Understanding how front-line staff use patient experience data to improve service
Improving the staff experience (NHS survey)
The emphasis here is on using the staff experience not simply as a means of gathering or understanding the patient experience, but as a legitimate target for action, which would in turn influence the patient experience through indirect cultural and attitudinal change.
The exact nature of causality in the relationship observed between staff and the patient experience is complex and several mechanisms have been identified:
- Motivated staff provide better care
- Staff who feel that their experience is taken seriously are more likely to be motivated and receptive to feedback
- Involvement in patient-centred quality improvement is itself motivating
- Improving patient experience can directly improve the staff experience
Motivated staff provide better care
Staff suggest that if they feel supported and valued they would be in a better position, emotionally and psychologically, to provide good support to patients. The patient experience manager says that a good staff experience is a necessary, but not sufficient, condition for a good patient experience.
Staff who feel that their experience is taken seriously are more likely to be motivated and receptive to feedback
Information on how staff and patient experiences could be improved was gathered from staff. The rationale was twofold: first, that staff had a valid perspective on the patient experience and how to improve it; second, that seeking staff input and showing that it is being acted on would be affirming and empowering. This in turn could have a positive effect on their morale and motivation. It was also suggested that staff members who feel that their views are listened to and their expertise is respected would be more receptive to patient feedback and more likely to want to be involved in quality improvement. The importance of creating a sense of ownership, trust and ability to act is a common theme.
Time constraints and the demands of a difficult work environment can hamper a willingness to engage with patients and their concerns. One service manager describes that staff who have a difficult work environment tend to put up a barrier between themselves and patients.
Involvement in patient-centred quality improvement is itself motivating
Some participants described how staff directly derived fulfilment from being involved in patient-centred quality improvement work, as it aligns with the intrinsic motivations that have driven many staff to work in the NHS.
Improving patient experience can directly improve the staff experience
Staff identified a possible circular relationship between staff and the patient experience. They suggest that a poor patient experience could cause the patient to behave in ways that made employees’ working lives more difficult. This could be the result of an increased workload (for example, if staff are unable to respond to call bells in a timely manner, the patient’s need may become more acute, requiring greater staff intervention in the long term). This could also lead to poor patient–staff interactions, when patients are frustrated, bored or uncomfortable. This in turn could demotivate staff.
A focus on the patient experience is a priority for the NHS, but may imply that the patient and staff experience are somehow in tension or opposition to each other, rather than mutually reinforcing and being compatible. Approaches such as experience-based co-design seek to pay attention to both, seeing clinical staff as part of the solution and not of the problem.
The data show that there is a relationship between staff and the patient experience. These findings align with the conclusions of Luxford et al that a prerequisite for patient-centred care is a sustained focus on the staff experience, and with Shaller’s argument that to gain the commitment of front-line staff to patient-centred care, they must be directly involved in the design and implementation of processes.
To deliver patient-centred care, it is important to nurture an environment in which the organisation’s most important asset – its staff – is valued and treated with the same level of dignity and respect as they are expected to show to patients. As one participant argued, to deliver patient-centred care an organisation needs to be people-centred, not just patient-centred.
In addition to reflecting this growing evidence on the importance of the staff experience and creating a positive working environment, this study adds two new points:
Undertaking quality improvement activity could in itself improve staff morale, appealing to staff’s intrinsic motivation to provide good patient care. This could be done through variables such as a feeling of “effective teamwork” and increasing the feeling that “patient feedback is used to make informed decisions”.
Improving the patient experience can reduce their feelings of boredom and frustration, and create more positive relationships between staff and patients, thereby improving the staff’s own experience and making their work less stressful.