Smarter use of information on front line NHS employees could help prevent more scandals over poor patient care by highlighting early warning signs before problems escalate to crisis point. That’s according to new research by the CIPD, the professional body for HR and people development, in collaboration with the Healthcare People Management Association (HPMA), which found four in ten (43%) healthcare workers surveyed are concerned that examples of poor patient care such as those highlighted at Mid Staffordshire NHS Foundation Trust could occur in their organisation.

The research, based on a survey of 1,021 healthcare workers, also found a quarter of doctors and surgeons1 (27%) and a third of nurses (33%) surveyed say they have been put under excessive pressure or bullied to behave in ways that are counter to patient care within the last two years.

The survey 'Focus on culture change and patient care in the NHS’  was commissioned to explore the state of play in the healthcare sector following the report by Robert Francis QC into poor patient care provided at Mid Staffordshire NHS Foundation Trust, and to identify ways in which organisations can identify future problems before they escalate. Francis called for the creation ‘of a common culture shared by all putting the patient first’, but the survey suggests there is a long way to go before this is achieved.

Peter Cheese, CIPD Chief Executive, said the survey highlighted why NHS boards and leaders should ensure they put more emphasis on their people management and employee data: “NHS leaders should ensure they are putting more emphasis on monitoring, analysing and, crucially, acting on people management information and feedback from staff, which can provide early warning indicators for potential culture, capability and capacity problems linked to poor standards of care. Information from patients about their experience is of course crucial but good quality management information can flag problems further upstream before patient care has been fatally undermined.

“This issue has rightly been flagged as a priority for action by the recent Keogh Mortality Review. Better collection, reporting and analysis of data on, for example, training and development, appraisals, employee engagement, stress and absence can provide trust boards with key intelligence on how NHS Trusts are really functioning and highlight early warning signs which might indicate patient care is being compromised.”

Kevin Croft, president of the Healthcare People Management Association, comments: “These survey results are disappointing but similar to messages from the national staff survey.  The findings reinforce the need for a much greater focus on the staff experience, good people management and staff engagement, at both a system and local level, to improve the patient experience. We know there is a clear correlation between a positive staff experience and better health outcomes for patients. Good quality people management information which shines a light on these issues can play a crucial role in helping care providers understand what underpins good patient care and provide earlier insight if things are going wrong.”

The study also reveals that too many nurses, doctors and other healthcare staff lack confidence in their organisation, its integrity and its leadership and feel that the biggest barriers to changing culture in the NHS and improving patient care are quality of leadership and a lack of confidence among staff that whistleblowers will be protected:

  • Six in ten respondents (58%) say they would be confident to raise a concern about the quality of patient care to senior management and of these just 57% would feel confident that their concern would be properly addressed and investigated.
  • A quarter of employees (26%), rising to nearly half of all nurses (46%), report they feel under excessive pressure every day (compared with an average of between 11% and 14% outside the NHS2) and less than a third of respondents (32%) claim they are actively engaged at work.
  • The most commonly cited way to improve patient care in the NHS was to improve engagement and consultation with staff (55%).
  • Only one in four respondents (27%), and just one in five nurses (20%), agree they have confidence in their senior managers.
  • Of the four in ten employees (44%) who say there has been a culture change initiative to improve patient care in their organisation in the past 12 months, just 15% say this has been very effective, with a fifth (19%) believing it has failed to have any impact at all.


Croft, who is also Director of People and Organisational Development at Epsom & St Helier University Hospitals NHS Trust, comments: “To a large degree, efforts to improve the quality of patient care will hinge not on changes to regulation or new codes of practice but on the quality of leadership and management and the extent to which NHS staff can be engaged at work. This is why the HPMA has launched its APPRECIATE Campaign to improve the aspects of people management needed to create patient-centric organisation cultures including empowerment, team working, communication, recognition, personal and professional development, and effective performance management.”

Ben Willmott, head of public policy at the CIPD, adds: “Our survey suggests there is a need to reconsider how we embed values in organisations with the behaviour of the executive board and managers at all levels key to creating an environment in which patient care comes first. Unless we have the type of leadership that supports mutual trust and respect in the workplace, people will not have the confidence to hold up their hand and challenge when they see something happening that is wrong.

“All the regulation in the world won’t solve this problem. We need a long-standing commitment from health service leaders to embedding the quality of leadership and management, from the board down to the front-line that creates more engaged workforces and more satisfied patients.”

The CIPD is working with the HPMA and NHS Employers to produce best practice guidance to ensure over time there is smarter use of people management data to help improve patient care outcomes.

Kevin Croft and Peter Cheese will be joined by Paul Nowak , TUC Assistant General Secretary , at the CIPD’s annual conference in November where they will deliver a master class on how to put employee voice at the heart of sustainable business practice.  They will explore how corporate scandals can be prevented when employees are able to identify issues and confront board members, how simple changes to organisational culture can allow for employee concerns to be raised, and future practices and policies to help reduce organisations’ exposure to risk. For more information visit cipd.co.uk/conference13

1 It should be noted that there were only 48 doctors and surgeons in the survey sample.

2 Reported by respondents to the CIPD’s quarterly Employee Outlook survey based on a representative sample of people in employment in the UK.