Undoing the damage of Mid Staffs may be a bit more complex than that. But is HR up to the task?
Most NHS employees probably gave up reading the popular press long ago. If they haven’t, the headlines of the past few weeks may have tipped them over the edge: a damning report into the failings at Mid Staffordshire NHS Foundation Trust, grim warnings of financial cuts to come and dire pronouncements from ministers.
The report into Mid Staffs called for a change in culture across the entire NHS, with a total of 290 recommendations. HR undoubtedly has to be part of that. “This is a real opportunity for HR leaders to step up to the plate,” says Kevin Croft, president of the Healthcare People Management Association (HPMA) and director of people & OD at Epsom & St Helier University Hospitals NHS Trust. There has been “constant improvement” over the past 20 years, he says, but the latest staff survey shows that “HR leaders have not really managed to establish high quality people management across the [entire] service”.
Although the survey revealed improved job satisfaction, only 28 per cent of employees say senior managers involve staff in important decisions and only 55 per cent receive clear feedback.
More work also needs to be done to ensure staff are confident that senior managers will act on concerns – while 86 per cent felt encouraged to report errors, only 61 per cent thought action was taken to prevent errors occurring in future.
US expert Don Berwick, called in by David Cameron to head a national advisory group on patient safety, believes the NHS has the capacity to be the safest healthcare system in the world. Can HR play its part in that transformation?
“There has been increased professionalism in terms of the role of HR and the contribution it makes,” says Dean Royles, director of NHS Employers and chair of the CIPD’s executive board. “We have won the argument around the value of HR but there is more we can do in terms of encouraging more and more people to take up that challenge.”
That will no doubt be helped by the creation of a new NHS HR Partnership set up by the CIPD, HPMA and NHS Employers. After all, as Michael West from Lancaster University Management School points out: “The biggest cultural challenge facing the NHS is increasing the involvement of staff in all levels of decision-making, encouraging innovation and engaging. That fundamentally requires HR to recognise that its role is to shape the culture.” He should know – a decade ago his groundbreaking research proved there was a strong correlation between people management and patient mortality. So what should HR be doing?
1. Be open and honest
Health secretary Jeremy Hunt believes the newly imposed ban on gagging orders for departing staff will help to create a culture of openness and transparency, but whistleblowers are merely the thin edge of the wedge. Existing NHS staff need to feel safe raising concerns and that comes down to organisational culture.
“Involving staff is one of the key things in creating an environment where people feel they can speak out,” says Croft, but he admits that the NHS still has some work to do in this area, with the staff survey showing work-related stress, harassment, bullying, abuse and feeling under pressure to come into work when sick are a reality for some.
Ben Willmott, head of public policy at the CIPD, says: “If you don’t consult staff as a leader you are effectively saying we don’t think staff have a valid opinion.”
2. Engage, engage, engage
If you want to pick just one area to focus on it should be engagement, says Royles, citing West’s ongoing research that shows engagement, in particular involvement in decision-making, is a powerful predictor of organisational outcomes. That’s something that’s been taken to heart at Countess of Chester Hospital. “The staff on the front line are very much the people who know how we can improve the quality of service,” says HR and OD director Susan Young. For example, “How are we doing?” noticeboards on the wards contain a number of measures, some of which the trust is targeted on and others that are suggested by staff – such as checking the call bell in the toilets after one distressed lady got locked in.
3. Empower line managers
HR professionals may be guardians of good people management, but it’s managers who have to deliver it, usually alongside a clinical role that leaves them with little time.
The HPMA’s “Appreciate” campaign, a 10-point people management checklist, includes areas such as recognition, empowerment, communication, accountability and involvement. “[Locally] we have put a lot more focus on the people issues within performance management meetings with the directorates and divisions,” says Croft. West adds: “If you want patients to be treated with respect, dignity and compassion, you have to ensure that managers and leaders in the NHS treat their staff with respect and dignity.”
4. Know your numbers
Young, an ex-tax inspector, admits she’s a bit obsessed by data but she believes HR is of a much better quality if it is driven by real numbers. “We have got a single system in the NHS that has all our staff records,” she says. “If I can understand my workforce, I know where there’s potential to make savings. In the last year, for instance, we were heading for an overspend on agency staff of about £3 million. Once we could understand why we were spending such a lot of money we could start to tackle the root cause.”
5. Focus on teamworking
Given that the best predictor of patient mortality is the percentage of people who work in well-structured teams, according to West, it’s unfortunate that only around 40 per cent of NHS staff are in proper, well-organised units. “At the basic level that means ensuring teams have challenging and measurable objectives, get feedback on performance, are clear who the other members of the team are, are working cooperatively together and meet regularly to review performance,” says West. “Just ensuring that is in place makes a real difference in terms of performance.” Croft says Epsom & St Helier will be working with 16 teams across the trust over the next 12 months, including the executive, using teamworking tools provided by Aston Business School.
6. Support the values
Around 40 per cent of NHS employees are support staff – but they cover around 70 per cent of the patient contact time, says Royles. “If we could really drive forward recruiting [support] people on the basis of values and train for skill, it would build confidence in the workforce and with patients.” He adds that among regulated staff (such as doctors), more involvement with higher education institutions would help to ensure people with compassion as a core value were recruited.
Croft says that putting patients first is a key component of most NHS values statements and the challenge for HR is to support the conversion of those values into behaviours that happen on every ward, every day. At Epsom & St Helier, this means talking to staff about what behaviours they associate with the values.
7. Don’t turn a blind eye
It may be the easy option to ignore poor performance, dysfunctional behaviour and conflict, but doing so can have profound consequences. Croft cites one organisation where a rise in stress-related absence turned out to be mostly due to poor performance by colleagues not being addressed. “It is about giving line managers the courage to have the conversation when they see behaviours that don’t fit the values, rather then letting that go on,” he says. “It is giving people the skills to have difficult conversations and making sure any formal process is managed effectively.”
✶ Mid Staffordshire public inquiry final report midstaffspublicinquiry.com
✶ NHS Employers nhsemployers.org
✶ HPMA hpma.org