Staff wellbeing impacts on the ability to empathise with patients, says Michael West
Nurses, along with teachers, housing officers and welfare officials, are among the most stressed workers in the UK, indicating they experience emotional depletion, a lack of support and work overload. Yet nurses are called upon to deliver compassionate care all day every day.
Those leading NHS organisations must address this fundamental issue and recognise that the cultures of NHS organisations have to change. But how?
In the biggest-ever such research programme, funded by the Department of Health’s Policy Research Programme and published in September in the British Medical Journal Quality and Safety, we used observations in wards, primary care and accident and emergency units, conducted hundreds of interviews and studied board meetings over 18 months; we made extensive use of the national staff survey, patient satisfaction surveys and other national data to study acute, mental health, ambulance and primary care organisations across the whole of England.
“Too many nursing staff reported spending time on tasks that added no value to patient care”
We found considerable variation within and between trusts as well as clear clues about how to create healthy organisational cultures that support and sustain staff.
The annual NHS staff survey showed that where staff were strongly supported, felt positive about their leaders and felt they were listened to and appreciated, patient satisfaction, quality of care and financial performance were much higher. Staff absenteeism and even patient mortality were lower.
In the best trusts, staff were intrinsically engaged in their jobs, were proud of their organisations and were involved by their managers in decisions, and such trusts were high performers in terms of quality and safety. However, too many nursing staff reported spending time on tasks that added no value to patient care.
Appraisals and teamworking were often poor in the NHS and praise was too rare. Command-and-control style cultures were pervasive in many organisations. The most effective teams regularly took time out to review their performance and how it could be improved. Offering more praise and being supportive to hard-pressed staff is essential, as is dealing with disruptive, hostile or poorly performing staff, especially at senior level.
We found staff in the best settings worked in well-structured teams with clear, challenging and measurable objectives (true of only 40% of NHS staff). The best teams also focused working effectively with their health and social care colleagues.
In the best trusts, nurses were consulted about change and listened to when they identified care quality problems and solutions. In these settings, managers made the most of input from experienced, skilled and motivated staff. Unfortunately, many nurses had little sense of being able to control, influence or innovate. For trusts to perform well, there must be a radical transformation in how staff are involved in decision making.
Too often, staff were expected to work in environments that were not conducive to compassion, caring, respect and dignity for staff or patients. The best trusts had good systems, constantly evolving, to plan workload demand to ensure staff were able to deliver high-quality care with the right level of resources. Staff health and wellbeing was considered vital because the wellbeing of staff affects their ability to empathise with their patients. Our research suggests that if we want patients to be treated with care, compassion and respect, we must treat staff with care, compassion and respect as well.
Michael West is professor of organisational psychology at Lancaster University Management School and visiting fellow at the King’s Fund