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The challenges faced by UHMBT

Posted by admin on November 2, 2017

The pressures on NHS staff and NHS Trusts are unprecedented. According to the Nuffield Foundation:

“a hospital will be given just £937 in cash this year to treat a patient they would have received £1,000 in cash to care for in 2009/10. Factor in eight years of inflation, and that £937 is more like £760” https://www.nuffieldtrust.org.uk/news-item/when-the-price-isn-t-right-how-cuts-in-hospital-payments-added-up-to-the-nhs-deficit

For UHMBT the financial challenges were exacerbated by what Jackie Daniel described as the “devastating and far reaching failures across a decade for women, babies, families and their loved ones.”

So where should the Trust have started? The largest cost, and the greatest asset of any healthcare provider is its workforce. A round table of American hospital chief executives and patient safety experts concluded with a statement which should be pinned to the dory of every manager across the NHS:

Trust, respect for others, and inclusion are essential to creating environments that are both physically and psychologically safe. Building trust involves managing conflict and making the environment safe for communicating bad news. It also involves practicing honesty, inclusion, transparency, and respect with everyone. Each member of the workforce must feel compelled and empowered to uphold mutual accountability and speak up for safety. Healthcare leaders develop trust within their organizations by having authentic relationships and conversations. Behavioural standards and expectations should apply to everyone, without exception. Respect for others—be they patients, family members, peers, or subordinates—is essential for creating and sustaining trust. Leading a Culture of Safety: A Blueprint for Success. The American College of Healthcare Executives and the NPSF Lucian Leape Institute

https://www.osha.gov/shpguidelines/docs/Leading_a_Culture_of_Safety-A_Blueprint_for_Success.pdf

I’ve no idea if senior leaders at UHMBT have read this excellent document but the initiatives taken have certainly sought to meet those standards – in particular prioritising tackling bullying which is toxic for good healthcare for several reasons.

Firstly, bullying undermines the mental and physical health of staff and can trigger low self-esteem, anxiety, depression and disengagement in affected individuals.

Bullied staff are less likely to raise concerns, less likely to admit mistakes and are less likely to work in effective teams.

Secondly, bullying adversely impacts on organisational effectiveness. A decade ago, NHS Employers reported that “the costs of bullying and harassment include increased sickness absence, low productivity, high staff turnover, costs of potential litigation and damage to the reputation of the organisation.” 

Thirdly, bullying impacts adversely on patient care and safety. Bullied staff are less likely to raise concerns, less likely to admit mistakes and are less likely to work in effective teams. There is a strong negative correlation between NHS staff reporting harassment, bullying or abuse from managers and colleagues, and whether patients reported being treated with dignity and respect. Not only that but we now know that bullying behaviours seriously affect those who witness bullying and that even low level rudeness towards staff can have damaging impact on patient care.

Research shows that “managing staff with respect and compassion (is important) since doing so correlates with improved patient satisfaction, infection and mortality rates, Care Quality Commission ratings and trust financial performance.” 

So what about UHMBT?

UHMBT’s staff survey data painted a sorry picture. In 2015, 28% of staff (39%) of BME staff reported they had experienced bullying, harassment or abuse from (staff (managers and colleagues) in the previous 12 months. That was worse than the average for acute Trusts and was even worse for BME and disabled staff. Only 18% of staff even bothered to report their most recent experience of bullying and harassment – one of the very worst in the entire country.

So the new Trust leadership was absolutely right to focus on improving staff engagement and tackling bullying. The Behavioural Standards Framework, published exactly two years ago, places staff engagement and mutual respect at the heart of the Better Care Together’ strategy. It places patients at the centre of all behaviours and quite rightly sets out the professional behaviours expected of staff (and managers) as well as those (such as bullying) which are unacceptable.

And it is starting to work.

  • Reported levels of bullying have started to slowly fall though there is much to do as the level in October 2016 was still far too high (27%) and above the average for acute trusts.
  • Dramatic progress, however, was made on the other bullying indicators. Whereas in 2015 only 18% of staff said they reported bullying, harassment or abuse, just one year later the proportion had astonishingly trebled to 52%, much better than the acute trust average.
  • The proportion of staff reporting the most recent experience of violence improved sharply from below the acute trust average to well above it
  • The proportion of staff attending work in the last three months despite feeling unwell because they felt pressure from their manager, colleagues or themselves fell significantly

But much remains to be done

  • Staff confidence and security in reporting unsafe clinical practice significantly increased, but, paradoxically, the proportion of staff reporting errors, near misses and incidents witness fell significantly. I’m not clear why?
  • The proportion of BME staff being bullied by staff and the public fell (good) but still remains significantly higher than that for white staff
  • The proportion of BME staff believing there were equal opportunities for career progression and promotion improved (good) but is still worse than that for white staff
  • There are very significant variations between different groups. For example, the proportion of medical/dental staff reporting bullying, harassment and abuse remains poor. The proportion of staff with disabilities reporting work related stress is high. The proportion of staff with disabilities reporting bullying is high whilst the proportion of BME staff actually reporting bullying is significantly lower than the trust average.

All in all the progress made is very substantial. Considering where the trust was just three years ago, the progress is sharp.

The current 2017 survey will show if that progress, notably on bullying, has been sustained and improved upon. Much has been achieved but as trust leaders know there is still more to do

In the preface to his 2013 report on Mid Staffordshire Robert Francis QC said:

“There lurks within the system an institutional instinct which, under pressure, will prefer concealment, formulaic responses and avoidance of public criticism.”

UHMBT’s openness about its past shortcomings is a welcome antidote to that approach. On bullying in particular, the Behavioural Standards Framework is as good as any I have seen in NHS Trusts. Being proud of the progress made but acknowledging the challenges remaining is the best way any Trust can ensure that the care provided is of a standard staff would be happy with their own close relatives receiving. That test is ultimately the one to work towards.

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