Why NHS targets can be bad for your health
A report by a health think tank finds that less target-driven leadership in the NHS can reduce infection and mortality rates while saving money and raising staff morale.
The King’s Fund report ‘Together we can’ – the culmination of a year-long review – has found that as well as abandoning a leadership style driven by targets, healthcare outcomes are improved when there is a focus on getting staff and patients involved in how care is delivered.
The report makes a business case for engagement drawing on examples from such companies as Sainsbury’s which reported recent growth built on strong engagement with their staff.
King’s Fund Chief Executive Chris Ham said: “Instead of making swingeing cuts to the number of NHS managers, our research suggests that a new style of leadership could significantly improve financial and service performance.”
In the annual survey of NHS staff in England, staff’s psychological involvement was measured through the response to three statements:
• I look forward to going to work.
• I am enthusiastic about my job.
• Time passes quickly.
Those staff who say they have an interesting job report higher levels of engagement, as do those with good support from their manager.
The research found that patients’ experiences mirrored the level to which the staff would recommend the organisation as a place to work and be treated.
In the annual NHS survey staff were also asked if they felt able to make suggestions to improve the work of their team, or had frequent opportunities to show initiative. Engaged staff were less likely to suffer from stress.
Ambulance trusts were found generally to have much lower engagement among their staff.
Improved outcomes
The King’s Fund report found that trusts with lower infection rates have more staff who feel they can contribute towards improvements. Much lower levels of absenteeism and staff turnover were seen where staff felt engaged. The report estimates that every trust could save an average of £150,000 annually by reducing staff absenteeism alone.
Practical steps
Well-structured appraisals were linked to high staff engagement, however poorly structured appraisals left staff feeling worse than if they had not had one.
Despite the success in recent years in achieving shorter waiting lists and faster treatment in A&E, the report emphasised the need to move away from a purely top-down management style and called for NHS boards to act on the results of NHS staff surveys. It quotes a 2008 Chartered Institute of Personnel and Development finding that leadership is not about being an extraordinary person, but being open, accessible and transparent. Success is predicated on an environment in which the status quo is challenged, ideas both listened to and valued, and innovation and entrepreneurialism encouraged.
So how can the NHS change? The King’s Fund calls for NHS leaders to engage others to deliver improvements in patient care, quoting The Commission on Dignity in Care for Older People which found “If senior managers impose a command and control culture that demoralises staff and robs them of the authority to make decisions, poor care will follow.”