Current NHS priorities
Evidence shows clearly the case for staff engagement through the survey, with important links seen between staff experience, service quality, safety, productivity and the patient experience in the NHS. High levels of engagement result from a combination of experiences in the NHS including being supported, healthy, developed, fulfilled and motivated.
The survey has a critical role in supporting continuing delivery and will be equally important in the design of the new system. It can support NHS employers to improve health outcomes, to fulfil their duties under the NHS Constitution and deliver the priorities in the 2010/11 Operating Framework. It also supports effective system regulation through use of the data by CQC in Quality and Risk profiles. As David Nicholson’s letter of 10 September 2010 confirmed, it is important to maintain current performance and we have confirmed this includes running the NHS staff survey.
While we recognise the survey is not a replacement for necessary local staff engagement activities, as we begin the transition to a new health and care system, it is a vitally important indicator of how staff are responding to change and its management. This is only possible if the NHS staff survey is run in all NHS trusts and primary care trusts.
Staff survey results and the links to better patient care
There is increasing evidence of the relationship between staff experience, service quality, safety, productivity and the patient experience in the NHS. For example, one study(1) found relationships between HR practices and patient mortality in acute hospitals – the extent and sophistication of staff appraisals was shown to be particularly strong but training, team working, clarity on objectives, good leadership, and communication also matter.
Research(2) by the then Healthcare Commission in 2008 also shows that patient satisfaction and staff satisfaction go together. Although the nature of the relationship still requires further research, work by Aston Business School(3) on behalf of the Department of Health, is helping to understand the connections. For example, staff who are satisfied and engaged with their work are more likely to deliver a better quality of communication with patients which can help engage them in their treatment to deliver better outcomes.
The latest findings of research evidence from Aston Business School(4) shows that within NHS trusts levels of staff engagement are significantly linked to lower patient mortality, higher patient satisfaction ratings, lower absenteeism and more positive Care Quality Commission (CQC) annual health check ratings.
The SPF submitted evidence in direct response to Para 4, section (e) of the Francis Inquiry into the Mid Staffs NHS Foundation Trust based on its findings which demonstrate that staff engagement is a key driver for organisational health and performance.
There is increasing evidence of the relationship between staff experience, service quality, safety, productivity and the patient experience in the NHS. Measuring staff experience is important to identify where there may be risks and issues to those areas. Delivering improvements does however require the investment of leadership to meaningful staff engagement and this can be tracked through the national NHS Staff Survey.
The SPF evidence highlighted that the results from the NHS staff survey were one of the indicators which alerted the Healthcare Commission to potential problems (the question asking whether or not staff would be happy to be treated at the trust).
The evidence suggests that increasing the prominence of the staff engagement indicator as a measure of wider organisational health will help regulators and trust boards in the early identification of problems with the quality of care being delivered to patients.
The report on health and well-being in the NHS conducted by Dr Steve Boorman as well as identifying links to productivity and efficiency, also identified links between staff health and well-being and patient satisfaction, CQC annual health check scores, and MRSA rates.
All the important variables are reflected in the pledges made to staff in the NHS Constitution and are measured by the NHS staff survey.
The evidence of relationships provides the business case for change – for using the survey as a key management tool to understand more about local staff experiences, where there may be risks and issues, and where only by taking action to improve staff experience can trusts expect to deliver improvements in the quality of patient safety, outcomes and experiences.
Where can I find out more?
The Department of Health has produced a range of materials presenting the business case for the staff survey and highlighting recent research to support it.
These include a compelling case on why the NHS staff survey matters and a more detailed business case produced by the Institute for Employment Studies on behalf of the Department of Health which sets out this research and case studies for the staff survey.
NHS Employers in partnership with NHS trade unions has developed a useful series of resources which stress the importance of effective staff engagement and how the NHS staff survey can be used.
(1) West Midlands et al (2002). `The link between the management of employees and patient mortality in acute hospitals.’ The International Journal of Personnel and Human Resource Management 13 (8) 1299-1310.
(2) Raleigh, V (2008) `Surveys of inpatients and staff in NHS acute trusts: is there an association?’ Healthcare Commission
(3) `Does the work experience of NHS staff link to the patient experience of care?’Aston Business School ( 2009) www.dh.gov.uk
(4) The findings were launched at the NHS Employers' conference in 2010.