Creating a workplace where NHS staff can flourish

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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.

Comments

Nicola skitt

Position
Podiatrist,
Organisation
Bridge water NHS trust
Comment date
01 February 2016
Sounds interesting

Teresa Jennings

Position
Clinical psychologist in occupational health,
Organisation
Northumbria healthcare trust
Comment date
01 February 2016
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

Jude

Position
RMN,
Comment date
02 February 2016
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.

Jude

Position
RMN,
Comment date
02 February 2016
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.

Alison Tong

Position
Director of Nursing,
Comment date
02 February 2016
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.

Jude

Position
Rmn,
Comment date
02 February 2016
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.

Umesh Prabhu

Position
Medical Director,
Organisation
Wrightington Wigan and Leigh FT
Comment date
02 February 2016
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.

Jude

Position
Rmn,
Comment date
03 February 2016
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

Hesk

Position
Talent Management Professional,
Comment date
07 February 2016
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

Thea

Position
CEO,
Organisation
LCH
Comment date
08 February 2016
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>

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