Corporate social responsibility:a potential lifesaver?

Abstract

Corporate social responsibility (CSR) has become a familiar concept for those working in the private sector and is now making a slow entry into the consciousness of the NHS, the UK’s biggest employer with a budget of over £100 billion (NHS Choices, 2011). Some elements of CSR fit well into any modern organisation, for example, addressing the need to reduce waste and use of fossil fuels. Similarly, it is easy to understand the potential strength of locally sourcing the £11 billion annual supplies and services (Coote, 2002). The NHS Supply Chain produced their first report in 2008 (NHS Supply Chain, 2008) and some hospital trusts are producing CSR reports, although these are sometimes a synthesis of policies relating to other corporate targets (Royal United Hospital, 2010) or merely address environmental concerns (NHS London, 2011). With regard to the ethical behaviours of CSR, the NHS might be expected to have a head start given that professionals employed by the NHS are governed by strict ethical codes of behaviour from external bodies (e.g. General Medical Council, Nursing and Midwifery Council) and there are no fee-perservice agreements with employees. Previously there was no need for hospitals to be competitive, but the current funding arrangements where primary care trusts commission services from hospitals mean that secondary care providers, whether NHS or privately funded, compete for contracts. In business, CSR has been shown to be successful in ‘building a better image and reputation’ and in demonstrating ‘differentiation from competitors’ (Formbrun and Stanley, 1990) and these benefits might easily lead to similar competitive advantage in a predominantly public sector market. However, using taxpayers’ money to fund activities other than those for which you have been commissioned seems, at first glance, to be unacceptable. Surely any money left over after fulfilling taxpayers’ needs should be returned to taxpayers? Could there be any justification of health service workers contributing to their local communities in the same way during working time as workers in commercial enterprises, for example, hearing children read, litter collecting or helping in a night shelter? Hospitals are nowadays beset with targets, the results of which are published and publicised. Just as anxious parents pore over OFSTED reports when choosing schools for their offspring, patients can hardly avoid reading about the successes and failures of their local hospitals before choosing where to have surgery. But does all this information change the decisions patients make? Patients have to take into account the travel convenience of choosing local services. A Kings Fund study (2010) found that 69% of patients always choose their local provider and 20% choose the local provider in all hypothetical circumstances, however bad the performance characteristics given. Therefore, the information in the public domain is more likely to set patient expectations than to cause them to choose an alternative hospital. Mondloch et al (2001) undertook a systematic review of the evidence for expectations affecting health outcomes and found that ‘15 out of 16 studies showed that positive expectations were associated with better health outcomes’. Therefore it is likely that patients who have faith in their local hospital are more likely to have a good outcome. Conversely, patients who have low expectations of their hospital may actually do worse. If we accept this argument, then the hospital public relations department has a role in direct clinical care. After an error has occurred, Fiona Martin is Specialist Registrar, Anaesthetics, Peninsula Deanery