“Employers have to get the balance right; empowering and motivating their team to do and be better.” Dr Andrew McCulloch
It is widely thought that there is a fundamental relationship between staff and service user experience, and that this plays a massive part in the quality of the consumer experience. Happy, motivated employees provide a better service than their miserable, disengaged co-workers – don’t they?
Although this is a perception observed by, and apparently obvious to consumer industry employees and customers alike (including me!), it is not a formula that can be directly applied to all service areas without taking account of some other factors. The reality – particularly in the case of the health and social care industry, is much less black and white, and far more complex.
In fact, analysis of previous national surveys of NHS staff and patients show mixed correlations. There are some strong correlations (in the order of r=0.6 to r=0.7) but others are moderate or weak. This begins to show just how complex the relationship between staff and patient experience is. Although the relationship is important in understanding the quality of care provision, it is not the only consideration.
Though staff play a massive role in people’s experiences of care, the responsibility for this exchange does not solely lie with them. Other factors, ranging from obvious infrastructural building conditions (environment), to forward planning issues surrounding waiting lists and staff shortages (process and resources), and less visible, internal communications issues (culture) have key roles. For example, line management, or basic and continuing training, can have a significant, positive or negative impact on both parties. Equally they are issues that neither individual staff nor patients have the power to alter or improve. Therefore for health and social care staff experience to be truly understood, a complex web of factors must be appreciated.
Perception bears massive influence on experience, and in this case how staff perceive themselves, their roles, their employers, and in turn, their own value. Since it is neither visible nor tangible to others, monitoring staff feedback is key to understanding such perceptions, and preventing them from becoming ingrained, warped, or worse; impacting an individual’s morale and/or productivity. This is about how the individual sees themselves, in terms of their job, the organisation, and their relationship to the organisation’s culture.
Without measuring staff feedback, there is no way to truly understand the reality of their experience, and no objective to benchmark it against. Instead employers just come to see their team as being either satisfied or dissatisfied, without any recollection of why, or, more crucially, what they can do to change this. For measures to be accurate and actionable, a high feedback response rate is key, as is a consistent spread of data to draw from. Without either, it is impossible to determine a majority opinion, or observe changes and trends, as they emerge over time.
Wellbeing is also a pivotal piece of the healthcare staff experience landscape. Left ignored, it can not only make or break this experience, but the quality of the care delivered. Healthcare is essentially a human business, where the staff are core to productivity. When you consider this, and the fact that the current percentage of sickness related absences in the NHS can stand at 5-6%, the value of wellbeing and stress management becomes clear. This can be compared with for example, medium sized charities like Picker where absence is less than 1%, often much less. Prioritising staff wellbeing, could not only go a long way towards cutting the organisational sick rate, but increasing productivity and delivering better care for patients.
It’s also important to set realistic expectations, both on the individual and the organisation. Some jobs are naturally more stressful than others, while it can be better managed, it can not necessarily be removed. It stands to reason that taking responsibility for another life would be more stressful than roles with no human impact. But if you select the right workforce, and nurture them accordingly, naturally stressful environments do not have to affect contentment levels. The difference can be as simple as providing an additional layer of support, by making more time to check on an employee’s work-load, or by providing fora for staff discussion and support.
With any workforce, in any environment, support is key, and underpins staff empowerment, wellbeing and morale. Each one directly impacts the other, playing an equal role in the staff experience. Air traffic control is sometimes quoted as the most stressful job, and yet there are happy teams in this arena.
Staff empowerment is key to turning negative factors into positives. When there is a visible path to improvement, either walked independently, or organisationally, staff will naturally feel better about their roles and themselves. A difference that becomes apparent to the patient, and forms part of their positive care experience. Admittedly, against a backdrop of increasing funding cuts, and staff shortages, this positive picture of achievement is easier to visualise than it is to meet, but regardless, it is essential to navigate. Failure to do so, and the knock on effect of low staff morale, motivation and ability is potentially lethal, both to the individual and to the patients they care for.
Healthcare employers have to get the balance right, continuously asking the right questions, monitoring and listening the responses, and in the process empowering, motivating and growing their team to do and be better. It’s important to say that there are many NHS trusts who do all of these things and are getting it right. We suspect that these organisations are getting the best results, and delivering the best care for patients but we need to refine our metrics to get a better handle on exactly what works best.