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One million whistle-blowers tomorrow. Staff can be the best safety monitor?

February 22, 2013

Yet more evidence that simple ratings can help patients (and doctors and nurses) find great care. Yesterday it was evidence for ratings and reviews from patients, today Pinder, Greaves (again!) et al look at back at old data from the NHS and demonstrate what many have suspected all along: simply asking staff who work in hospitals “would you recommend your hospital?” might well be a powerful way to detect great (and not so great) care.

 Hospitals in England with lower mortality rates were more likely to have members of staff satisfied with the quality of care they provide.

They focused on whether or not staff would recommend their NHS trust to a friend or colleague. Over 60,000 responses were collected across the 147 acute general NHS hospitals in England, from doctors and nurses as well as administrative and support staff.

Dr Pinder asserted, “in this paper, what we are suggesting is that staff willingness to recommend their hospital may actually be a more sensitive indicator of the quality of care than HSMR. What this work does is demonstrate that staff satisfaction is correlated with organisational performance” he said.

Two other details buried in the paper which should not be lost:

1. Nurses are better predictors of the quality of their hospitals than doctors

2. Staff’s assessment of the care they personally provide does not correlate with hospital mortality – but Dr Pinder does not comment on this. My guess (based on 30 years working for or in the NHS) would be that most staff think they do a great job – but the early evidence from this paper does not support them having an accurate perception of their ability in this regard. (This is of course why all staff need regular feedback on their performance as viewed by others, [advert alert!] which is just one of the things that iWantGreatCare does for Trusts across the NHS.)

So, once again we see that simple ratings can predict care quality – but unlike mortality rates, can most likely be used to prevent disasters and deaths in the NHS. To really increase the power of these staff ratings and reviews, the NHS – in the wake of the Mid-Staffs, Worcester, Morecambe Bay tragedies – needs to do a few really clever, innovative and brave things:

  1. Add reviews to the ratings – all staff should be given the chance to add their reviews to the simple rating. This will instantly make it clear not just that “Houston, we have a problem”, but rather, “Houston, Ward 7 is always dirty and the managers won’t accept the infection risk or do anything about it”.
  2. Total transparency: all the ratings and reviews should be fully published in the public domain. The local and national media should be able to follow (Twitter feed?) what staff are saying about the hospital and will react accordingly. Some cautious types in Whitehall offices might claim this will stop people speaking out – I can tell you the reverse is true: many more will use the system if they are confident that what they say – good or bad – will be shared and will make a difference. (Oh look, we’ve suddenly made it incredibly easy for all one million people in the NHS to be a “whistle-blower” whenever they need to! Gagging clauses? What were they?)
  3. Real-time. All of this needs to happen continuously and be published in real-time. In the past this has been a once a year survey, but if – as Dr Pinder asserts – such a system can be a safety warning system then the “smoke-alarm” needs to be turned on all the time, not just for two weeks a year!
  4. Independent. Trusts must not be allowed to collect or edit the data themselves. One great way to stop this system working is if staff (and the public) feel that hospital management know who has written the comments, or for the public to worry that Trusts can edit what is shared. [As CEO of iWantGreatCare I’ve had Trusts tell me they will only work with us if they can edit or control the feedback from patients “so we don’t look bad”!]. Ratings and reviews from staff must be collected by totally independent organisations with the ability to share these fully in the public domain.

Good news to end with. Although the Imperial paper focused on identifying the minority of hospitals that are poor, combining staff reviews with the feedback from patients will show that the vast majority of hospitals are okay, and some indeed are fantastic. Done properly, this will be just as useful for highlighting excellence, as it will be for giving us early warning of failing organisations.

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