Transcript Nurse Staffing and Patient Outcomes

Staff engagement and wellbeing in
the current climate…
Nursing Times Summit
4 March 2011
Dr Jill Maben
National Nursing Research Unit
King’s College, London
UK Nursing outcome study: effect of nurse patient ratio - odds
ratios for patient and nurse outcomes
2
1.92
Fair/poor quality care
1.78
1.71
1.5
High emotional exhaustion
Job dissatisfaction
1.26
Mortality
1
<8.3 patients
per nurse
8.6-10 patients
per nurses
10.1-12
patients per
nurse
>12 patients
per nurse
Nurse patient ratio (quartile)
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.
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…..
… over 80% of staff felt that their health and well-being impacts upon
patient care, and virtually none disagreed…
52.8%
60.0%
50.0%
40.0%
32.5%
30.0%
13.2%
20.0%
10.0%
1.1%
0.4%
Neither
Disagree
Disagree Nor
Agree
Strongly
Disagree
0.0%
Strongly
Agree
Agree
Source: RAND Europe
Inconsistent Provision and Management Support
Yet less than 40% of staff believe their service proactively tries to improve
staff H&WB, other issues also exist…
•
•
Cultural barriers and management practices
• Less than half staff believe concerns are listened
to
• Major barrier believed to be management and
leadership ‘buy in’
50.0%
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”
30.0%
41.7%
40.0%
30.0%
15.3%
20.0%
7.8%
10.0%
5.2%
0.0%
Strongly
Disagree
Disagree
Neither
Disagree
Nor Agree
Agree
Strongly
Agree
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:
Disengaged:
• Proactive, take the
• Reactive, go through
motions
initiative
• Less stressed, or able to
manage stress
• May be stressed but not
productive
• Own goals compatible with
those of employer
• Not committed to
organisation
• Want to stay and develop
• 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?