Empowered and engaged NHS staff will provide better care

Empowered and engaged NHS staff will provide better care A study shows a mismatch between the positive outlook of NHS managers and staff who feel overworked and disempowered.

It should not be news to anyone working in healthcare that the way staff feel about their workplace has an impact on the quality of patient care, as well as on the efficiency and financial performance of an organisation.

This has been driven home by the Boorman review on the importance of health and wellbeing in the NHS. Research also demonstrates the link between staff satisfaction and mortality rates, that higher staff satisfaction is linked to higher patient satisfaction, and that staff experience shapes patients' experience, rather than the other way around.

Yet despite these studies, NHS staff engagement – as measured by a score from the NHS staff survey, which takes account of measures including staff involvement and overall job satisfaction – fell for three consecutive years from 2009 before rising slightly in 2012. Only 55% of staff would recommend their organisation as a place to work.

Working in healthcare ought to be rewarding and interesting, yet all too often healthcare professionals feel overworked, disempowered and unappreciated. This is not a unique NHS problem: research shows it's a problem in healthcare in all the advanced economies worldwide. According to the Boorman review, healthcare staff in the UK report higher levels of stress and burnout than those in other sectors. In 2013, over a third had reported feeling unwell as the result of work-related stress in the previous year. Among nurses, the figure was 55%.

Caring for patients is hard work. It is especially hard during a period of institutional change such as we are experiencing now, because this creates uncertainty and anxiety about job security and the future. Feeling valued, supported and listened to is crucial if staff are to have the mental and emotional stamina needed to provide the best-quality care.

However, as the Point of Care Foundation's report published today highlights, only one in three NHS staff say communication between senior managers and staff is effective. And while three-quarters of staff say they are able to make improvement suggestions, only 26% say senior managers act on them. Yet our research shows senior leaders report a far more positive outlook, citing staff engagement as one of their top priorities and an overwhelming confidence that staff can raise concerns.

This sort of gap between perception and reality can undermine confidence and enthusiasm and engender cynicism. I don't believe it's the product of deception or deliberate intent, it is the inevitable result of people positioned at different levels of the hierarchy having different experiences and points of view.

Bridging the gap is possible, but it requires deliberate and intentional action on the part of senior executives to overcome it. It requires clear communication, trust and acknowledgement of the experiences of others. Our report, has eight case studies of organisations initiating good practice.

There is not one single lever that can be pulled to engage staff. But there are steps board members and managers can take to increase staff wellbeing and engagement. These include:

• Articulating values in plain English and showing how they translate into behaviours

• Giving frontline staff responsibility and authority to solve the problems they think affect patient care

• Creating time and space for staff to reflect on the emotional challenges in their work with patients. Schwartz Center Rounds sessions, which the foundation supports, are one way of doing this.
• Training line managers in people management skills – including the large number of clinicians who lead and supervise other staff but don't see themselves as managers.

These steps are important, but they are not a substitute for taking a truly strategic approach to staff engagement. Good practice in a couple of teams or on a couple of wards is not going to bring about the level of cultural transformation called for by the Robert Francis's inquiry into Mid Staffordshire NHS foundation trust. This is why our report calls on the NHS to make supporting staff a central driver of its strategies to improve patient care, productivity and financial performance.

Jocelyn Cornwell is the founding director of the Point of Care Foundation Guardian Professional.