“Overspending on agency staff in the NHS is understandable, undesirable and unsustainable.” So said Simon Stevens at the NHS Confederation last month. Agency spending is a major driver of the fiscal deficit and also adversely affects quality through lack of continuity of patient care.
Rob Webster, CEO of the confederation, suggested two reasons why agency costs have increased: insufficient numbers of permanent staff to fill rotas, and a problem with culture. He is quoted as saying “We have really got to build our commitment with staff and really make them feel like we mean it when we say they are our biggest asset and our biggest investment.”
There is increasing evidence that engagement of employees with their work and organisation impacts on performance. It links to improvements in outcome measures including staff sickness and turnover, patient satisfaction and mortality, and safety measures including infection rates. Engagement comes from two sources: internal, personal resources and external, ‘job’ resources (such as those provided by employer). In times when no funding is available to increase external resources, engagement must come from focusing on personal resources – optimism, resilience and self-efficacy.
Verita has developed ‘ORA’ (organisational resilience assessment) as a pre-emptive, patient safety and corporate governance tool. It works through facilitated workshops with groups of managers, clinicians and frontline staff to identify specific areas of risk, target improvement where it will have most impact and benchmark performance against peer organisations. Differences in perceptions between the groups can be drawn out and addressed.
We have successfully used ORA across a number of trusts and services. We are struck by the impact it has had in creating high-levels of engagement with participants. ORA generates this by utilising the views of staff as the foundation of the assessment’s output. The experience of working together in small facilitated group sessions enables staff to think about organisational vulnerability and resilience in ways that they can relate to and own. Frontline staff are involved in drawing up action plans for how areas of weakness are going to be addressed and shared with the board. This approach generates staff ownership of improvement plans and commitment to their success.
Delivery of many of the current challenges facing the NHS – whether they are efficiency savings, service improvements or new models of care – requires the engagement of frontline staff. And when staff feel valued and well cared for, they can they can fulfil their professional calling of providing outstanding care for patients.