Jill Maben: 'We need strong evidence to improve standards'
Hearsay, common knowledge and instinct are not enough. Strong evidence is needed if we are to make the case for ensuring staff wellbeing, says Jill Maben
A three-year study by the National Nursing Research Unit, reporting links between staff wellbeing and patient experience, was recently reported on nursingtimes.net (“Nurse wellbeing has ‘direct impact’ on patient care”, http://tinyurl.com/czz2sgv). Many readers responding online were not impressed, suggesting they could have “concluded this study in 3 seconds” and wondered: “How much of a slice of the NHS pie did these numpties get to tell us something that we already knew?”
As the lead “numpty”, I can tell you that the way research is funded in the UK (by the National Institute for Health Research) does not take away from the NHS pie and from frontline staff. And, while I totally sympathise with the frustration felt by nurses responding, I’m depressed by some of the hostile comments, and the failure to see this research as a useful tool to argue for the resources and support that staff need to do a very difficult job.
“The fact that we found evidence of a link between staff wellbeing at work and patient experience is important”
I care passionately about how best to support staff in practice to deliver high-quality care – we are on the same side – yet, when nursing research with important policy relevance gets publicity, there are those who feel the need to insult those undertaking the research. In doing so, they miss the important wider picture.
In the current climate what we – together – need most is to argue for the resources required to deliver high-quality care. To do that, we need evidence. It is not enough for us to know instinctively that “happy staff equals happy patients”. We need clear evidence that it is true for a specific team of staff delivering care to a group of specific patients.
Our study set out to examine how and why staff wellbeing at work matters, not just to staff but to patient care too. We wanted to see how it differed between areas, with different patients, different staff and different degrees of emotional labour. We therefore undertook detailed fieldwork in eight case studies – four in the community (including a rapid response team and adult community nursing) and four in the acute setting (including acute admissions and care of older people).
Our study involved more than 200 hours of direct care observation, more than 100 patient interviews and nearly 500 patient surveys, interviews with 55 senior managers, surveys of more than 300 staff and 86 staff interviews at four trusts. The majority of our respondents were nurses, but some were doctors and allied health professionals.
The fact that we found evidence of a link between staff wellbeing at work and patient experience is important. One of our key findings is that in all settings it was not the wider organisational climate that mattered most to staff (as evidence outside healthcare suggests), but that the local team climate is crucial – what participants called “family at work”.
Our evidence supports calls for investment in unit level leadership to create well-functioning teams in challenging contexts. Our research supports the case for staff wellbeing champions to be embedded in NHS trusts at board level so that staff experience becomes as important as patient experience for the board. Because we now have evidence that the two are so closely intertwined, we can argue that looking after staff is key to improving experiences for patients.
This study is now part of the evidence base. As nurses, we can and should use it to challenge organisations with poor practice.
The research has been presented to the select committee on public service and demographic change regarding the quality and performance of the health and care system for older people. It is up to all of us – nurses and researchers – to use it to help secure improvements in our working lives and to ensure high-quality care for our patients.
Jill Maben is chair in nursing research at the National Nursing Research Unit, King’s College London