The NHS needs to be careful to ensure it is not forgetting about its staff in its quest to improve patient care, says Jill Maben
The Mid Staffordshire inquiry highlighted poor staffing, a blame culture and senior leaders who were not listening, or could not or would not hear the cries of their own staff. Since then further reports have highlighted the challenges facing frontline staff. This summer the Commons health committee’s report highlighted the problems facing accident and emergency departments where staffing levels are low, primarily because these are not seen as good places to work. Then the Berwick review called for a no blame culture, which we are very far from realising in many healthcare environments in the UK.
‘Successful companies outside health, Disney and John Lewis for example, understand well the business case for supporting staff’
The recent report by Michael West suggests creating a work environment that supports, nurtures and really listens to staff is critical for safe and compassionate care delivery. This echoes findings from our own work at King’s College London. Examining links between staff wellbeing and patient experience we found evidence of a bullying and blame culture in some settings and an unwillingness to report problems up to the board by middle managers for fear of being seen as failing. Here too patient care suffered
The NHS is working hard to put patients first in all that it does, and rightly so – but in doing so it needs to be careful it is not putting staff last. Successful companies outside health, Disney and John Lewis for example, understand well the business case for supporting staff. The John Lewis motto is “partners first” – knowing that if their staff feel well supported, good customer care will follow.
Need for recognition
All staff, from directors to porters, need to feel recognition, thanks and support for the work they do. Yet far too few organisations truly listen to their staff or recognise the importance of their experience. Even fewer act upon what they hear to make staff feel it is worth speaking out – worth raising their head above the parapet to state that staffing levels are unsafe or that they are being bullied. We need to listen to staff better and act upon what they say if we want them to feel valued, remain in their chosen profession and deliver compassionate care.
The majority of people enter professional doctor and nurse education motivated by ideals and a sense of altruism, at least initially, but these qualities can become eroded over time by the demands of the system and the job.
‘Our work has found that compassionate high ideals and values, held dear by graduating students, can become abandoned and crushed’
There are particular challenges associated with working with, and directly caring for, patients. We ask staff in the NHS to not only deliver high quality care effectively and safely, all the time, but to empathise with their patients, to be kind, considerate and compassionate and to give of themselves. We ask them to do this all day, every day, in a fast paced environment where they often feel unrecognised and unsupported and where some will experience high stress and burn out. It is little wonder that some units have difficulty with staff turnover and recruitment.
Our work has found that compassionate high ideals and values, held dear by graduating students, can become abandoned and crushed, with nurses reporting some degree of burn out within two years of qualification. Across all staff groups, the demands of caring work mean that cynicism can develop and staff can become less empathetic and more distant from their patients. It is therefore critical to protect staff from the ravages of caring work. Everyone needs support and renewal.
Schwartz Center Rounds
Time to discuss care, debrief, share experiences and gain experience from each other has become eroded in our frantic work environments. Recognising this need, Schwartz Center rounds are supported in 31 organisations in the UK by the Point of Care Foundation with support from the Department of Health. The rounds are a method introduced from the US, which provide staff with a safe and facilitated space where they can meet together regularly to discuss the challenges of their work.
They are a multidisciplinary forum, where clinical and non-clinical staff come together for one hour, once a month, to discuss the psychological, emotional and social aspects of their jobs. They are not about seeking solutions, but about reflection and enabling staff to feel more connected to their colleagues and their own values and commitment to caring. The Point of Care Foundation trains local facilitators to run the Rounds and will soon be supporting them across all trust types, as well as in hospices and care homes.
‘Really relating to patients takes courage, humility and compassion on the part of staff. It also requires recognition, re-enforcement and support from colleagues and managers’
Rounds focus on the human dimension of medicine. An evaluation undertaken in the US found that they helped facilitate “changes in institutional culture and greater focus on patient-centered care [providing] an opportunity for dialogue that doesn’t happen anywhere else in the hospital”. It is the Point of Care Foundation’s commitment to use an evidence based approach to improving patient experience and supporting staff that inspired me to become a trustee.
Really relating to patients takes courage, humility and compassion on the part of staff. It also requires recognition, re-enforcement and support from colleagues and managers. Rounds help organisations to deliver those values which cannot be taken for granted in a staff group that is asked to go the extra mile at work every day.
Jill Maben is director, at the National Nursing Research Unit, Florence Nightingale School of Nursing and Midwifery, King’s College London and a trustee of the Point of Care Foundation