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Managers 'much more positive' about workplace culture than nurses

Executive directors are far likelier to have an upbeat view of their organisation’s working culture than other staff, such as doctors and nurses, according to research.

This was one of the key findings from a survey of 2,000 NHS staff published today by the King’s Fund think-tank.

The survey revealed a “consistent disconnect” between the views of executive directors and other NHS staff, especially nurses and doctors, the King’s Fund said.

Executive directors tended to be much more positive about the working environment and culture within their organisations than other staff, especially nurses.

For example, 63% of executive directors said there was a “pride and optimism” among staff, as opposed to only 20% of nurses and 22% of doctors.

“The disconnect between the views of executive directors and other staff, especially nurses and doctors, is cause for concern”

Nicola Hartley

Meanwhile, only 39% of NHS staff felt that their organisation was characterised by openness, honesty and challenge – despite the warnings made around these topics in last year’s Francis report into care failings at Mid Staffordshire Foundation Trust.

In addition, the survey found staff thought inappropriate behaviour was not being dealt with effectively or quickly enough in their organisation.

This was the view of 43% of NHS staff questioned and 16% of the executive board members who were surveyed.

Most staff (89%) said they thought their organisation encouraged feedback from patients, while 61% thought the feedback would be acted upon.

The King’s Fund noted that dealing with inappropriate behaviour effectively was an important process to ensure the right cultures are fostered which will deliver high-quality patient-centred care.

Commenting on the survey findings, the fund’s director of leadership development Nicola Hartley said: “The survey reveals a mixed picture of leadership and compassion in the NHS. The disconnect between the views of executive directors and other staff, especially nurses and doctors, is cause for concern.

King's Fund

Nicola Hartley

“Creating truly compassionate patient services requires collective leadership, where all staff take responsibility for the success of the organisation and that this is actively promoted by leaders in the organisation.”

The survey was carried out from February to March in partnership with a range of organisations including the Royal College of Midwives, the Royal College of Nursing, medical royal colleges and several groups representing NHS managers.

RCN chief executive and general secretary Peter Carter said: “There is a worrying discrepancy between the upbeat views of NHS executives and the far less positive perceptions of senior nurses, who are anxious about their organisation’s working culture and are not confident that concerns will be taken seriously.

“Nurses in the NHS are extremely hardworking and dedicated to their patients,” he said. “It is demoralising for them to feel that their organisation isn’t delivering the highest possible standards in patient care.”

He highlighted the importance of health service leaders walking the wards and talking to senior frontline nursing staff.

“It is demoralising for nurses to feel that their organisation isn’t delivering the highest possible standards in patient care”

Peter Carter

Professor Norman Williams, president of the Royal College of Surgeons, said it was vital that staff avoided burying their heads in the sand when problems cropped up.

He added that addressing problems swiftly and effectively could prevent a deterioration in care quality.

Professor Williams backed a report accompanying the survey, which called on the NHS to foster better cultures of care by promoting a system of collective leadership in which all staff take on responsibility for their organisation’s success.

He added that it was crucial that worries could be raised and acted upon openly, safely and speedily.


Readers' comments (18)

  • None of this surprises me as a hardworking nurse on the frontline services. It would appear from this survey that NHS management teams across the country are not interested in the concerns that stops nurses delivering the high quality patient centred care that they strive to give in their patients. More and more nurses are leaving the NHS because they are feeling demoralised. Too many managers and not enough staff to deliver the care that people deserve when they come into hospital. We have had nursing staff who have retired or moved on and they have not been replaced for the past 18 months and now we have a nursing shotage in most areas.

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  • As someone who worked for 20 years in industry, in the private sector, before joining the NHS, this scenario is certainly not unique to the health sector. My perception is that a 'positive' world view is part of management culture in any organisation ... because it is inherent in senior managers that they should be seen to be positive and upbeat rather than negative and cynical; somewhat like politicians, there is a belief that a positive 'spin' should be found in all situations.

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  • It is because most of the managers have no concept of life on the front line.

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  • Our staff survey results were shockingly bad, the management's response? Well they decided to ignore it!

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  • "He highlighted the importance of health service leaders walking the wards and talking to senior frontline nursing staff".

    Perhaps it might be best to talk to the most junior ones - who are actually delivering the care. And not just talk, but listen and act upon what they hear, rather than deciding to ignore what they don't like.

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  • michael stone

    'For example, 63% of executive directors said there was a “pride and optimism” among staff, as opposed to only 20% of nurses and 22% of doctors.'

    To state the blindingly obvious: if you want feedback about 'pride and optimism' amongst doctors, ask the doctors; if you want feedback about 'pride and optimism' among nurses, ask nurses; only ask executive directors, if there is 'pride and optimism' amongst executive directors.

    It really isn't rocket science !

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  • tinkerbell

    most managers might appear to listen but ultimately once they turn away it's mostly a case of 'face - bothered?' cos nothing seems to make any difference no matter how often nurses express their concerns. If they had listened then mid staff wouldn't have happened and still it seems to be going on elsewhere. This change is taking so long to come about some of us might not see it in our lifetime. All this talking is not the same as taking ACTION! and we are running out of time and sadly peoples lives at are stake, what does it take to get the message home that ENOUGH IS ENOUGH!

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  • Agree with all the above; like the musicians playing while the titanic sinks!

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  • michael stone

    tinkerbell | 22-May-2014 4:37 pm

    Tink, I'm cautiously optimistic about one thing: I've been swapping e-mails with various people at the Care Quality Commission during the last 6 months, and I think the CQC really does want things to improve. I'm not yet convinced, however, that the CQC will be able to force things to improve.

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  • michael stone | 23-May-2014 2:48 pm

    are you running the whole show yet?

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  • tinkerbell

    Mike, I don't enjoy bursting anyones bubble, but all the tory 'sleepers' are in place now to privatise the nhs, they're all at it. So if you think things are going to improve I wouldn't be holding your breath.

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  • tinkerbell | 23-May-2014 3:39 pm

    determined to blame the tories but they are all in it. it is cross party politics and the future plans have been made and approved by tories and labour alike decades ago. some reforms have been introduced more gradually than others and the final step in the reforms is the speculation by senior medical and other hc staff to introduce some type of insurance so that patients pay up front for their care instead of through general taxation. timing is key for the least damage to these parties and both are reluctant to introduce it because of the effects on their chances of election or reelection.

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  • tinkerbell

    yes they're all in it, but tories are in it now, and we have to deal with what we have now, what's done is done and we can't get in a time machine and change that can we?
    So vote NHA Party if you want to see an end to this 'pushmepullme' state of affairs with OUR NHS. Otherwise just sit back and state the obvious and no change with ever occur.

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  • I agree with you that the here and now is important and has to be dealt with but it doesn't alter the fact that all of the NHS reforms have been in the planning for decades and involve all parties. it is just a question of timing and when and which one decides to implement them. it is an ongoing process and it is highly unlikely that at this late stage all of of the plans already carried out or still in the pipeline are reversible. It has also been said by the experts that the public and NHS workers have no idea of half of what is actually going on.

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  • tinkerbell

    that was also said by Lord Owen at the NHS rally. We really are clueless. Time to participate in change so that we are not held to ransom by corrupt politicians who are totally disconnected from ordinary folks reality rather than lie down and roll over.

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  • michael stone

    tinkerbell | 23-May-2014 3:39 pm

    Tink, I'm not holding my breath - I'm as worried as you are.

    The only really good way to persuade a politician to do something, is usually to convince him/her that 'unless I do it, I'll get voted out of office'.

    But I can only try ! And I'm fairly sure that it would be better, if more people tried.

    What we need, is for Tink to trap Hunt (or better yet Cameron) on camera into a 'Joanna Lumley [Gurkas] moment'.

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  • tinkerbell

    michael stone | 24-May-2014 3:20 pm

    can't knock you for trying, at least you are doing 'something' and each of us in our own way must if we want to see any change. The pity party must end and spur us to action.

    there are plenty of others out there also trying and thank God! Vote NHA or labour, I am mostly tweeting now and there's a movement afoot. Hallelujah!

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  • Tiger Girl

    I would love to see Tinkerbell trapping Cameron in a Joanna Lumley moment!

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