Published: 14/04/2005, Volume II5, No. 5951 Page 36 37

The Healthcare Commission's annual staff survey can help to identify how to improve employees' working lives.

Alexis Nolan reports

It is less newsworthy than the data on violence and harassment that created the headline reports in the media, but careful reading of the Healthcare Commission's staff survey highlights the organisations that are responding to staff concerns and making working lives better.

To find out how the NHS is looking after its staff, the commission asked almost 250,000 employees from around 600 organisations questions on how they felt they were being treated across 28 topics. Areas ranged from training and working hours to quality of senior management and work/life balance.

It is perhaps no surprise that the organisations that did well included many strategic health authorities. But arguably the attention should be on more patient-focused organisations:

the ones facing the tougher challenges of everyday NHS life and that can improve the patient experience through a happier workforce. The following four are among the organisations doing just that.

The pay packet pay-off If there is one thing never far from people's minds, it is money. So attaching information to employees' pay packets is a smart and simple way to get their attention. It has worked for The Royal Marsden foundation trust in London, which uses it as a quick and effective way of disseminating information.

When last year's staff survey was published, director of human resources Norma French presented the results to the board and the executive. Then the staff committees looked at the results and discussed the best way to address concerns and improve the environment to increase employees' perceptions about their workplace.

The results of those ideas were put into a plan, agreed at board level and implemented throughout the year. To make sure all staff knew what was happening, a summary of the action plan was attached to all employees' pay slips.

'That is why our response rate [to the staff survey] is consistently high, ' says Norma. 'Staff can see It is all worthwhile.' For Norma, the most pleasing aspect in the significant improvement the trust achieved on last year's survey is that specific efforts stretching back over 18 months are now showing some return.

And in common with others that have seen their performance improve, it is not down to highfalutin ideas but the simple, effective solution of listening to staff, putting in place common-sense solutions and communicating in effective ways - such as the pay packet concept - to show they are listening.

The Royal Marsden makes sure the resources it puts in to improve employees' lives are a direct result of the staff survey results. One area it has been working hard on is childcare and people with carer responsibilities.

The trust responded to staff concerns in these areas by appointing a care coordinator and providing childcare vouchers for staff to access subsidised nursery places and a play scheme where there was no capacity for on-site facilities.

'Another aspect That is come up over the past 12 months is training and development, ' says Norma. 'It is easy if you're a professional because It is mandatory, but we were falling down with non-professional frontline staff.' The trust has put more courses in place for these staff and made them more accessible. And the staff survey bears the results of that. The trust has shown a significant increase in the percentage of staff receiving training.

In the commission's latest NHS staff survey, the trust was high ranking across a number of measures. Among acute trusts it attracted the highest rating from staff for the quality of their senior management and was fourth for the amount of positive feeling expressed by staff.

Staying power Airedale primary care trust is one of the top performing PCTs in the staff survey. It was among the top 20 NHS organisations in nine of the 28 categories and was the highest ranked PCT for the quality of work/life balance, quality of senior management leadership, the extent of positive feeling of employees and staff's intention to leave.

Airedale PCT director of human resources and organisational development Lorraine Wardle puts the progress it is making down to the work started two-and-a-half years ago.

'We created a vision for our PCT with our people, ' says Lorraine. The message is not cold corporate-speak but a strategy full of words such as 'integrity', 'respect, 'dignity' and 'team', she explains.

'We are here to improve patient care and our ethos is to do that through our people, through transformational development, communication and listening to our people, not just paying lip service, ' she says.

Again, she reinforces the need to take staff ideas for improvement seriously, get to grips with creating solutions and share that with the rest of the organisation.

'Two to three years ago we started on working to build up that trust and respect with our staff, ' says Lorraine.

'Our people are passionate about the care they give. And because our staff have got that positive attitude and are committed, we know the patient is benefiting.' One example of where the PCT listened to what staff were saying was on palliative care. It responded to concerns about service provision by setting up a palliative care team.

'Carers and patients are reporting the difference the team is making to people near the end of their days, ' says Lorraine. 'It is a different way of caring for them.' Each year the PCT holds a series of development days to which every member of staff is invited. The first year these were held it was more a case of managers explaining how they wanted to work with staff and what they could expect from all managers and leaders in the PCT. 'When we held them last year, the biggest thing was that people were saying they really felt listened to, ' says Lorraine.

The PCT has an open structure for debate. Ideas are gathered and then given out to the most appropriate director for a response.

The ideas are then communicated across the whole organisation. Lorraine says the important thing is to deliver on commitments.

Some of the areas Airedale PCT will be looking to develop further are flexible working and childcare, with the intention of keeping its staff happy.

'At the end of our first two years as an organisation we knew we had low labour turnover. But we knew we couldn't rest on our laurels, ' says Lorraine. 'There are lots of other organisations out there with quite high profiles, so It is good to hear that we are doing something good to keep our people here. I am really pleased because I do not want our quality staff leaving us.'

Feedback time Wakefield West PCT is among the top 20 NHS organisations in 13 of the measures.

Head of communications Ruth Wilkin says the PCT's Team Link group, part of its Improving Working Lives programme, is a forum for a member from each team in the PCT to meet. Every six weeks they look at the results of the staff survey and at any action they should take.

'The idea is that people on the Team Link will feed back and gain feedback from staff on their team, ' says Ruth.

Since the last staff survey the PCT has taken action on areas such as violence - something that remains a serious problem for many NHS organisations, particularly ambulance trusts. The PCT has put bullying and harassment advisers in place as part of a newly drafted violence and aggression policy developed by Team Link and the working group the team set up to concentrate on the issue.

'We have also done a lot of work on incident reporting this year, ' says Ruth.

'We have had training in all staff locations to try to increase awareness of how to report incidents and where and how lessons can be learned.'

An open culture Tavistock and Portman trust is among the highest ranked mental health trusts in the staff survey, one of the top 20 NHS organisations in five of the categories and the fifth highest ranked for job satisfaction and ninth for support from supervisors.

Director of human resources Susan Thomas puts the positive feelings down to the commitment of staff and how the trust treats them. 'We have a very low staff turnover and I think That is perhaps what effects the job satisfaction and the amount of support people get, ' she says.

The trust is relatively small, employing just 450 people, and is highly specialised around therapeutic interventions.

'We are also a training organisation, so we train people who later apply for a job here and succeed, ' adds Susan. 'So in terms of clinical activity and training we are used to giving people supervision. It is integral to the way we practise.' The trust has carried out staff surveys for the last five years, has focus groups in place for staff to provide feedback and develop ideas and promotes an open culture. 'We try to show our staff we listen to what they tell us, ' says Susan. 'We take the evidence they give us and do something with it.' The trust has a staff advice and consultation service where employees can talk about issues with the clinicians and lay staff who make up the service. It tries to extend the care it shows to its patients to its staff.

'We are pleased to have performed well in work/life balance because It is very important that in specialising in the treatment of children and family groups we try to make sure that happens for our staff as well, ' says Susan.