Abstract
ObjectivesThe views of practitioners at the ‘sharp end’ of care provision are increasingly recognised as important indicators of quality of care. The National Health Service (NHS) Staff Survey in England has quantified employees' views on how far they would be happy with the standard of care provided by their organisation if a friend or family member needed treatment. We aimed to characterise the concerns that might affect the willingness of staff to recommend their own organisations.DesignQualitative study involving semi-structured interviews. Data analysis based on the constant comparative method.ParticipantsMembers of clinical and managerial staff in four NHS organisations (n = 70), and senior stakeholders across the NHS including clinicians, managers and others with a strategic or senior-level perspective (n = 98).SettingOne hundred and sixty-eight interviews were conducted: 70 in four case study organisations and 98 across the wider English NHS.Main outcome measuresNot applicable.ResultsAsking study participants the ‘if a friend…’ question offered insider views on the quality of care. Some staff had no concerns, but others, identified significant problems with consistency, reliability and behaviour of staff. Participants identified reasons for poor care that included inadequate organisational systems; structural problems of understaffing and under-resourcing; weaknesses in professional cultures and professional competence and failure to deal with problems such as unacceptable conduct. Participants emphasised that staff were not always able to deliver high-quality care because they worked in difficult conditions.ConclusionsAsking staff to give accounts of their willingness to recommend their organisation to family and friends elicits important insights into quality and safety of care. Such accounts might be able to provide warning signs that could signal organisational decline and avert healthcare scandals, but use outside a research context requires further evaluation.
Highlights
The views of practitioners at the ‘sharp end’[1] of care provision are increasingly recognised as important indicators of quality of care.[2,3,4,5,6,7] Studies have shown associations between measures of staff morale and satisfaction and clinical outcomes, patient safety and patient satisfaction.[8,9,10,11] Direction of causality in such studies remains difficult to establish, but the views of staff are increasingly seen as one important signal of organisational culture relating to patient safety and quality of care
Inquiries led by Sir Robert Francis into failures of care at Mid Staffordshire National Health Service (NHS) Trust in England, for example, identified staff concerns about care quality in the hospital’s emergency department as a warning sign that went unheeded.[12]
One important way of obtaining data on the views of those at the sharp end is through the use of a socalled net promoter question, which assesses how far staff are prepared to recommend their own organisation to others.[13]
Summary
The views of practitioners at the ‘sharp end’[1] of care provision are increasingly recognised as important indicators of quality of care.[2,3,4,5,6,7] Studies have shown associations between measures of staff morale and satisfaction and clinical outcomes, patient safety and patient satisfaction.[8,9,10,11] Direction of causality in such studies remains difficult to establish, but the views of staff are increasingly seen as one important signal of organisational culture relating to patient safety and quality of care. Inquiries led by Sir Robert Francis into failures of care at Mid Staffordshire National Health Service (NHS) Trust in England, for example, identified staff concerns about care quality in the hospital’s emergency department as a warning sign that went unheeded.[12] The public inquiry suggested that staff feedback on quality of care be ‘ encouraged but insisted upon’ in healthcare organisations.[12]. ‘agree’ or ‘strongly agree’) and hospital standardised mortality ratios.[15] In 2013, the most recent year for which data are available, the proportion of staff who gave a positive response was in the range of 39.5–94%, with a mean of 67%.16. This suggests that while on balance many staff are supportive In 2013, the most recent year for which data are available, the proportion of staff who gave a positive response was in the range of 39.5–94%, with a mean of 67%.16 This suggests that while on balance many staff are supportive
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