Staff engagement and wellbeing in the current climate…

Nursing Times Summit4 March 2011

Dr Jill MabenNational Nursing Research UnitKing’s College, London

Source data: Rafferty, A. M., S. P. Clarke, et al. (2006). "Outcomes of variation in hospital nurse staffing in English hospitals: Cross-sectional analysis of survey data and discharge records." Int J Nurs Stud.

UK Nursing outcome study: effect of nurse patient ratio - odds ratios for patient and nurse outcomes

1.92

1.78

1.71

1.26

1

1.5

2

<8.3 patientsper nurse

8.6-10 patientsper nurses

10.1-12patients per

nurse

>12 patientsper nurse

Nurse patient ratio (quartile)

Fair/poor quality care

High emotional exhaustion

Job dissatisfaction

Mortality

Burnout….“A persistent negative work-related state of mind

in normal individuals that is primarily characterised by exhaustion, which is accompanied by distress, a sense of reduced effectiveness decreased motivation and the development of dysfunctional attitudes and behaviours at work” (Schaufeli and Enzmann 1998)

“Depersonalisation is the area that is most likely to limit

compassion or, worse, produces cruelty in dealings with patients” ….(Firth-Cozens and Cornwell 2008)

Health and wellbeing…..

Source: RAND Europe

… over 80% of staff felt that their health and well-being impacts upon patient care, and virtually none disagreed…

Inconsistent Provision and Management Support

• Cultural barriers and management practices• Less than half staff believe concerns are

listened to• Major barrier believed to be management

and leadership ‘buy in’

• Staff attitudes and engagement• “... would require a massive culture

change to see it as a professional duty to take care of ourselves and each other”

Yet less than 40% of staff believe their service proactively tries to improve staff H&WB, other issues also exist…

5.2%

15.3%

41.7%

30.0%

7.8%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

StronglyDisagree

Disagree NeitherDisagree

Nor Agree

Agree StronglyAgree

Source: Staff Perception Survey, Boorman Review, 2009

What Matters to Staff…(DH 2007)

Engaged Employees …• respect colleagues and helps others

• willing to ‘go the extra mile’

• work to make the organisation better

• … and so bring patient and organisational benefits

(multiple sources such as Gallup show similar figures)

Why does engagement matter?Engaged:

• Proactive, take the

initiative

• Less stressed, or able to manage stress

• Own goals compatible with those of employer

• Want to stay and develop

Disengaged:• Reactive, go through motions

• May be stressed but not productive

• Not committed to organisation

• Want to leave but can’t

Enabling engagement: the drivers• feeling valued and involved• two-way communication • development opportunities • good management (*of frontline staff by

frontline staff)• interesting, satisfying work with job autonomy• organisation is serious about staff safety,

equality of opportunity and staff well-being• aligned performance – staff understand their

contribution• reward and recognition (not necessarily

financial)

Robinson IES 2009

Positive, optimistic and warm

Robinson: IES: The Engaging Manager 2009

Communicating and listening

Robinson: IES: The Engaging Manager 2009

Protecting team and individuals

Robinson: IES: The Engaging Manager 2009

Training in people management• What makes a good manager?

• What training do supervisors and first line managers get in managing people? Many training budgets diverted away from people at this level?

Senior management• Managers are people, too, who need to

be managed in an engaging way – are they? Will they take their behavioural cues from how they are treated?

• There will always be engaging managers in any organisation, but to really embed engaging management, senior leaders need to lead by example – do they?

Key messages• Staff wellbeing critical for motivated and engaged

workforce & kind, compassionate patient care• Motivated & engaged workforce critical to service re-

design & delivery of £20bn savings• Staff burnout more likely in an NHS needing to save

costs either through workforce reduction or increased acuity or throughput

• Evidence suggests frontline staff not heard nor feel valued in times of change and financial downturn….

• Line managers – interaction and management style critical to support engagement and motivation….. especially in time of change and upheaval and system ‘stretch’

• Who supporting the managers? Blame culture? and what training available for managing staff in turbulent times to retain / increase engagement and motivation?