Make the missing link between quality, workforce and data

The national NHS staff survey results and a service provider’s workforce, quality and performance data are often considered and analysed in isolation.

‘What is measured by one dataset often has impact elsewhere within a healthcare setting’

However in reality, what is measured by one dataset often has impact elsewhere within a healthcare setting.

In light of the Keogh and Francis reports, the release of the 2013-14 national staff survey results, and the upcoming fieldwork for the 2014-15 national staff survey, it is important to simultaneously look at the impact workforce may have on other areas within the healthcare system.

• Lord Darzi: Electronic records are the next ‘breakthrough drug’
• The new way for trusts to improve staff engagement
• NHS staff report better communication with managers
• Are patients being heard? The friends and family test reviewed

Understanding relationships

The King’s Fund and the Centre for Creative Leadership last month released their research on collective leadership, Developing Collective Leadership for Healthcare, explaining the responsibility required at all levels of the organisation. This included cross-working and understanding the wider impact, which is why it is necessary to start looking at all available evidence and data, and use this to build patterns to gain an understanding of the key issues to be addressed.

Taking these individual results and building an understanding of their relationships allows commissioners to fully understand the extent of their decision making and subsequently their operating plans and quality, innovation, productivity and prevention schemes.

‘The purpose was to build an understanding of common factors that affect multiple outcomes at a national level’

In a recent project the workforce team from South Commissioning Support Unit and the quality team from South Eastern Hampshire and Fareham and Gosport clinical commissioning groups worked together to triangulate data for all English trusts from a variety of sources, including the national staff survey, the electronic staff record system, inpatient survey, Unify2 data collection, the friends and family test, the Health and Social Care Information Centre and NHS Choices.

The purpose of the project was to identify where one data source correlated with another and to build an understanding of common factors that affect multiple outcomes at a national level.

What the data means

Below are some of the statistically significant correlations identified by the project relating to acute trusts.

Trusts with higher sickness absence rate averages tended to have:

• higher mortality rates measured by summary hospital level mortality indicator value;
• less effective communication between senior managers and staff;
• more pressure on employees to come into work when feeling unwell; and
• fewer staff feeling an appraisal helped them to do their job.

Trusts with a higher proportion of staff with greater than 15 years’ service tended to have:

• lower staff satisfaction around their level of pay;
• reater proportion of staff who enjoyed coming into work;
• higher average sickness absence rate;
• a greater proportion of staff who disagreed that they were able to make improvements happen in their area of work;
• more staff who were dissatisfied with the recognition they receive for their good work;
• a greater proportion of staff who were dissatisfied with the organisation valuing the work they do;
• a greater amount of staff who were dissatisfied with senior managers acting on their feedback; and
• a greater proportion of staff who disagreed that the organisation’s top priority was patient care.

Trusts with a higher stability index rate tended to have:

• higher inpatient friends and family scores;
• a greater proportion of patients who had confidence in nurses;
• a greater proportion of patient felt they had someone to talk to about their hospital fears; and
• a greater proportion of patients who felt their follow up care was discussed.

Trusts further from central London tended to have:

• higher average sickness absence rate;
• lower leaver rate and a higher stability index;
• higher inpatient friends and family scores;
• staff who were more likely to be satisfied around levels of pay;
• ahigher proportion of elective patients who felt they did not have to wait too long on a waiting list; and
• a lower proportion of patients who received copies of letters sent from their hospital to their GP.

Making links

At a national level, we have identified overarching themes in the correlations between workforce, quality, performance and national staff survey data. Some of the areas of correlation support existing knowledge, others present potential new findings.

We found trusts with a higher sickness absence rate tended to have staff with a negative perception of senior staff communication and the appraisal process.

The Care Quality Commission has said that a high sickness rate may indicate dysfunctional working conditions. Additionally the Keogh review into 14 acute trusts with high mortality rates found that those trusts tended to have a higher rate of sickness absence.

We also found that stability index is associated with several patient experience measures. This supports the CQC’s position that a high staff turnover rate could be symptomatic of a work environment that could negatively impact on the quality of care and delivery of services. 

‘Workforce should be embraced as a key enabler for positive change throughout the NHS’

However, hospitals that had retained staff over the longer term – those with higher proportions of staff with more than 15 years service – were more likely to see a greater number of negative outcomes in the staff survey, in addition to a higher sickness absence rate.

At a local level, our next step will be to work with individual trusts to understand the local context and to test the theories developed from the national data, including potential service improvement opportunities.

Although workforce expenditure makes up approximately 70 per cent of NHS costs and budgets, according to the King’s Fund, workforce outcomes have not, until recent years, been considered alongside quality and performance indicators. 

In order to improve quality, it is vital to begin with an understanding of workforce to build the foundations of long term improvements.

National Quality Board guidance, and the requirement to publish staffing levels at a more granular level, indicate a step in the right direction in terms of data availability.

To ensure the new availability of data adds value to the system, it is vital to continue the triangulation of workforce, quality, and staff and patient experience data. Workforce should be embraced as a key enabler for positive change throughout the NHS.

Leahamey Wilson is head of workforce of South CSU and Chris Davis is senior data analyst of Fareham and Gosport CCG and South Eastern Hampshire CCG