THE BLOG

Nursing Broken Cultures in the NHS and Beyond

12/09/2013 12:28 BST | Updated 10/11/2013 10:12 GMT

The well-publicised scandal at Mid Staffordshire NHS Foundation Trust and the subsequent Keogh Mortality Review have put the topics of patient care and NHS culture firmly in the public domain. Almost every day we open the papers or switch on the news to yet another report on what's going wrong in the NHS.

Just last week Professor Ben Bridgewater, who has led government efforts to publish data on doctors' performance, was quoted as saying that doctors risk becoming as mistrusted as bankers unless they change their ways and listen to what patients have to say about the treatment they receive.

Professor Bridgewater is absolutely right to highlight the importance of listening, and I also agree that strong parallels can be drawn between the banking sector, and the deep cultural issues that have emerged there, and what we're now seeing in the NHS.

There's no disputing the fact that open and honest feedback from patients is critical to improving standards in patient care. However, a survey of more than 1,000 healthcare workers by CIPD and the Healthcare People Management Association suggests that listening to those responsible for providing the care - and using and acting on people management information - is equally elucidating. Essentially, it could identify the problems that lead to poor patient care further upstream, with the potential to significantly reduce patient care incidents

While there is some evidence of progress being made in the health service, our research paints a picture of a great British institution that is suffering from serious cultural issues, where employees lack confidence in their employer, its integrity and its leadership. A quarter of employees tell us they feel under excessive pressure every day. Even more concerning, a third of nurses say they have been bullied or put under excessive pressure to behave in ways that are counter to patient care. Most worrying of all, staff often don't feel confident about speaking up and raising concerns about the quality of patient care or, if they do, that their concerns will be listened to or addressed. Such a negative staff experience does not bode well for patient care.

Staff engagement is key to tackling systematic cultural failures such as these, and such as those we've seen in the banking sector. In order to be able to make changes, it is important that NHS bosses truly understand what is going on within their organisations. The value of quality management data should not be underestimated. Greater emphasis needs to be put on collecting, analysing and, crucially, acting on employee data, such as levels of engagement, rates of stress and absenteeism, and on heeding feedback from staff. A key recommendation of the Keogh Mortality Review that received little publicity highlighted the importance of the NHS leaders confidently and competently using data and other intelligence in order to improve patient care. HR can play a crucial role in providing this data to help gauge culture and to provide Trust boards with key intelligence on how hospitals are really functioning. When used properly such data can provide early warning indicators for potential problems linked to poor standards of care. I would even go as far to say that good quality people data coupled with better appraisal systems and training could have red-flagged failings at Mid Staffordshire at a much earlier stage.

Morale in many parts of the NHS is incredibly low. If management teams, in the NHS, the banking sector and in business in general, start to really know how their organisations are functioning, how their employees are performing and what they are feeling, then huge strides can be made in cultural change, productivity, standards of patient care and even reductions in mortality.