Creating a workplace where NHS staff can flourish

Work-related stress is widespread among staff in the NHS; last year, according to the NHS Staff Survey, nearly 40 per cent of staff reported feeling unwell as a result of stress.

Chronic stress can have significant impacts on physical and mental health, being implicated in heart disease, early mortality, depression and a wide variety of psychosocial disorders. In effect, NHS staff are more likely than the rest of the working population to become patients, increasing demands on the system they work in.

Moreover, the Care Quality Commission says poor staff health and wellbeing in NHS provider organisations is associated with poorer-quality patient care, lower levels of patient satisfaction and high levels of absenteeism. The ability of staff to pay close attention to patients, to have empathic responses and take intelligent action to help is detrimentally affected by high and chronic levels of stress.

What are we to do? One solution is to introduce health and wellbeing strategies for stressed staff, offering massage, yoga, mindfulness, exercise and dietary advice. But although these are worthy interventions, they do not address the root causes of the problem.

Research has shown that the most important factor contributing to stress is workload, with staff simply being asked to manage too much work. Another is a lack of clear roles – knowing what the objectives, requirements and limits of their responsibilities are. Other factors include bullying and harassment (particularly by managers and other staff), discrimination, lack of resources, conflict, and dealing with pain and suffering. These core problems are to do with organisational culture and processes, so the solutions need to address organisational causes. We cannot just rely on health and wellbeing strategies as ‘fig leaves’ for inaction around management, structures and culture.

If we are to address the causes of stress at work then we need to nurture cultures that ensure a focus on providing the high-quality, compassionate care that NHS staff wish to provide. This means that leaders must have an unwavering focus on ensuring commitment to quality of care. As I have said before, absolutely key to this is developing, selecting, promoting and empowering leaders to nurture such cultures. But we also need to move swiftly away from unhealthy command-and-control cultures and this requires a comprehensive and wholesale change in the way in which leadership is developed and understood in the NHS.

It is not enough simply to aim to reduce staff stress levels. We should be promoting the idea that humans can flourish in the workplace, by ensuring that staff have opportunities for growth and development, the experience of supportive relationships at work, work environments that promote their physical health, and leaders who provide the resources that enable them to cope effectively with the demands of their work.

There are some organisations in the NHS that are making progress towards understanding how to reduce stress levels and promote staff wellbeing, and others should be striving to do the same. But NHS organisations must also look beyond the sector for outstanding examples of organisations – both nationally and internationally – that have shown how to create positive work environments and promote human health and wellbeing, rather than damage their staff. It is right that the NHS should aspire to be a model in this regard, rather than the bad example it currently is.

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Comments

#545730 Nicola skitt
Podiatrist
Bridge water NHS trust

Sounds interesting

#545731 Teresa Jennings
Clinical psychologist in occupational health
Northumbria healthcare trust

I agree and feel strongly that managers and leaders are key to wellbeing of their team members. One survey we conducted found that staff felt managers were the most important influence on their wellbeing at work.We need to ensure that health and wellbeing programmes incorporate support and training for leaders too so that they can provide a positive work environment for their teams

#545732 Jude
RMN

The health and wellbeing strategies should be extended also to patient care.
I think the 40% figure is grossly underestimated. We work in an environment where assault risks are high, intensive patient interaction can sap your soul & many staff are on antidepressants themselves. I think to blame ward level managers is wrong. It's the culture of the institution that stops managers managing. Managers are not permitted to own their wards like they used to and are caught between a rock and a hard place. We are even expected to do our own hours individually now, which when you sometimes go without even toilet breaks is unrealistic and yet another stressor. I love my job but the amount of times I feel out of my safety zone is ever increasing. Sometimes you don't want to go home and leave the next shift.

#545733 Jude
RMN

The health and wellbeing strategies should be extended also to patient care.
I think the 40% figure is grossly underestimated. We work in an environment where assault risks are high, intensive patient interaction can sap your soul & many staff are on antidepressants themselves. I think to blame ward level managers is wrong. It's the culture of the institution that stops managers managing. Managers are not permitted to own their wards like they used to and are caught between a rock and a hard place. We are even expected to do our own hours individually now, which when you sometimes go without even toilet breaks is unrealistic and yet another stressor. I love my job but the amount of times I feel out of my safety zone is ever increasing. Sometimes you don't want to go home and leave the next shift.

#545735 Alison Tong
Director of Nursing

Yesterday I was privileged to listen to Em Rahman speak about a programme he has been running called Making Every Contact Count. He was inspirational to listen to; as he spoke about 'healthy conversations' I thought about how great it would be if we could use this simple programme to support areas that are struggling to make sense of life/work etc. working together to find sustainable solutions is in my view the answer. Using this approach in a supportive well being programme can only lead to benefits for individuals/teams and patients.

#545736 Jude
Rmn

I shall look further for his work. Working together for sustainable solutions is most certainly they key, along with people being committed to mean what they say and do what they say. Nothing is ideal with budget constraints and ever increasing demand, but creating a positive environment where people feel there will be action from interactions is so important for both staff and patients alike.

#545738 Umesh Prabhu
Medical Director
Wrightington Wigan and Leigh FT

Well said Michael. Happy staff - Happy patients Mantra has made Wrightington, Wigan and Leigh FT one of the most successful Trusts in the country. You know it very well and hope one day The King's Fund will visit us and learn so many things which has made our Trust so good. Of course, our success is purely due to our wonderful staff and our amazing values based leaders and excellent governance.

Care for staff so that they can care for their patients. So simple yet so difficult to do in our NHS because of targets, financial pressure and poor accountability for the Board level leaders. This has to change and change soon.

#545739 Jude
Rmn

Umesh, your last paragraph spoke volumes. If only everyone was prepared to take accountability. Sounds like you have happy staff & happy patients. The way forward

#545758 Hesk
Talent Management Professional

Bang on Michael West! The problem is that until we are able to move all the great people we have identified, trained and developed who are able to deal with the culture problems, we are stuck. I have seen so many leadership reviews, taken part in research, developed supporting talent management approaches, but until there's a willingness to make space to remove demonstrably bad performers and break the cycle of unimaginative, incompetent individuals there is no hope to make a change. Being 'too expensive to sack' or waiting for a public sector pension will finish off the NHS

#545762 Thea
CEO
LCH

I couldnt agree more strongly. I am nodding very very vigorously. I need space and time to make it happen. Culture does not support across the NHS>

#545763 sharon paterson
retired
ex NHS

I am old enough to remember the days when night staff had the opportunity to have a freshly cooked omelette so could be sustained with hot,healthy food-sounds ridiculous ,now,but if the organisation does not care for the carers-how can they give proper care to the patients? I worked in a/e most of my life-and watched young ,stressed doctors trying to survive on a diet of unhealthy snack food -when they should have had good "brain food" to help with the many demanding situations they worked in.

#545766 Hilda Dent
Retired Matron/ Nursing Officer
was NHS

In as much as possible , nursing staff need to blossom in their own way,organising their strategies with both patient good care and nurse competence in mind.

I found the Enrolled Nurse team leader of basic care ,to be of great value, allowing the senior nursing. Staff to deal with their job, knowing that the patients were comfortable.
The frustration of seeing patients lacking basic care, does distress the senior staff, whose minds become shattered by the lack of basic care.
How can stress be avoided.? There is no doubt food intake helps.
wHen I trained , we broke off for a cuppa , with French toast and lemon ,taken on the wards

#545778 bob
Left
CIC

I worked for an organisation that had the role of increasing the wellbeing of local residents, but the person who founded and managed it was awful at looking after the wellbeing of staff. Wellbeing was being treated as a commodity, increase it in the population (because the CCG are paying for those outcomes) but the wellbeing of staff matters little. That organisation is now paying the price because it can't retain staff

#545782 Claire Quinn
Head of Learning and OD
Frimley Health Foundation Trust

I recently completed my Anderson programme dissertation which sought to understand the connection between compassionate leadership and higher levels of staff engagement (knowing that higher levels of staff engagement result in better quality patient care).
I interviewed staff from both high and low staff engagement scoring areas (Staff Survey results) and the corollary was abundantly clear, that staff working with managers who were compasssuonate towards them felt more engaged, more willing to go the extra mile, more able to discuss their concerns and better supported
I did not explore the extent to which this connected with stress, but I could guauge from the nature of those conversations with individuals and the language and tonality with which they spoke that stress was higher in those areas where leaders demonstrated less compassion.

#545856 Geoff Watson
Consultant Anaesthetist
Hampshire Hospitals NHS FT

I have immense respect and admiration for you Michael and this is another example of how eloquently you are able to state what should be obvious but sadly doesn't appear to be. It feels (being caught in the middle) that the disconnect between the bullying from above and the great compassion, skill and dedication from the coalface is driving an ever wider gap between "Management" and workforce. How do we select, train and promote leaders who understand the needs of the workers as well as the artificial construct of the balance sheet and targets?

#548136 Robin Rootes
Midwife. RCM Rep Health and Safety rep.
Southport and Ormskirk NHS Trust

Thank you everyone, this is both fascinating and inspiring reading.
In our Maternity unit we are travelling though enormous changes and with these come challenges. These have all needed to occur. Recently we signed up to the Caring for you Campaign Charter from the RCM. This is an excellent piece of work. We had already started implementing many of the changes and now are progressing to ensure that the others are covered. We are fortunate in having a committed Senior management team in Maternity.
I would be glad to visit your Hospital Umesh, indeed I would be grateful for any positive input. It is only through working with others do we ever find the correct solution.

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