Healthcare staff in the NHS – and globally – are feeling undervalued, overworked and demoralised.
In a survey of 17,000 American doctors, 54% reported low morale. In China physician burnout rates of 66-87% have been reported, while doctors in India and the UK have taken strike action in the past three years. In 2016 a survey of nurses and midwives in Australia found almost a third had considered leaving the profession because of burnout.
The latest NHS staff survey revealed 40% of staff had felt unwell because of work-related stress, 21% wanted to quit the NHS, 78% experienced unrealistic time pressures and fewer than a third felt their organisation took firm action to improve staff wellbeing.
Health Foundation analysis shows record numbers of NHS staff quitting because they are fed up spending so long at work. Around one in 11 NHS posts are unfilled. Health Education England, which oversees workforce policy, says the biggest single cause of this crisis is poor retention.
In my book Human: Solving the Global Workforce Crisis in Healthcare, I argue that if the NHS and other health systems want to retain people throughout their working lives, they must support them through life events – parenthood, deaths, older age – and every stage of their career. They are also going to have to meet legitimate expectations of a healthy, happy relationship with work; staff need to find joy in their roles.
Small changes can make a big difference. For example, Capital Nurse, a London-based retention programme, recognised that many nurses never had conversations about their careers at work. They introduced a document nurses could use to record their qualifications and skills, track career progress, and use as a template for career planning with managers and mentors.
Training is another great retainer. The health select committee said a 60% cut in the nurses’ continuous professional development budget was a major contributor to nurses quitting.
Retaining the skills and experience of older workers is a priority as the workforce ages. This requires investment in health and wellbeing and better planning around older age, such as preventing and managing mental illness and musculoskeletal problems, common causes of long-term sickness.
Employers offer an array of services to keep employees healthy but, in the absence of serious attempts to reduce stress, initiatives such as free yoga lessons look tokenistic. British Gas shows the difference a carefully planned intervention can make – its back care workshop cut back pain-related absence by 43%.
As well as supporting clinicians through the course of their lives, organisations need to create the right culture. Although tricky to define, it is a strong driver of retention. The widely admired Frimley health NHS foundation trust has demonstrated how putting a big effort into getting the culture right can deliver extraordinary results.
In 2014 it took over the struggling Heatherwood and Wexham Park hospitals. After a massive programme of listening, talking and training to unite staff across its sites around values of excellent care, supportive teams and continuous improvement, Frimley Health saw an increase in staff recommending it as a place to work from 44% to 77% in one year.
Managing workforce performance is widely neglected in healthcare. I have worked in 77 countries, and in nearly every conference I speak at I ask the audience who has had meaningful objective-setting and appraisals aligned with their team’s goals. Barely a third put their hand up.
In forward-thinking organisations, performance management is evolving from a yearly appraisal into a more continuous two-way coaching conversation to nurture talent. It now needs to shift from managing individuals to supporting team development, particularly as we prepare for massive digital disruption.
This is more advanced in other industries but we are starting to see something like it in the NHS. Getting It Right First Time, a programme delivered by clinicians, visits medical departments, compares their performance with similar organisations, and helps teams improve care quality. The results can be startling.
Instead of demotivating staff and haemorrhaging talent, a drive across the NHS is needed to bring joy back to the work. If we want them to care for us, we need to care for them.
• Mark Britnell is global chairman and senior partner for health, government and infrastructure at KPMG International. His new book Human: Solving the Global Workforce Crisis in Healthcare is published on 18 March.
