The Great Western Hospitals NHS Foundation Trust (formerly the Swindon and Marlborough NHS Trust) provides health services from two main sites - the Great Western Hospital in Swindon, which is a district general hospital, and Savernake Hospital in Marlborough. It serves a population of about 300,000 people and the annual turnover is around £156 million.
Using HSE's Management Standards as a basis, we recognised the clear link between stress management and patient care – if your employees are unhappy, their productivity levels fall. Looking after your staff well being can also directly impact on hospital safety and staff satisfaction. And as we started preparing to be a Foundation Trust, we looked again at our priorities, values and standards - asking questions like 'what are we going to stand for – why would patients choose us?
And the figures spoke for themselves: our staff attitude questionnaire showed 32% of staff reported suffering from work-related stress; it was one of the main reasons for absence. We needed to act.
'It's not just about stress management - good health and safety leads to quality patient care and makes us a more productive trust.' – Oonagh Fitzgerald, Director of Workforce and Education.
A few years ago it was hard to persuade people that stress was a real issue. Things have developed a lot since then and we've been tackling stress successfully now for 18 months. We don't just look at stress either, but consider the wider issues of health and well being.
Buy in from Executive and Senior Board members was very important and they continue to be very supportive and involved. Members often tour the wards talking to nurses about what it's like to work there.
How we did it
Key targets before we set out:
We used several ways to collect data:
Once results are in from the staff survey – working groups look at hotspots across directorates. Our staff engagement programme is very important in this process. But there's also a stress working group that meets monthly so we're always considering new initiatives.
We communicate the results of the staff survey via the staff newsletter, team briefings and HR representatives. Once we've put actions in place, we let the staff know this through the same channels.
Nurses identified the following areas as potential causes of stress:
Each area of the hospital has their own action plan, but for nurses, these are some of the key initiatives working to reduce stress:
'It's quite tangible…You walk on the ward and you can positively sense the difference.' – Productive Ward project lead
The 'Productive Ward' aims to improve the way a ward works so that nurses get to spend more time with patients. National research, echoed at Great Western Hospital, has demonstrated that nurses spend an average of 40% of their time on direct patient care. Nurses come into the profession to care for patients and if they don't get to do this for the majority of their daily shifts, job satisfaction decreases, while fatigue and stress levels increase.
On one particular ward at the hospital, nurses were spending 38% of their time on patient care, while 16% was spent walking around and 10% on admin.
By rearranging the ward layout, nurses were able to free up time for direct patient care and spend more time doing their job.
'A nurse on one of the wards was going to leave but changed her mind. In her words, the ward is a much better place now, a lot tidier, with everyone working more harmoniously and spending more time with patients. - Productive Ward project lead
After six months of the initiative, the same ward increased its level of patient care by 20%, whereas the amount of time spent walking around came down from 13% to 7%.
'The nurses don't spend as much time walking up and down the ward now as the store cupboard is more centrally located. The project has worked really well. I think as a ward community, people take more pride in their workplace. Nurses have more time to spend with patients now.' – Ward manager
In Feb 2009, two wards adopted the Productive Ward approach and since then another 12 have implemented it; by May 2010 all wards will have started on the programme.
Other solutions include face to face briefings at the end of each shift, so nurses can raise any issues.
All sessions are transcribed so people who can't make the briefing can go back and read what was said. Email is a fairly poor way of communicating on wards and nurses respond better to direct communication like this.
Staff engagement also runs through the heart of the stress management process. Employees have the opportunity to take part in individual discussions and senior managers also take time out to visit wards and talk to members of staff. Some of the most junior members come up with the best ideas.
To deal with the complaints about staff shortages, we have looked again at workforce planning. One day a month is set aside for recruitment, even if we don't have immediate vacancies. This sends a good message to the ward that we're planning ahead.
In another initiative called 'generic ward', nurses get to experience all disciplines of nursing and receive intensive training so they are able to work across different areas. Ward managers' feedback about this is very positive. These nurses have valuable skills which can be allocated in any ward.
Employees feel more empowered to change things; they feel like their opinions will be listened to and acted upon. And with a more satisfied workforce, comes a more productive one.
In a year the percentage of people reporting cases of work-related stress via the staff survey has fallen by 7% from 32% to 25%, which is better than the national NHS average. The percentage of sickness absence due to stress is still high, but we can see a downward trend emerging. In December 2008, 13% of the total absence was down to stress, whereas it caused nearly 20% of absence the year before.
'In the early days there were ideas about stress management and it's satisfying to look back and say this is something that can make a difference to your business. Stress management at Great Western came at a time when the NHS was under financial pressure and it's good to see the Management Standards process working as part of a productive business model. There are design issues with this hospital which present challenges, but there has been a culture change here which it's even had an impact on other local organisations.' - Emma Darvill, HSE Inspector.