NHS staff satisfaction and performance? – Missing the target and missing the point

In this blog Pete Gordon (Head of Emergency Care Improvement) and Chris Green (Head of Information) from the emergency care improvement support team (ECIST) discuss the link between staff satisfaction and higher levels of operational performance within the NHS. Follow Pete and Chris on Twitter @PeteGordon68 @chrisgreenNHS

Over the past 18 months the NHS has gone through some of the most challenging issues in its history. Although, even before then, pressure has always been felt by staff to achieve certain performance measures. The trouble is that we all react differently to pressure; sometimes positively, sometime negatively (often referred to as fight or flight). We were having a chat recently and asked each other this question, is there a link between staff satisfaction and higher levels of operational performance within the NHS? Intuitively we felt there may be as we have visited multiple organisations whilst working for the ECIST and often discuss our perceived views on the culture of organisations (particularly how front line teams perceive it) and the possible impact (negative or positive) it may have upon operational performance.

Before we go any further, it is important to say that performance measures are not there ‘just because’. There are multiple documents written on the impact of patient safety and quality outcomes for patients waiting longer for treatment either within the emergency department or on the elective / cancer waiting lists.

After years of intensive analysis, Google found the key to good teamwork is being nice. The tech giant set up a project to look at what creates great teamwork. It was known as Project Aristotle took several years, and included interviews with hundreds of employees and analysis of data about the people on more than 100 active teams at the company. Google’s data-driven approach ended up highlighting what leaders in the business world have known for a while; the best teams respect one another’s emotions and are mindful that all members should contribute to the conversation equally. It has less to do with who is in a team, and more with how a team’s members interact with one another.

Being nice and civil to each other is crucial to ensuring high levels of satisfaction within teams. We are both big fans of the Civility Saves Lives campaign (run by the brilliant Dr Chris Turner – an emergency medicine consultant). The evidence is  compelling when people find themselves working within a culture where incivility is rife.

We also watched this brief two minute ‘Performance v Trust’ video by Simon Sinek where he discusses the Navy Seals. They’d rather have a team member with slightly lower performance but higher levels of trust rather than an individual who is high performing, but no one trusts. Translating that to the NHS, everyone can think of some leaders that are obsessed with performance but have low levels of trust for their teams. Of course, these untrusting leaders rarely sustain performance and often wonder why they struggle to retain team members.

After watching the Navy Seals video, we then said to each other would we see any patterns if we looked at emergency care performance information and the most recent NHS staff satisfaction survey results? We used readily available information from the NHS satisfaction survey and emergency department 95% performance.

The NHS staff satisfaction survey has multiple questions, but the one we initially focussed upon was ‘does your organisation take positive action on health and well-being’. We plan to look at the information in greater detail and use statistical analysis in the future but what initially surprised us was that before we looked at the data, we both predicted many of the results especially those organisations that have high levels of 95% performance and positive health and wellbeing answers e.g. Fig 1. We also could predict many of the organisations that have low levels of 95% performance and less positive responses to the ‘does your organisation take positive action on health and well-being’ question e.g. Fig 2.

Fig 1 – high 95% performance and second highest results for the does your organisation take positive action on health and well-being’ staff satisfaction survey question (2021)

Fig 2- low 95% performance and second poorer results for the does your organisation take positive action on health and well-being’ staff satisfaction survey question (2021)

So, we were left with more questions than answers and we aren’t making any definitive assumptions, but it has stirred up several thoughts for us.

Should we make a greater effort to link information together? If we know or think that greater staff satisfaction and well-being is connected to better and safer outcomes should these measures take an equal footing with performance management?

The House of Commons Health and Social Care Committee have just published Workforce burnout and resilience in the NHS and social care which describes the very real issue of burnout across the NHS due to a number of issues. Notably it highlights our significant workforce challenges which link to staff burnout and low morale. NHS England and Improvement have produced the excellent WE ARE THE NHS: People Plan 2020/21 – action for us all The challenge is how to take these plans from a macro to a micro level i.e. at the frontline of care delivery.

There’s lots of advice and guidance encouraging leaders to treat their colleagues like people rather than workers, employees or human resources e.g. doing the things listed below 12 Ways to Treat People Like People by @wallybock and placing equal emphasis upon them instead of solely focussing upon performance management and assurance. 

12 ways to treat people like people

• People crave control. So, give it to them. Let them control as much of their work life as is possible.
• People want to know what’s expected of them and how they’re doing. Whenever possible, give them ways to figure that out for themselves. When that’s not possible give people regular and usable feedback. That includes praise.
• People want to be competent. Let them demonstrate it. Help them do work that builds on their strengths.
• People want to grow and develop. They want to do a little better tomorrow than they’re able to do today. So, help them.
• People like to do important work. Tell them why what they do matters. Connect them with the people who use the product of their labours.
• People prefer to work with people they like. That’s why group dynamics are important. Pay attention to things that keep the team a safe and enjoyable place to work. Root out the folks who make it hard for everyone else.
• People have a life. Work is just a part of it. They’ll bring pieces of that life to work with them. That’s okay. Let them share. Sometimes, parts of their outside life will have an impact on how they work.
• People have off days. Even the best, most productive, most cheerful people have days when they make mistakes, aren’t productive, and grump. That’s part of the deal. Treat them like people and you get their best, and you also get their off days.
• People have ideas. When they have ideas, they want to share them. When they share them, treat those ideas like the gift that they are. Sure, most ideas need a little tweaking to work. Some ideas won’t work at all. But every idea is a gift.
• Machines have serial numbers. People have names. Use their name. Use a name that they like. When in doubt, ask them what they’d like you to call them.
• People like to be thanked. Thank them for their work, for their effort, for helping other people.

We don’t proclaim to have the answers, we probably have more questions having looked at the data. However, our intuition tells us that there continues to be a significant improvement opportunity here that costs very little except our time along with a real focus and commitment to support our staff (as we would want to be).

Between both of us, we have met multiple NHS leaders who do exactly this, create a brilliant team culture with higher levels of staff satisfaction and performance (across many measures). However, is it the norm? Imagine if it were?