FOSTER’S PHILOSOPHY
The marriage of leadership and care
© 2014 MA Healthcare Ltd
L
ast month, The King’s Fund launched a report on the review of NHS staff engagement (King’s Fund, 2014). The review found compelling evidence that NHS organisations with high levels of engagement deliver better quality care, with lower mortality rates, a better patient experience and lower rates of sickness absence and staff turnover. The review calls on all NHS organisations to make staff engagement a priority at a time of unprecedented financial and service pressures. The King’s Fund leadership review (2012) described employee engagement ‘as simply spelling out the relationship at its heart’. MacLeod and Clarke (2009) define staff engagement as when ‘the business values the employee and the employee values the business’. The King’s Fund (2014) found emerging evidence that staff-led mutuals deliver higher levels of staff engagement and recommends NHS organisations are given greater freedom to become mutuals. It calls on the government to gather further evidence on the benefits of mutuals and whether they could be adopted on a larger scale across the NHS. This is nothing new; for the last 5 years at least we have known the importance of a positive staff experience: Equity and Excellence: Liberating the NHS (Department of Health (DH), 2010a) confirmed the government’s commitment to staff engagement, The Operating Framework for the NHS in England 2011/12 (DH, 2011) defines requirements to complete the NHS staff survey, the quality accounts guidance (DH, 2012) recommends including staff survey results in returns and the NHS Constitution (NHS England, 2013) sets out the rights that staff can expect. Over the last decade, healthcare regulators have assessed levels of staff engagement. The Care Quality Commission makes judgments about providers based on various sources, including information on staff experience. The terms of reference cited in The Mid Staffordshire NHS Foundation Trust Inquiry included gathering staff views (Francis, 2010). The inquiry concluded that the culture of the trust from board to ward was not conducive to providing good patient care or a supportive working environment. A DH Staff Engagement bulletin cited the Social Partnership forum, which brings together NHS employers and trade unions, who told Francis: ‘Results from the NHS staff survey were one of the indicators that alerted the Healthcare Commission to potential problems. The 2006 survey showed only 27% of staff said that they would be happy to be cared for at the trust, compared to a national average of 42%’(DH, 2010b: 2). Organisational behaviour and the retention of a qualified, committed workforce might be a promising area to improve hospital care safety and quality, and this can be a relatively low-cost strategy. Research in the USA showed that best practices such as ‘magnet’
British Journal of Nursing, 2014, Vol 23, No 21
recognition are associated with successful organisational transformations (Aiken et al, 2008). Despite a strong evidence base that suggests links between leadership, staff experience and patient outcome, this learning has yet to be systematically put into practice. It is suggested that the annual staff survey, the minimum requirement for NHS organisations, is where most organsiations stop. Until we understand any valuable correlations, it is suggested staff experience will not be seen as a meaningful wardlevel key performance indicator. Sawbridge and Hewison (2011) note that, all too often, the final reports that follow the inquiries into failings in care produce recommendations and action plans to address failings with aims for NHS-wide learning. However, before long another report into poor care emerges. The findings of a systematic review undertaken by Wong and Cummings (2007) focused on leadership styles and outcome patterns for the nursing workforce and work environment, point to specific leadership approaches that are more effective at achieving positive outcomes than others. They conclude that as healthcare faces a looming shortage of leaders, nurses and all health professionals, implementing strategies to ensure effective leadership is paramount. By developing and promoting viable nursing leadership for the future, organisations can achieve the goal of BJN providing quality care for patients
Aiken LH, Buchan J, Ball J, Rafferty AM (2008) Transformative impact of magnet designation—England case study. J Clin Nurs 17(24): 33303337. doi: 10.1111/j.1365-2702.2008.02640.x Department of Health (2010a) Equity and Excellence: Liberating the NHS. http://tinyurl.com/mk4m6hd (accessed 12 November 2014) Department of Health (2010b) Staff engagement. Making a difference within your organisation. http://tinyurl.com/ldct4bx (accessed 13 November 2014) Department of Health (2011) The Operating Framework for the NHS in England 2012/13 http://tinyurl.com/n6nay5m (accessed 12 November 2014) Department of Health (2012) Quality Accounts reporting requirements for 2011-12 and planned changes for 2012-13. http://tinyurl.com/ mov3h5k (accessed 12 November 2014) Francis R (2010) Independent Inquiry into care provided by Mid Staffordshire NHS Foundation Trust January 2005–March 2009. http://tinyurl.com/o6shv97 (accessed 13 November 2014) King’s Fund (2012) Leadership and Engagement for improvement in the NHS. Together we can. http://tinyurl.com/bmqyoap (accessed 12 November 2014) King’s Fund (2014) Improving NHS Care by engaging Staff and Devolving Decision-Making http://tinyurl.com/k5ysb72 (accessed 12 November 2014) MacLeod D, Clarke N (2009) Engaging for Success: Enhancing performance through employee engagement. http://tinyurl.com/nz6mbks (accessed 12 November 2014) National NHS Staff Survey Co-ordination Centre (2013) Briefing note: Issues highlighted by the 2012 NHS staff survey in England. http:// tinyurl.com/prfbpro (accessed 12 November 2014) NHS England (2013) The NHS Constitution for England. http://tinyurl. com/c9qmsac (accessed 12 November 2014) Sawbridge Y, Hewison A (2011) Time to care? Responding to concerns about poor nursing care. http://tinyurl.com/74gambs (accessed 12 November 2014) Wong CA, Cummings GG (2007) The relationship between nursing leadership and patient outcomes: a systematic review. J Nurs Manag 15(5): 508–21. doi: 10.1111/j.1365-2834.2007.00723.x
Sam Foster Chief Nurse Heart of England NHS Foundation Trust @safetySamFoster
1165
British Journal of Nursing. Downloaded from magonlinelibrary.com by 130.194.020.173 on November 26, 2015. For personal use only. No other uses without permission. . All rights reserved.
The marriage of leadership and care
© 2014 MA Healthcare Ltd
L
ast month, The King’s Fund launched a report on the review of NHS staff engagement (King’s Fund, 2014). The review found compelling evidence that NHS organisations with high levels of engagement deliver better quality care, with lower mortality rates, a better patient experience and lower rates of sickness absence and staff turnover. The review calls on all NHS organisations to make staff engagement a priority at a time of unprecedented financial and service pressures. The King’s Fund leadership review (2012) described employee engagement ‘as simply spelling out the relationship at its heart’. MacLeod and Clarke (2009) define staff engagement as when ‘the business values the employee and the employee values the business’. The King’s Fund (2014) found emerging evidence that staff-led mutuals deliver higher levels of staff engagement and recommends NHS organisations are given greater freedom to become mutuals. It calls on the government to gather further evidence on the benefits of mutuals and whether they could be adopted on a larger scale across the NHS. This is nothing new; for the last 5 years at least we have known the importance of a positive staff experience: Equity and Excellence: Liberating the NHS (Department of Health (DH), 2010a) confirmed the government’s commitment to staff engagement, The Operating Framework for the NHS in England 2011/12 (DH, 2011) defines requirements to complete the NHS staff survey, the quality accounts guidance (DH, 2012) recommends including staff survey results in returns and the NHS Constitution (NHS England, 2013) sets out the rights that staff can expect. Over the last decade, healthcare regulators have assessed levels of staff engagement. The Care Quality Commission makes judgments about providers based on various sources, including information on staff experience. The terms of reference cited in The Mid Staffordshire NHS Foundation Trust Inquiry included gathering staff views (Francis, 2010). The inquiry concluded that the culture of the trust from board to ward was not conducive to providing good patient care or a supportive working environment. A DH Staff Engagement bulletin cited the Social Partnership forum, which brings together NHS employers and trade unions, who told Francis: ‘Results from the NHS staff survey were one of the indicators that alerted the Healthcare Commission to potential problems. The 2006 survey showed only 27% of staff said that they would be happy to be cared for at the trust, compared to a national average of 42%’(DH, 2010b: 2). Organisational behaviour and the retention of a qualified, committed workforce might be a promising area to improve hospital care safety and quality, and this can be a relatively low-cost strategy. Research in the USA showed that best practices such as ‘magnet’
British Journal of Nursing, 2014, Vol 23, No 21
recognition are associated with successful organisational transformations (Aiken et al, 2008). Despite a strong evidence base that suggests links between leadership, staff experience and patient outcome, this learning has yet to be systematically put into practice. It is suggested that the annual staff survey, the minimum requirement for NHS organisations, is where most organsiations stop. Until we understand any valuable correlations, it is suggested staff experience will not be seen as a meaningful wardlevel key performance indicator. Sawbridge and Hewison (2011) note that, all too often, the final reports that follow the inquiries into failings in care produce recommendations and action plans to address failings with aims for NHS-wide learning. However, before long another report into poor care emerges. The findings of a systematic review undertaken by Wong and Cummings (2007) focused on leadership styles and outcome patterns for the nursing workforce and work environment, point to specific leadership approaches that are more effective at achieving positive outcomes than others. They conclude that as healthcare faces a looming shortage of leaders, nurses and all health professionals, implementing strategies to ensure effective leadership is paramount. By developing and promoting viable nursing leadership for the future, organisations can achieve the goal of BJN providing quality care for patients
Aiken LH, Buchan J, Ball J, Rafferty AM (2008) Transformative impact of magnet designation—England case study. J Clin Nurs 17(24): 33303337. doi: 10.1111/j.1365-2702.2008.02640.x Department of Health (2010a) Equity and Excellence: Liberating the NHS. http://tinyurl.com/mk4m6hd (accessed 12 November 2014) Department of Health (2010b) Staff engagement. Making a difference within your organisation. http://tinyurl.com/ldct4bx (accessed 13 November 2014) Department of Health (2011) The Operating Framework for the NHS in England 2012/13 http://tinyurl.com/n6nay5m (accessed 12 November 2014) Department of Health (2012) Quality Accounts reporting requirements for 2011-12 and planned changes for 2012-13. http://tinyurl.com/ mov3h5k (accessed 12 November 2014) Francis R (2010) Independent Inquiry into care provided by Mid Staffordshire NHS Foundation Trust January 2005–March 2009. http://tinyurl.com/o6shv97 (accessed 13 November 2014) King’s Fund (2012) Leadership and Engagement for improvement in the NHS. Together we can. http://tinyurl.com/bmqyoap (accessed 12 November 2014) King’s Fund (2014) Improving NHS Care by engaging Staff and Devolving Decision-Making http://tinyurl.com/k5ysb72 (accessed 12 November 2014) MacLeod D, Clarke N (2009) Engaging for Success: Enhancing performance through employee engagement. http://tinyurl.com/nz6mbks (accessed 12 November 2014) National NHS Staff Survey Co-ordination Centre (2013) Briefing note: Issues highlighted by the 2012 NHS staff survey in England. http:// tinyurl.com/prfbpro (accessed 12 November 2014) NHS England (2013) The NHS Constitution for England. http://tinyurl. com/c9qmsac (accessed 12 November 2014) Sawbridge Y, Hewison A (2011) Time to care? Responding to concerns about poor nursing care. http://tinyurl.com/74gambs (accessed 12 November 2014) Wong CA, Cummings GG (2007) The relationship between nursing leadership and patient outcomes: a systematic review. J Nurs Manag 15(5): 508–21. doi: 10.1111/j.1365-2834.2007.00723.x
Sam Foster Chief Nurse Heart of England NHS Foundation Trust @safetySamFoster
1165
British Journal of Nursing. Downloaded from magonlinelibrary.com by 130.194.020.173 on November 26, 2015. For personal use only. No other uses without permission. . All rights reserved.
