Agenda Item 9.4

CENTRAL MANCHESTER UNIVERSITY HOSPITALS NHS FOUNDATION TRUST Report of:

Margot Johnson Executive Director of Human & Corporate Resources

Paper prepared by:

Helen Parker, Associate Director of OD&T

Date of paper:

24th April 2015

Subject:

2014 Staff Survey Results Indicate which by  • Information to note

Purpose of Report:

• Support • Resolution • Approval 

Consideration of Risk against Key Priorities:

(Impact of report on key priorities and risks to give assurance to the Board that its decisions are effectively delivering the Trust’s strategy in a risk aware manner) The staff survey provides a snapshot of organisational culture at a moment in time. It has a particular emphasis on the levels of staff engagement which impacts directly on the experience of patients and also on the overall productivity and effectiveness of the organisation.

Recommendations:

Contact:

1)

The Board of Directors are requested to note the strengths, improvements and areas for development.

2)

Agree the goals in section 8 and actions in section 9.

Name: Tel:

Helen Parker Associate Director of Organisational Development 0161 276 6171

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Agenda Item 9.4

1.0

Introduction

1.1

This report outlines the results of the 2014 National NHS Staff Survey, providing a national and regional context for the results and key messages for CMFT. It also includes a summary action plan.

1.2

The survey results are used by the Care Quality Commission (CQC) in their Annual Health Check, as evidence towards compliance with Department of Health core standards.

1.3

There are 29 key findings within the survey plus an overall staff engagement score.

1.4

It should be noted that the data provided in the Staff Survey Report is weighted to take account of differing response rates from different staff groups.

1.5

The staff engagement score remained the same as last year at 3.76. This is above the national average for all Trusts and average when compared with Acute Trusts. Sustaining this level of engagement in the context of the current pressure is an achievement,

2.0

2014 NHS Staff Survey Results- the national context (All Trusts)

2.1

NHS Employers highlighted the key trends across all Trusts from the 2014 Staff Survey. A comparison of how CMFT compares against these is summarised below:

2.2

A new question on raising concerns shows that 68% of staff nationally would feel safe to raise a concern about unsafe clinical practice and 93% would know how to do so. 67% of CMFT staff would feel safe to do so and 93% would know how. This will now be a key measure for the Trust.

2.3

Staff Engagement

2.3.1

The staff engagement score is used as an indicator for the direction of travel on the quality of care being delivered and is made up of the following aspects of staff engagement: • • •

Staff perceived ability to contribute toward improvements at work Staff willingness to recommend the Trust as a place to work and receive treatment (advocacy) Staff motivation and engagement at work

2.3.2

Nationally the overall staff engagement score fell slightly from 3.71 to 3.70 due to decreases in staff motivation and advocacy scores. Staff ability to contribute toward improvements at work remained the same.

2.3.3

By comparison CMFT scores reflect: • An increase in the number of staff reporting an ability to contribute towards improvements in work, and • An increase in staff motivation at work, and; • A decrease in staff willing to recommend the Trust as a place to work or receive treatment

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Agenda Item 9.4 2.3.4

The change in the measure of staff willing to recommend the Trust as a place to work or receive treatment’ was a decrease of 0.6 from 3.71 in 2013 to 3.65 in 2014. Whilst this is not statistically significant and has NOT resulted in a reduction in overall staff satisfaction, it is a bigger decrease than the overall national position from 3.64 in 2013 to 3.62 in 2014. This has impacted on our ability to improve our engagement score. Four questions feed into this key finding. The responses for 3 out of the 4 questions improved or remained the same in 2014. However there was a 4% drop from 69% in 2013 to 65% in 2014 in staff reporting that ‘care of patients/service users is my organisations top priority’. The average for acute Trusts was 70% in 2014. It is highly likely therefore that this perception has had a direct impact on staff recommending the Trust as a place to work or receive treatment and consequently our ability to improve the staff engagement score.

2.3.5

The reasons for the decreased staff advocacy score needs to be fully understood and addressed as this clearly has a direct bearing on staff satisfaction and consequently, on patient satisfaction.

2.3.6

The table below outlines CMFT comparison of staff engagement results 2013 and 2014 and our ranking alongside Acute Trusts.

2013 CMFT

2014 CMFT

2014 Ranking compared to All Trusts and National Averages

2014 Ranking Compared to all Acute Trusts and averages

3.76

3.76

3.70 Above average

3.74 Average

67%

69%

68% Above average

68% Average

Staff recommendation of the Trust as a place to work and receive treatment

3.71

3.65

3.62 Above average

3.67 Average

Staff motivation at work

3.87

3.92

3.84 Above average

3.86 Above average

Overall Staff Engagement Staff ability to contribute toward improvements at work

2.4

Line Manager Support

2.4.1

The key positive trend across Trusts nationally was the improvement of indicators in the perception of support from line managers. The percentage of staff reporting that they were happy with the support they get from their manager rose from 65% to 68%. At CMFT this rose from 67% to 70% which is above the national average.

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Agenda Item 9.4 2.5

Training and Development

2.5.1

Nationally the number of staff receiving appraisals has remained stable at 83%, at CMFT this figure is 84% which although down on the previous year (from 88%), is still above the national average. The percentage of staff who report that they receive a wellstructured appraisal has risen slightly from 37.87 to 38.07. Although remaining above the national average the % of CMFT staff reporting well structure appraisals fell from 43% to 39%.

2.5.2

Overall the levels of staff training increased across most areas including health and safety and equality and diversity. This is also true for CMFT.

2.6

Health and Wellbeing

2.6.1

Nationally the percentage of staff saying that they had suffered work-related stress in the previous 12 months rose from 38.61 to 39.50. However the percentage of staff feeling under pressure to work when feeling unwell fell from 27 to 25%.

2.6.2

At CMFT we saw a decrease in the percentage of staff suffering from work related stress from 43% to 33% and also a decrease in those feeling under pressure to work when unwell from 28% to 24% keeping us above average nationally.

2.6.3

The percentage of CMFT staff who believe the Trust takes positive action on health and wellbeing has fallen from 43% to 39% which is below the national average of 43%

2.6.4

7% of CMFT staff reported experiencing physical violence from patients, their relatives or other members of the public in the previous 12 months, down from 15% in 2013. Nationally, this was 15% in 2013, down 1% to 14% in 2014.

2.6.5

There has been a 5% decrease (from 29% in 2013 to 24% in 2014) in the percentage of CMFT staff reporting that they experienced bullying, harassment and abuse from patients, their relatives or other members of the public in the previous 12 months. This is below the national average of 28%.

2.6.6

Although nationally there was a small rise ( 23.20 to 23.68) in staff reporting experiencing bullying and harassment from staff CMFT staff reported a fall from 21% to 19%.

3.0

Progress against goals identified in 2013

3.1

The following summary benchmarks CMFT against all Acute Trusts.

Goal

Achievement

Comments

Improve the staff response rate to ensure it is equal to or above the national average.

In 2014 CMFT have achieved a response rate of 44% which is average for acute Trusts.

Overall the national average dropped by 7% from 49% to 42%.

Maintain an ‘above average’ for the staff engagement score and those key findings where this was achieved this year

The CMFT score of 3.76 is slightly above the national average for acute Trusts of 3. 74

When reviewing the indicators feeding the staff engagement score the Trust is above the national average for job satisfaction and motivation, but below for advocacy (recommending the Trust as an employer/care provider).

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Agenda Item 9.4 Achieve a 30% increase in the number of key findings scoring in the 20% of trusts.

In 2013, CMFT was in the top 20% of Trusts for 8 key findings. This has increased to 11 which is a 37% increase.

To achieve improvements in the 3 areas where staff experience has deteriorated These were:

The Trust appears in the top 20% of acute trusts across all three areas where we had deteriorated in 2013.

• More staff suffering workrelated stress • More staff experiencing physical violence from patients, relatives or the public • More staff experiencing physical violence from staff

The Trust has maintained the top 20% position in the key findings relating to: • Health and safety training, • Harassment from patients/the public or staff • Effective team working. • Reporting near misses, errors or incidents CMFT moved into the top 20% for : • Work related stress • Staff experiencing physical violence from patients and staff • Staff having equality and diversity training • Support from immediate managers • Staff job satisfaction The Trust has however moved out of the top 20% of acute trusts for key findings relating to: • Staff working extra hours, • Well-structured appraisals, • Fairness/effectiveness of incident reporting, and • Work pressure felt by staff. For these indicators, the Trust has moved from below average to within the top 20% of trusts Furthermore, CMFT is also in the top 20% of acute Trusts for high levels of reporting errors and incidents and we saw improvements in equality and diversity indicators, support from immediate managers and an in staff job satisfaction.

4.0

CMFT 2014 Staff Survey Results

4.1

The following is a summary of all key findings for CMFT benchmarked against all acute Trusts.

4.2

The 2014 survey is broken down into 29 key findings. In 2014 Q13 and Q19 were replaced with new questions, because of this Key Finding 12 ‘Percentage of staff saying hand washing materials are always available’ has been removed.

4.3

Two new Key Findings have been introduced based on the new questions, these are ‘percentage of staff agreeing that they would feel secure raising concerns about unsafe clinical practice’ and ‘percentage of staff agreeing that feedback from patients/service users is used to make informed decisions in their directorate / department’, these scores now feature as Key Findings 15 and 29 respectively.

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Agenda Item 9.4 4.4

When compared to the 2013 survey, the Trust has improved in 17 areas, deteriorated in 9 areas and remained the same in 1 area.

4.5

This section is broken down into four areas – key strengths, areas where CMFT is above average, below average and areas for development.

4.6

Key Strengths

4.6.1

When compared to 2013, there has been a statistically significant positive change in the following Key Findings since the 2013 survey:

4.6.2

Percentage of staff… • experiencing work-related stress in the last 12 months. • experiencing physical violence from and patients public • experiencing physical violence from staff • having received E&D training in last 12 months

4.6.3

There are 11 key indicators where CMFT ranks in the top 20% of acute trusts nationally: • • • • • • • • • • •

Percentage of staff receiving health and safety training in the last 12 months Percentage of staff experiencing work related stress Percentage of staff reporting errors, near misses or incidents Percentage of staff experiencing physical violence from and patients public Percentage of staff experiencing physical violence from staff Percentage of staff experiencing bullying and harassment from and patients public Percentage of staff experiencing bullying and harassment from staff Percentage of staff having E&D training in the last 12 months Percentage of staff reporting effective team working Percentage of staff reporting support from immediate managers Levels of staff job satisfaction

4.7

Areas Above Average

4.7.1

When reviewing change in key findings since 2013 and ranking compared with all acute trusts in 2014, the following 8 areas are identified as above (better than) average: • • • • • • • •

Percentage staff agreeing that their role makes a difference to patients Percentage of staff witnessing potentially harmful errors, near misses or incidents in the last month Fairness and effectiveness of incident reporting procedures Percentage of staff feeling pressure in last 3 months to attend work when feeling unwell Percentage of staff reporting good communication between senior managers and staff Levels of staff motivation at work Percentage of staff experiencing discrimination at work in the last 12 months Percentage of staff agreeing feedback from patients/service users is used to make informed decisions in their department

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Agenda Item 9.4 4.8

Areas Below Average

4.8.1

Using the same rationale used to identify areas above average, the following 2 areas are identified as below average: • •

4.8.2

Percentage of staff staff working extra hours Percentage of staff staff appraised in the last 12 months

Finally, there was one Key Finding where the Trust has not only experienced a negative change since 2013 survey, but also is in the worst 20% of acute trusts: •

Percentage of staff staff feeling satisfied with the quality of work and patient care they are able to deliver.

4.8.3

The average for acute trusts has fallen by 2% against this indicator from 79% in 2013 to 77% in 2014. CMFT sits at 75% a fall of 5% from 2013.

4.9

Areas of Development

4.9.1

This section highlights the three Key Findings for which CMFT compares least favourably with other acute trusts in England. It is suggested that these areas might be seen as the focus of improvement plans • • •

Staff satisfaction with the quality of work and patient care they are able to deliver Working extra hours Number of staff appraised in the last 12 months.

4.9.2

As mentioned earlier in this report we also saw a decrease in the percentage of staff recommending the Trust as a place to work or receive treatment which has meant we have not improved our staff engagement score. It is anticipated that focussing our efforts on addressing the three key findings above will have a direct impact on our ability to improve our overall staff engagement score.

5.0

Staff Friends and Family Test

5.1

The Staff Friends and Family Test was implemented in 2014/15 across all staff in quarter 1, with Sodexo staff and the Board in quarter 2 and with staff participating in the sample in quarter 3. Results are detailed below: Not Recommended Recommended - Work - Work

Recommended - Care

Not Recommended - Care

64%

15%

74%

9%

Q2: Cohort 1 Leading 100% for Excellence

0%

*85%

0%

Q2: Sodexo

50%

35%

74%

11%

Q3: Staff Survey

62%

Q1: All staff

67%

*Not 100% due to net promoter score calculation

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Agenda Item 9.4 5.2

The table shows variations in advocacy between the different staff groups. The Q3 staff survey results are not directly comparable to the other quarters.

6.0

Comparisons to Shelford Group and Greater Manchester Acute trusts

6.1

National Benchmarking – Shelford group

6.2

The table below shows how the Trust compares to our peers in the Shelford group across a range of indicators including response rate, staff engagement score and the number of key findings in the top/bottom 20% of acute trusts nationally. The table has been arranged by the highest number of key findings in the top 20% of acute trusts nationally.

Organisation

Newcastle Sheffield CMFT GSTT Birmingham Oxford Kings Imperial Cambridge

Response Rate

Staff Engagement Score

Key Findings in top 20% of acute trusts nationally

Key findings in bottom 20% of acute trusts nationally

53

3.90

13

0

42

3.81

13

4

44

3.76

11

1

35

3.96

10

6

56

3.87

9

1

31

3.82

7

4

30

3.79

7

10

41

3.77

7

4

25

3.70

3

10

6.3

The table shows that CMFT has the second highest number of key findings in the top 20% of Trusts from the Shelford Group. The response rate is worthy of note with the Trust having the third highest (following Birmingham and Newcastle).

6.4

Despite achieving 11 key findings in the top 20% of Trusts our staff engagement score is one of the lowest scores in the Shelford Group. This can be explained by the fact that none of the11 key findings in the top 20% include the key findings that make up the staff engagement score.

6.5

However despite a decline nationally, which is reflected by a decline in the scores of 50% of the Shelford group, CMFT has maintained its staff engagement score over the last two years. This means CMFT is one of only 5 Shelford Group members that have not seen a decline in staff engagement scores meaning CMFT has maintained its year on year improvement against the mean average Shelford Trust staff engagement score

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Agenda Item 9.4

6.6

Greater Manchester Acute Trusts

6.6.1 The table below shows how the Trust compares to our peers in Greater Manchester Acute trusts across a range of indicators including response rate, staff engagement score and the number of key findings in the top/bottom 20% of acute trusts nationally. Again, the table has been arranged by the highest number of key findings in the top 20% of acute trusts nationally.

Organisation

Response Rate

Staff Engagement Score

Key Findings in top 20% of acute trusts nationally

Key findings in bottom 20% of acute trusts nationally

Wrightington, Wigan and Leigh

36

3.95

23

1

Salford

56

3.98

19

0

Bolton

47

3.81

15

0

CMFT

44

3.76

11

1

Stockport

29

3.74

9

2

South Manchester

35

3.84

8

1

East Cheshire

34

3.68

5

7

Tameside

38

3.78

3

2

Pennine Acute

32

3.61

2

8

6.6.2 The table shows the Trust is 4th when compared against local trusts for key findings in the top 20% and also the 3rd highest response rate in the region. 6.6.3 Finally, CMFT is ranking 6th out of the 9 GM acute Trusts for staff engagement despite achieving 11 key findings in the top 20% of Trusts. This can again can be explained by the fact that none of the11 key findings in the top 20% include the key findings that make up the staff engagement score. 7.0

Establishing the link between staff satisfaction and patient satisfaction

7.1

The Association of UK University Hospitals’ HR Forum commissioned a piece of work via Trovus to establish whether there was a relationship between inpatient satisfaction levels and staff motivation data (collected through the staff survey). More importantly what can be learnt from the analysis to improve both staff motivation and therefore positively impact inpatient satisfaction.

7.2

This work is underpinned by research carried out by Professor Michael West which has shown that Inpatient care and satisfaction is higher when staff performance and motivation is high.

7.3

The research found that there is a causal relationship between staff motivation and inpatient satisfaction. This is significant, because it means that the data relating to these Trusts do align to Professor West’s principles. Therefore we can go on with confidence to look at the guiding factors that influence staff motivation, which in turn support patient satisfaction.

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Agenda Item 9.4

7.4

The research broke the Association of UK University Hospitals’ member Trusts into four groups as follows: 1. 2. 3. 4.

Staff and Patient Stronger Performers (Staff Motivation is high / Patient Satisfaction is high) Staff and Patient Weaker Performers (Staff Motivation is low / Patient Satisfaction is low) Patient Stronger Performers (Staff Motivation is low / Patient Satisfaction is high) Staff Stronger Performers (Staff Motivation is high / Patient Satisfaction is low)

7.5

CMFT falls into group 4 and the OD&T team are working closely with the Corporate Nursing Team and Service Improvement Teams to understand this in more detail and include findings into actions moving forward.

8.0

Conclusion

8.1

As a consequence of developing a high level collaborative approach between HR and divisional staff, with focus being applied in the areas of development identified in last year’s survey, the Trust has achieved a response rate higher than the national average and had and an overall increase of 38% in Key Findings achieved in the top 20% of acute Trusts.

8.2

A significant achievement is the improvement made to the findings relating to staff experiencing physical violence from other staff and from patients and staff where we have moved from the bottom 20% of acute Trusts to the top 20%.

8.3

We have also achieved a reduction of 66% (3 to 1 indicators) for findings in the bottom 20% of acute trusts nationally.

8.4

However despite maintaining an average (as compared to Acute Trusts) overall staff engagement score we were not able to make improvements. This is primarily due to a decrease in staff advocacy scores i.e. staff recommending CMFT as a place to receive treatment or care; in particular the staff response to the question ’care of patients/service users is my organisations top priority’. CMFT is also in the bottom 20% of Acute Trusts for staff feeling satisfied with the quality of work and patient care they are able to deliver.

8.5

There has also been deterioration in the numbers of staff reporting they have received an appraisal in the last 12 months with more staff reporting that they are working extra hours.

8.6

The focus of improvement plans will therefore need to be on addressing these key areas.

8.7

For the 2015 Staff Survey our goals are to: • • •

Continue to improve the staff response rate to ensure it is either equal to or above the national average. Improve the staff engagement score to within the threshold for the highest 20% (3.82) and those key findings where this was achieved this year. Improve advocacy rates to at least an average of acute Trusts

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Agenda Item 9.4 • • • •

Achieve top 20% of Trusts for the new ‘raising concerns’ measure introduced this year. Continue to increase the number of key findings scoring in the 20% of trusts by a minimum of 10% To have no key findings in the bottom 20% of acute trusts. To achieve improvements in the areas where staff experience has deteriorated.

8.8

These goals will be achieved through the delivery of the actions outlined below.

9.0

2014-15 Actions and Next Steps •

Continue to work with divisions to develop plans to build on strengths and address areas of concern

•

Embed the Trust Values and Behaviours framework which defines the behaviours and attitudes we expect of each other. This includes: o

Delivery of Living the Values sessions across the organisation

o

Rollout of a revised appraisal form, policy and development programme

o

Sharing of staff recognition stories as identified by the We’re Proud of You Awards widely across the organisation

•

Continue to build on the staff engagement programme by introducing a new medical engagement framework, sustaining the Vision2Action and Transformation programmes.

•

Further develop and sustain high levels of leadership and management development

•

Modify the staff friends and family test to allow a cultural diagnostic of key areas.

•

Implement the Workforce Recovery Plan to: o

Reducing staff sickness to NHS average and below

o

All managers are achieving compliance with workforce standards

o

Ensure all staff are in receipt of corporate and clinical mandatory training

o

Ensure all staff are in receipt of an appraisal

•

Introduce a consistent staff ‘pulse check’ to measure and monitor staff experience throughout the year

•

Continue to develop alignment between staff and patient survey plans

•

Integrate staff survey plans into the Quality Review process

•

Through the Freedom to Speak Up action group implement principles and actions that will embed good practice and improve performance in handling concerns and the treatment of those who raise them.

•

A high level action plan is included as appendix A.

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