Sir, Nigel Hawkes points out that measuring how well a hospital is
performing is expensive and not satisfactory (BMJ 2009; 339: b5242). No
use, however, has been made of a readily available source of information –
responses to the annual Care Quality Commission (CQC) NHS Staff Survey
that each Trust conducts.
Each Trust in the UK has well trained, front-line staff who must be
aware of the standard of patient care they are able to deliver and, to
what extent their senior managers support them in delivering it. In order
to test the truth of these suggestions we compared the answers of NHS
staff to three key questions in the CQC National NHS Staff Survey 2009
(ref 1) with the CQC, NHS Trust performance ratings (2008/9)(ref 2).
The staff responses of 22 Trusts rated as 'Weak' were compared to
those of 25 Trusts rated as 'Excellent'. The differences in group mean
responses to 3 key questions were as follows:
1) I am able to do my job to a standard I am pleased with.
In the 'Excellent' Trust group an average of 3.5% of staff strongly
disagreed with this statement, compared to 6.4% in the 'Weak' Trust group
(P<_0.0001 t-test.="t-test." p="p"/>2) I am able to deliver the patient care I aspire to.
In the 'Excellent' Trust group an average of 1.8% of staff strongly
disagreed with this statement compared to 3.5% in the 'Weak' Trust group
(P<_0.0001 t-test="t-test" p="p"/>3) Senior managers where I work are committed to patient care.
In the 'Excellent' Trust group an average of 3.6% staff strongly
disagreed with this statement compared to 8.9% in the 'Weak' Trust group
(P=0.01, t-test).
In addition, the mean differences in responses for those who strongly
agreed with these statements were also significant (P=0.02), (P=0.05),
(P<_0.0001 xmlns:follows="urn:x-prefix:follows" t-tests="t-tests" for="for" questions="questions" _1="_1" _="_" _3="_3" respectively.="respectively." since="since" these="these" data="data" indicate="indicate" that="that" nhs="nhs" staff="staff" satisfaction="satisfaction" is="is" significantly="significantly" linked="linked" to="to" cqc="cqc" trust="trust" rating="rating" opinion="opinion" should="should" be="be" taken="taken" notice="notice" of.="of." the="the" both="both" cheap="cheap" and="and" easily="easily" accessible="accessible" our="our" suggestions="suggestions" are="are" as="as" follows:_="follows:_" p="p"/> - That the answers to the above three NHS Staff Survey questions
should become targets for each Trust to satisfy.
- In order to meet such targets and, for patient care to improve,
more notice will have to be taken of staff actually caring for patients.
It would be surprising if, as a direct consequence of this strategy,
patient care didn’t improve, together with staff morale. In addition, as
mandated notice would then be taken of the staff, the ever recurring
problem of the whistle blower might even disappear.
References:
(1) Care Quality Commission: National NHS Staff Survey 2009.
(2) Care Quality Commission: NHS performance ratings 2008/9. Appendix E.
Rapid Response:
An Insight into Trust Performance
Sir, Nigel Hawkes points out that measuring how well a hospital is
performing is expensive and not satisfactory (BMJ 2009; 339: b5242). No
use, however, has been made of a readily available source of information –
responses to the annual Care Quality Commission (CQC) NHS Staff Survey
that each Trust conducts.
Each Trust in the UK has well trained, front-line staff who must be
aware of the standard of patient care they are able to deliver and, to
what extent their senior managers support them in delivering it. In order
to test the truth of these suggestions we compared the answers of NHS
staff to three key questions in the CQC National NHS Staff Survey 2009
(ref 1) with the CQC, NHS Trust performance ratings (2008/9)(ref 2).
The staff responses of 22 Trusts rated as 'Weak' were compared to
those of 25 Trusts rated as 'Excellent'. The differences in group mean
responses to 3 key questions were as follows:
1) I am able to do my job to a standard I am pleased with.
In the 'Excellent' Trust group an average of 3.5% of staff strongly
disagreed with this statement, compared to 6.4% in the 'Weak' Trust group
(P<_0.0001 t-test.="t-test." p="p"/>2) I am able to deliver the patient care I aspire to.
In the 'Excellent' Trust group an average of 1.8% of staff strongly
disagreed with this statement compared to 3.5% in the 'Weak' Trust group
(P<_0.0001 t-test="t-test" p="p"/>3) Senior managers where I work are committed to patient care.
In the 'Excellent' Trust group an average of 3.6% staff strongly
disagreed with this statement compared to 8.9% in the 'Weak' Trust group
(P=0.01, t-test).
In addition, the mean differences in responses for those who strongly
agreed with these statements were also significant (P=0.02), (P=0.05),
(P<_0.0001 xmlns:follows="urn:x-prefix:follows" t-tests="t-tests" for="for" questions="questions" _1="_1" _="_" _3="_3" respectively.="respectively." since="since" these="these" data="data" indicate="indicate" that="that" nhs="nhs" staff="staff" satisfaction="satisfaction" is="is" significantly="significantly" linked="linked" to="to" cqc="cqc" trust="trust" rating="rating" opinion="opinion" should="should" be="be" taken="taken" notice="notice" of.="of." the="the" both="both" cheap="cheap" and="and" easily="easily" accessible="accessible" our="our" suggestions="suggestions" are="are" as="as" follows:_="follows:_" p="p"/> - That the answers to the above three NHS Staff Survey questions
should become targets for each Trust to satisfy.
- In order to meet such targets and, for patient care to improve,
more notice will have to be taken of staff actually caring for patients.
It would be surprising if, as a direct consequence of this strategy,
patient care didn’t improve, together with staff morale. In addition, as
mandated notice would then be taken of the staff, the ever recurring
problem of the whistle blower might even disappear.
References:
(1) Care Quality Commission: National NHS Staff Survey 2009.
(2) Care Quality Commission: NHS performance ratings 2008/9. Appendix E.
Drs Rod Storring and David Dighton
r.storring@hotmail.com
Competing interests:
None declared
Competing interests: No competing interests