People management in health care is a simple equation. If we want staff to treat patients with respect, care and compassion, we must treat staff with respect, care and compassion. If we don’t want staff to treat patients rudely, brusquely, aggressively or as onerous tasks rather than as vulnerable and often anxious human beings, we should not manage them rudely and aggressively.
Research evidence demonstrates that directive, brusque managers dilute the ability of staff to make good decisions, deplete their emotional resources and hinder their ability to relate effectively to patients, especially those who are most distressed or difficult.
The national staff survey data, collected between 2004 and 2013, is related directly to patient outcomes. Our research demonstrates clear links between staff experience and patient outcomes.
Satisfaction and Support
Patient satisfaction is highest in organisations where staff report clear goals at every level. In such organisations, patients say they experience good communication with staff and they feel involved in care decisions. Staff views of their leaders are strongly related to patients’ perceptions of the quality of care. The higher the levels of satisfaction and commitment that NHS staff report, the higher the levels of satisfaction patients report.
In particular, where staff report high levels of supportiveness from their immediate manager, patients report receiving better care also. And the more positive staff are about their work generally, the more positive are patients about their care. If leaders and managers create positive, supportive environments for staff, the staff in turn create caring, supportive environments and deliver higher quality care for patients.
Looked at in another way, when staff report poor health and well-being, trusts have higher injury rates, the patients are less satisfied, Care Quality Commission data indicate poorer quality of care and even poor financial performance of hospitals. And when staff say they are working in conditions of high work pressure, patients report too few nurses, insufficient support, lace of privacy and little respect in their treatment.
The data also show that as good HRM practices spread to include more staff, this is associated with low and decreasing levels of patient mortality. However, it is not just about increasing spread of poorly implemented HR practices. The data show that a well-structured appraisal leads to high staff engagement, better health and well-being while poorly structured appraisals have no effect. Although the percentage of staff receiving appraisals in the NHS has increased from around 60 to 76% over the last decade, the percentage reporting useful appraisal conversations has barely shifted from 35%.
What is the challenge?
The challenge is to ensure HR practices are of high quality in influencing for good, staff performance – too many appraisals are useless, box ticking exercises that don’t enable staff to do their jobs better, don’t involve good objective setting (see the last blog on this) and don’t leave staff feeling valued and respected.
And there is evidence that HR practices should be focused on encouraging high quality care and compassion, from recruitment, through induction, training and appraisal. Such HR practices are likely to be more effective in delivering high quality health services than general HR practices.
Overall, it is clear that when staff are working in a climate that they feel is positive and supportive, as evidenced by coherent, integrated and supportive people management practices, there are low and declining levels of patient mortality. And the associations between good people management, patient satisfaction and health care outcomes are consistent across all the domains of health care - acute, mental health, primary care and ambulance. The challenge is to ensure the simple equation is understood and enacted throughout the NHS.