The NHS Staff Survey: Is it time to try something different?

The much anticipated NHS Staff Survey has been published. Results from the survey are designed to measure progress against the NHS People Promise. Collecting almost 650,000 responses, the NHS Staff Survey is now the largest workforce survey in the world. The annual survey offers a limited peek into working life within the NHS. With the pressure of the pandemic combined with the staffing crisis taking precedence throughout 2021, the results have been needed for some time!There are a few challenges that the NHS needs to overcome to make it a happy, safe and supportive environment for its employees, and to help them thrive at work so they can deliver the best patient care. This year’s Staff Survey results don’t throw out anything new, in fact many of the results haven’t changed much for years, so it begs the question ‘What does the NHS need to do differently to see real positive change in the experiences of its people?’

Here are some the key takeaways from the survey and the statistics that have got everyone talking; 

  • Morale has declined - In 2021, only 59.4% of staff would recommend their organisation as a place to work. This sees a decline of more than 7% from 66.8% in 2020, and the lowest in the last 5 years. 
  • Only 1 in 5 said there were enough staff in their organisation for them to do their job properly. This fell from an already low 38.4% in 2020 - an 11% decline over the course of the last 12 months. And the drop was even steeper in ambulance trusts!
  • In some instances more than 3 in 5 NHS employees have gone to work despite not feeling well enough to do so. But with the staffing crisis at an all time high with one in ten nursing posts in England empty, combined with the pressure to ‘put patients first’, what’s their choice other than to go to work?

The main concern across social media and press publications covering the Staff Survey is around the declining statistics.But, what about what hasn’t changed? The same result year after year is worrying as it shows nothing in those areas has resulted in change for the better.

  • 18.7% of staff experienced at least one incident of harassment, bullying or abuse in the last 12 months from other colleagues. With this percentage remaining the same as in 2020 when it was also 18.7%. We’re sure that action has been taken off the back of previous Staff Surveys, so this suggests to us that whatever has been put in place across l NHS Trusts to tackle bullying, harassment and abuse in at least 2 years isn’t enough.
  • Nearly 1 in 2  NHS employees don’t feel like their voices are heard when it comes to involvement and making improvements. That declined this year - but has remained in and around 50% since before 2018 (data unknown before that).
  • Only 42% were satisfied with the extent to which their organisation values their work. The pandemic cannot be blamed as it was 43% in 2017. 

This data concludes that a large percentage of NHS employees don’t feel valued in their workplace.This is a factor that impacts all aspects of a job. If the workforce don’t feel their voices are being heard, your employees won’t trust you as an organisation. Therefore how can you ever expect to create a speak up culture? If employees feel like nobody is listening, they won’t bother speaking up. The evidence suggests that despite the NHS’s obvious hard work to improve the culture, little has been in creating a lasting positive impact on healthcare employees and to shift the culture in the public sector.

Why surveys can’t be the only tool in your box:

Staff Surveys can be a useful tool in identifying the issues facing staff within your organisation, but the limitations need to be considered; 

  • Surveys provide limited information. You can’t read between the lines when reviewing your survey responses. You’re giving your people a restricted space to tell you about their experiences and responses could be led by the options you give which are based on a certain set of assumptions. So, you have to take them at face value and might not necessarily learn anything new. 
  • Surveys don’t always provide context and can be misinterpreted. There are only a very limited number of questions you can ask on a survey, and whatever the questions, it is likely there will be a limited number of options from which respondents can choose. This is useful to confirm what you know already. But how about what you don’t know? What if the assumptions about staff experience problems are wrong, and they have some more painful problems to solve? You need them to tell you about their own experiences.
  • Surveys can delay meaningful change. Waiting once a year to get feedback from your staff can delay effective solutions. How likely would you report an incident of problematic behaviour if it happened 9 months prior to the annual survey? Naturally overtime, no matter how big or small you’re more likely to talk yourself out of bringing it back up, but just because this incident happened at a different time, doesn’t make it any less significant, and it still should and needs to be addressed.

In order for your organisation to create meaningful change, you need to use a number of tools to gain information from your employees. The same method simply won’t work for everyone particularly in an organisation as large as the NHS. When it comes to creating a workplace culture that's happy, supportive and safe and gives your employees their sense of belonging you need options. The limitations of an annual survey provides barriers for your employees, especially when we look back over the general results of the NHS survey, we aren’t seeing lasting change off the back of the findings.

Change within organisations needs to be ongoing, not just after staff surveys results are tallied up... In the case of many organisations there tends to be short term solutions to mask long term problems that can often feel like a monster to tackle, which results in results being the same year on year. At Culture Shift, we understand the limiting factors of surveys and the difficulty in knowing how to tackle the workplace culture. Finding effective solutions, especially in big organisations like the NHS is challenging and not for the faint hearted. This is why we believe strongly in the importance of reporting platforms like ours. 

The Power of Anonymous Reporting

Anonymous reporting can provide employees with the confidence to speak up about something harmful they have experienced without having to factor in potential barriers for example; 

  • Worried about retaliation
  • It might affect current/future career
  • Nothing would be done if they told someone
  • Worried about being called a troublemaker
  • Worried they wouldn’t be believed
  • The person they’re meant to go to with this information is the perpetrator

Many of these barriers apply to how healthcare professionals feel when looking at why they aren’t reporting problematic behaviour. For more information that supports this, check out our recent research and report:Paying the Price for Problematic Behaviour. The safety anonymous reporting provides could be the difference between reporting, choosing to suffer through harassment in silence, or worse still - removing themselves from your organisation entirely. Which in terms of the NHS, could be a huge contributing factor to the under staffing crisis which is already at breaking point. Anonymous reporting also provides your employees with the feeling that their voice and experience matters all year round, not just when the Staff Survey is issued.

Providing your employees with a reporting platform like Report + Support™ , gives individuals the power to report an incident in a time and place safest and most comfortable for them, We want to give the power back to the individuals after incidents like bullying, harassment, or discrimination takes it away. This is also a great tool to start building trust between your organisation and your staff, which in term plays a vital role in creating the speak up culture that is so wanted and needed in the NHS right now. 

It’s very difficult to create a speak-up culture without first having a workforce that trusts you. Your employees need to feel valued, their problems are listened to and feedback is acted on before they’re willing to ‘speak up’. Below is a case study showing data from an organisation using our reporting platform, it indicates how providing employees with the choice to report anonymously or named has helped be a tool in creating a trusted speak up culture.

As you can see, in the case of this organisation in year 1 of using our Report + Support™ system 65.4% of reports were anonymous, meaning if they hadn’t offered an anonymous reporting tool for their people, in this case, they would have only known 34.6% of the problem. By not giving the option of anonymous reporting your organisation is only seeing a certain percentage of the problem. The other 65.4% of victims are either removing themselves from your organisation or they’re suffering in silence and the effects of that then trickle down into how it’s affecting their work on a day to day basis.

Then, as we look further into year 2, not only were there less reports (as seen in the bar chart as follows), but the percentage of named reports increased to nearly 47%, which proves that overtime by providing a reporting platform to employees and using it to assist in their effort to build trust amongst their people, it can be a powerful and impactful tool which assists and builds the foundations of a speak up culture, which we know is a strong focus for the NHS’s people plan and the role of the Freedom to Speak Up Guardians too.

Anonymous reporting can also provide useful data about the behaviours and cultures that exist in your organisation. With this information you can take further action such as:

  • Increasing training to encourage positive and inclusive behaviours
  • Seeking external support to educate your team on areas that you may not be experienced in. This targeted support can help you to remove unconscious biases from your processes and shine a light on any blind spots that you may have
  • Ensuring employees take reports seriously so that people feel comfortable speaking up and can genuinely believe that inappropriate behaviour will be challenged. Starts the groundwork to build a speak up culture.
  • Ensuring that policies and processes are fit for purpose, creating consistency from policy through to action. Following through with your promises to support people means that victim-survivors have confidence in the process.

Taking this action can help to improve an organisation's culture for all staff. Using methods that haven’t been used previously in your organisation or even sector, but have been successful can have the power to create a real lasting impact, and positively change the organisation. 

Do you want the 2021 NHS Staff Survey results to be the starting point in creating meaningful long lasting change in your organisation?

Do you think a reporting platform can assist your efforts in building a speak up culture? Get in touch today.

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