association of Critical-Care Nurses' Healthy Work Environment standards, we developed a daily assessment tool.
  
  
  METHODS
  The Relative Environment Assessment Lens (REAL) Indicator was developed using a consensus-based method to evaluate the health of the work environment and to identify opportunities for improvement from the front-line staff. A visual scale using images that resemble emoticons was linked with a written description of feelings about their work environment that day, with the highest number corresponding to the most positive experience. Face validity was established by seeking staff feedback and goals were set.
  
  
  RESULTS
  Over 10 months, results from the REAL Indicator in the cardiac catheterisation laboratory indicated an overall good work environment. The goal of 80% of the respondents reporting their work environment to be "Great", "Good", or "Satisfactory" was met each month. During the same time frame, this goal was met four times in the cardiovascular operating room. On average, 72.7% of cardiovascular operating room respondents reported their work environment to be "Satisfactory" or better.
  
  
  CONCLUSIONS
  The REAL Indicator has become a valuable tool in assessing the specific issues of the clinical area and identifying opportunities for improvement. Given the feasibility of and positive response to this tool in the cardiac catheterisation laboratory, it has been adopted in other patient-care areas where staff and leaders believe that they need to understand the health of the environment in a more specific and frequent time frame.
authors.affiliation: 1Cardiovascular and Critical Care Services,Department of Nursing Patient Services,Boston Children's Hospital,Boston,Massachusetts,United States America.
authors.forename: Karen E
authors.initials: KE
authors.lastname: Hinsley
authors.affiliation: 2Department of Cardiology,Boston Children's Hospital,Boston,Massachusetts,United States of America.
authors.forename: Audrey C
authors.initials: AC
authors.lastname: Marshall
authors.affiliation: 1Cardiovascular and Critical Care Services,Department of Nursing Patient Services,Boston Children's Hospital,Boston,Massachusetts,United States America.
authors.forename: Michelle H
authors.initials: MH
authors.lastname: Hurtig
authors.affiliation: 1Cardiovascular and Critical Care Services,Department of Nursing Patient Services,Boston Children's Hospital,Boston,Massachusetts,United States America.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Thornton
authors.affiliation: 1Cardiovascular and Critical Care Services,Department of Nursing Patient Services,Boston Children's Hospital,Boston,Massachusetts,United States America.
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: O'Connell
authors.affiliation: 1Cardiovascular and Critical Care Services,Department of Nursing Patient Services,Boston Children's Hospital,Boston,Massachusetts,United States America.
authors.forename: Courtney L
authors.initials: CL
authors.lastname: Porter
authors.affiliation: 1Cardiovascular and Critical Care Services,Department of Nursing Patient Services,Boston Children's Hospital,Boston,Massachusetts,United States America.
authors.forename: Jean A
authors.initials: JA
authors.lastname: Connor
authors.affiliation: 1Cardiovascular and Critical Care Services,Department of Nursing Patient Services,Boston Children's Hospital,Boston,Massachusetts,United States America.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Hickey
mesh_terms: D003142:Communication; D006801:Humans; D062527:Meaningful Use; D011795:Surveys and Questionnaires; D014481:United States; D017132:Workplace
keywords: Healthy work environment; authentic leadership; meaningful recognition; skilled communication; tool measurement