As far as patient and staff experience is concerned, no problem is too small. As well as tackling the issues, leaders must involve their teams in the solutions, says Jocelyn Cornwell. Leave a comment on on this story to contribute to a national debate on the future of NHS leadership
The research evidence that links staff engagement with enhanced patient outcomes and experience is powerful. We know that organisations with satisfied staff
score well on patients’ experiences. We also know that teamworking is good for the mental health of both staff and patients, and that hospitals with good human
resources and management practice, with training, appraisal and team building, have higher levels of patient satisfaction and staff motivation and, importantly, lower patient mortality than others.
Those investigating NHS hospitals where patients have suffered very poor care have all found: remote and inaccessible managers who refused to listen to staff
and would not involve them in decisions; bullying; low staff morale; fatalism among clinicians about management; and a reluctance to raise concerns.
There is much more to learn about the quality of relationships between managers and staff and how they affect patient outcomes and experiences. What exactly is
it that connects the way nurses feel at work to the way they look after patients?
There is much we do know: evidence tells us nurse leaders who care about patients and about their organisations pay attention to how their staff feel about work and
about their employing organisation.
‘In hospitals with poor care, investigators have found remote managers who refused to listen to staff’
Consider this story and what it tells us.
A patient, asked about his experience in hospital, says his only minor complaint is that his morning cereal arrives drowned in milk. Hearing this, the charge nurse
seizes the opportunity to explore staff assumptions about patients’ preferences.
Rather than solve the problem himself, he asks the team to find a solution. Having consulted kitchen staff, they find they can provide milk in pitchers. They decide they will take patients their breakfast trays and remain briefly to check whether they need help with pouring.
The ward staff are stunned to discover the variation among patients on such a small matter, a revelation that clearly has implications for other aspects of care.
The message the charge nurse has communicated is that patients’ experiences matter; that he is actively interested in helping staff to provide compassionate care; and that it is possible for the team to reflect together on the nature of their work and solve practical problems.
Is this a trivial story? No. Patients’ stories are full of “small” things. Cumulatively, it is the small things that serve to reassure, to build trust and confidence or, conversely, to fuel anxiety, mistrust and tension.
For me, the story speaks volumes about leadership that manages to communicate - through the behaviour of the charge nurse - that it does not take care-giving for
granted. What could be more important?
Staff engagement brings together “how staff feel” about work with “what managers do” and describes the two together in terms of the presence or absence of “engagement”.
You can find and measure engagement in staff surveys where it shows up in positive employee attitudes, commitment to and belief in the organisation and a
willingness to go the extra mile.
In business terms, it matters because it correlates with positive attitudes towards change and innovation, as well as higher productivity. It is associated with higher
satisfaction, which means that staff are less likely to want to leave, and therefore with lower staffing costs.
There are multiple connections between what happens at the top of the organisation and the shop floor. The behaviour and conduct of leaders is critically important.
There is a host of reasons why nurse leaders should be interested in staff experience. Even the act of taking an interest will improve staff engagement.
Jocelyn Cornwell, PhD, is director of the Point of Care Programme at the King’s Fund
The Department of Health and the National Leadership council want your views on how the NHS should be managed. You can contribute to the debate by posting a comment below