“Doing more with less” will doubtless become, once more, a well worn NHS and healthcare phrase when we become accustomed to the austerity measures which will be imposed on public services throughout the land, to assist with the deep debt crisis facing the country. It remains to be seen whether the legacy of the last few years of feast, will indeed be followed by famine. One of the key measures of continuing to meet demand for services, will be the resilience and coping mechanisms of healthcare providers. A broad ranging piece of research, undertaken by Ipsos Mori and published in 2008,1 might be of assistance to managers identifying how they can provide an interesting and motivating environment for their staff, while efficiency savings are implemented. A model identified by the research focused on a number of outcomes including:
• Staff motivation to provide high quality patient care.
• Staff advocacy of the NHS.
• Patient and public satisfaction.
It was considered that the NHS could enhance the delivery of the above, by focusing on meeting emotional and functional needs of their staff. A huge survey among 28,939 staff working in 48 Trusts and two SHAs was undertaken which added further detail – which were then grouped into four themes:
1 The resources to deliver quality care for patients
• I’ve got the knowledge, skills and equipment to do a good job.
• I feel fairly treated with pay, benefits and staff facilities.
2 The support I need to do a good job
• I feel trusted, listened to and valued at work.
• My manager (or supervisor) supports me when I need it.
• Senior managers are involved with our work.
3 A worthwhile job with the chance to develop
• I’ve got a worthwhile job that makes a difference to patients.
• I help provide high quality patient care.
• I have the opportunity to develop my potential.
• I understand my role and where it fits in.
4 The opportunity to improve the way we work
• I am able to improve the way we work in my team.
Dedication and motivation
The dedication and motivation of staff in health services have always been claimed to be the biggest assets, and managers and the new Government – as it settles down to work – would do well not to ignore the working environment for staff. Many of the above identified themes of what matters to staff, as they provide daily care to patients, are soft, mainly costneutral aspects of culture and safety at work. The time has come for moving away from the top heavy culture, where central management dictats , targets and reforms were the order of every day to be replaced by a more supportive culture which places the delivery of quality care at its heart. It is not possible for teams to function effectively where the culture is one of not being heard or valued as a human being. Staff need to be able to respond to change effectively (as there will surely be more on the horizon), in a supportive and empowering environment. Increases in productivity for less of the taxpayers money will inevitably be required. The research undertaken by Ipsos Mori provides a key to factors which could contribute to a re-energised health service with engagement and contribution from staff and professionals at every level. A clear picture emerges of how staff could be made to feel better about their working environment, their colleagues and their role. These factors are linked inextricably with public and patient satisfaction. Areas of the research which were identified to have the greatest impact on the culture are the role staff play and where this fits into the big picture. Helping staff to understand their role can increase motivation to provide high quality care and improve staff support of their employer and the wider NHS. The report identifies that by helping staff to understand the vision for the NHS and how their role contributes to the whole, both at local and national level, are important factors to individuals, driving forward change and improving morale. Staff motivation to improve aspects of quality delivery is improved when managers ensure they are able to provide an environment in which each individual can realise their potential. Managers should support staff to keep up to date with developments in their field and value individual expertise. The research also strongly identified that senior managers need to be more visible and involved with staff at the care delivery level. Managers need to listen to what their staff are saying and act on feedback wherever possible. Staff say that they want to be involved in decision making by their organisation and want clinical managers and non-clinical managers to be able to work well together.
Provision of the correct culture for staff to flourish
During its exploratory and qualitative research, Ipsos MORI reported that many participants harked back to a perceived ideal of the NHS, which followed the original vision of “healthcare for all, free at the point of delivery”, where staff enjoyed a vocation, when patient care was the centre of all activity and, importantly, there was job security. They saw instead a new reality somewhat contrary to their expressed philosophy – where business procedures (characterised by language borrowed from commercial enterprise), financial management, and the setting and meeting of targets, are the focal point for measuring success. The brave new healthcare world, in their view, has been subject to endless change – operating to an agenda that is politicised and where fresh initiatives, without rationale, have been regularly imposed. It could be argued, according to Ipsos Mori, that this has resulted in an inherent conflict between the old and the new, driving degrees of resentment, frustration and discontent among staff. While staff know the old model is no longer valid, they believe that the new model has “gone too far”. Therefore, there are very strong requests for a new way which could develop as the NHS of the future, using the best of both models to form a confident, efficient and caring organisation. This new reality, they hope, should refocus the NHS to deliver and celebrate the delivery of best care for patients, establish meaningful targets and introduce initiatives to support agreed and well communicated aims. The expression of a new NHS they hope will be communicated not only to staff, but be clear and known to patients, their relatives and the public at large. This, therefore, will form the basis of expectations and delivery for all interested parties.2
Reality and stress
Anecdotally and from a number of reliable sources, the present degree of stress being experienced in the healthcare world has never been so great. Stories of acute Trusts being required to cut up to 15% of their total budget, for the foreseeable future, will not enable managers to deliver any of the cultural change identified by the Ipsos research – quite the reverse. In times of extreme stress, with reorganisations, budget cuts and productivity increases on the agenda, soft objectives are often left behind on the “cutting room floor”. Managers engaged in facilitating change, and their political masters, would do well to consider seriously the findings of the research. Change is best delivered by staff who are engaged, listened to, feel motivated by developments, and are fully participating in the decision making. It is unlikely that the “good old days” will become a reality again; the world has moved on, society expects accountability from its public servants and good value for money is not only vital to current tax payers but an essential element of recovering from the huge debt crisis threatening to swallow the country. The reality of caring effectively for our patients is going to have to be undertaken in the context of a far more austere climate, where ideals expressed in the research will seem to be an echo from the past. We need to prepare ourselves for a rocky road ahead.
References
1 Ipsos Mori for the Department of Health: What matters to staff in the NHS, June 2008 accessed at www.dh.gov.uk/en/ Publicationsandstatistics/publications/ publicationsPolicyAnd Guidance/ DH_085536 2 Ibid.