Annie Laverty, Chief Experience Officer at Northumbria Healthcare NHS Foundation Trust, offers her own reflections on engaging meaningfully with NHS staff during the pandemic.
In 2009 I was clinical lead for the Northumbria stroke service – an unusual role for a non-medic at the time. Working late in the stroke unit one night, I read Don Berwick’s paper What ‘patient centred’ should mean: confessions of an extremist. It made me reflect on the importance of shared decision making, and how real choice can often be limited in institutional settings. The article left me feeling frustrated and embarrassed that hospital care could be a lot more person centred than it actually was. I took my concerns to my CEO, Sir James Mackey. Jim challenged me to do something about it and the result was a new role to develop a comprehensive patient experience programme for Northumbria. It has been joyful work spanning a decade, and has fundamentally changed the way we deliver and improve care.
Sustaining high-quality and compassionate health care is not possible, however, if we – as health professionals – do not look after ourselves and each other. According to the 2019 National NHS Staff Survey, of the 1.3 million individuals working in the NHS, we know that 1 in 11 people will choose to leave the NHS permanently each year. Almost 8 in 10 will report unrealistic demands on their time, with nearly a third feeling frustrated that they cannot provide the level of care that they would like.
There was much that Northumbria was already doing to enhance staff health and wellbeing. But in the summer of 2018, we agreed to integrate our programme for patient and staff experience, with the aim of improving them both together.
The role of a ‘Chief Experience Officer’
My current role as Chief Experience Officer is designed to strengthen board accountability and ensure visibility and momentum for our trust-wide patient and staff experience programme. It was a new role for me, and for Northumbria, and is the only one of its kind in the NHS. I’ve been lucky to have the time and freedom to design a comprehensive measurement programme that allows the organisation to use feedback to truly understand what matters to patients, staff and families. This means we can quickly improve where we need to, as well as continuing to do the things that make a positive difference.
There is a wealth of evidence that supports the link between staff wellbeing and the quality of care that patients receive. We also know about the association between staff burn out and patient safety and neglect. Having board-level responsibility – and therefore the influence to improve the experience of both patients and staff, in an integrated way – is very meaningful work for me. I also get to do this in the context of an organisation that has demonstrated a longstanding and ongoing commitment to this work.
Drawing on the lessons from our patient experience programme, I reviewed the literature on workforce engagement and identified eight domains of staff experience that warranted particular attention and reflected fundamental needs of employees. These included psychological safety, autonomy and choice, and health and wellbeing as outlined in the IHI’s Joy in Work framework. We then developed measures to support each domain and launched our staff experience programme in December 2018.
The year that followed proved to be a very successful one. Our local measurement of staff experience, and the 2019 national staff survey results, both demonstrated that improving joy and pride at work, within a relatively short period of time, is possible. But this work takes organisational readiness, dedicated leadership time and attention, with skill development and investment.
Our plans for 2020 were radically interrupted by the arrival of coronavirus (COVID-19). Despite the pandemic leaving no time for in-depth enquiry, we needed an accurate thermometer check across all our sites, including of the staff self-isolating or shielding at home. We were already working with Open Lab colleagues at Newcastle University on an Innovating for Improvement programme, funded by the Health Foundation, testing new technologies to engage staff, but we also wanted to do this with real-time feedback during the pandemic. A new web-based platform was quickly developed and ‘corona voice’ launched on 6 April 2020.
Each week, staff are invited to reflect anonymously on their experiences. In a short online survey, they share how motivated they feel on a scale of 1 to 10, as well as the thoughts, concerns or emotions occupying their minds that week. In the first 3 months we will have received more than 10,000 responses from our workforce – a fantastic depository of reflections from NHS staff during this extraordinary time. We have been able to track motivation scores across all our sites and observe how these have changed over time. Each week I share this vital information with our executive team. During our response to COVID-19, this information is fed through to command meetings, helping our decision-making process.
Impact of the work
This work has felt important, personal and quite emotional at times. It’s clear just how frightened our staff have felt and how worried they’ve been about risk, for their patients and their families. We’ve regularly heard stories of extraordinary acts of kindness, camaraderie, compassion and courage. I recall one doctor taking the very human decision to enter a room, without full PPE for once, because he just wasn’t prepared for a patient to hear about their terminal cancer diagnosis from a man wearing a visor and a mask.
COVID-19 rapidly brought colleagues together from lots of different disciplines (public health, psychology, psychiatry, HR, staff experience, and communications) with a shared commitment to respond to the health and wellbeing needs of our teams. Corona voice feedback has enabled us to tailor the response of our staff wellbeing workplan in a very meaningful way, with a weekly understanding of where help might be needed and why.
Very early on, we became aware that staff experience was worse for those who remained at home – many felt isolated, lonely and guilty as they felt they weren’t doing their bit to support colleagues. We were able to increase our contact with this group of staff to establish and maintain regular support. More than 1,300 welfare calls have been made to date – sometimes just to listen, sometimes to address financial or safeguarding concerns, and for others to direct them to more specialist forms of emotional support through occupational health and psychology. Our wellbeing website has been well-utilised by many of our colleagues, while the guide we wrote for our managers on leading teams through COVID-19, was directly informed by some of the challenges and frustrations expressed by our workforce.
Our staff have also shared what they felt most proud of over the past 3 months. The teamworking and partnerships that have sustained them, the innovation and agility of the trust when responding to safety concerns such as PPE provision and supply, the strength and values of our leadership, and the open and honest way that our communications department has kept people reliably informed throughout the crisis.
One of the reasons I believe we were able to respond effectively and compassionately to staff concerns during COVID-19, was due to our staff experience programme already being in place – we could rely on high levels of staff engagement because we had already gained trust. Throughout all of this, I have felt most proud of the extraordinary response of our people, their courage, commitment, resilience and desire to keep doing what is right.
We still have much to learn about the longer term mental health implications of the pandemic for patients, staff and our communities. The situation has also rightly elevated staff wellbeing in many NHS organisations. My hopes are that we hold onto the importance of this work, and the strength of the partnerships, locally, that have made things possible.
Will my role still be unique for the NHS in 5 years’ time? I hope not. My wish is that all trusts are reliably measuring patient and staff experience – integrating it into their approach to improvement.
Annie Laverty is Chief Experience Officer at Northumbria Healthcare NHS Foundation Trust. She is also a GenerationQ Fellow and Q member.