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What could the NHS learn from business?

Jocelyn Cornwell 27 February 2015

The Point of Care Foundation’s Jocelyn Cornwell argues that the NHS could make the business of kindness a corporate goal.


Last year there was a BBC Radio 4 business programme on kindness in business. Apparently the world of business is not always like The Apprentice: the ‘business of kindness’ represents a significant management movement. A ‘trend watcher’ said kindness is a ‘mega trend’ that manifests in a variety of ways.  Individuals and small firms barter goods and services and help each other out for free.  Increasingly, consumers want to avoid feeling responsible for ruining the planet.  Given the choice, they positively prefer firms with reputations for treating suppliers and employees well, and firms with good ethical values.

Against this back drop, will the latest government report on the NHS – Freedom to Speak Up, Sir Robert Francis’ independent review on how to create an open and honest reporting culture in the NHS  – dent public liking for the NHS?

Freedom to speak up

To recap briefly some relevant headlines.  Sir Robert took a huge amount of written evidence from individuals and organisations. More than nineteen thousand NHS employees completed questionnaires, hundreds attended public meetings and seminars around the country and the vast majority spoke about bad experiences – they mentioned bullying and oppressive behaviour frequently, as a subject for concern and as a consequence of speaking up. Staff from black and ethnic minorities were disproportionately represented and suffered worse treatment.  Staff don’t have confidence in the reporting process: if and when they do speak up, they say they are met with the ‘culture of defend, delay and deny’ – adjectives that are all-too-familiar to the patients and families involved in campaigns like Justice for LB, John’s campaign and the experience of families likes the Titcombes and the countless others who campaign for change in the NHS.

Is NHS culture worse than in other industries?

The NHS is a dysfunctional place, but do we know if this is an NHS problem or a more general problem in modern healthcare?  In the USA, low staff morale, high stress, high levels of burnout and a culture of fear and bullying in the health system are also cause for concern. And how does the culture of the NHS compare with the culture in other UK industries? Is it worse than other employers, or does it reflect wider societal problems in relations in the workplace?  We, the public, know more about the issues in the NHS not least because – in England at least – we have an annual national NHS staff survey. But newspapers report bullying and fear in other public services – schools and the police for example – as well as in the commercial world, especially banks and financial services.

None of this means that the organisational culture of the NHS and honest and open reporting are not important. Of course not. But given the importance of public trust and confidence, it would be helpful to get the problems in the NHS in perspective.

Back to the trend of kindness in business. The healthcare industry in general, and the NHS in particular, because it is not for profit, is in an extraordinary position to make the most of the mega trend in kindness. It could aspire to be a business that is, and is seen to be, based on kindness to patients (consumers) and employees. If policy makers, senior leaders and clinicians had the imagination they could raise the level of debate about the future of the NHS. In a world where people yearn for something – some business, some institutions, some professions they can trust – why not make the business of kindness a corporate goal for the NHS?

Build on public support for the NHS

In 2014, overall public satisfaction with the NHS increased to 65 per cent – the second highest level since the British Social Attitudes survey began in 1983. Dissatisfaction with the service fell to an all-time low of 15 per cent. Is it completely fanciful to imagine that buoyed up by remarkable levels of public support, senior leaders, clinicians and managers might think about how to build on the extraordinary advantage of an industry that by any standard has so much going for it? The obvious good of the primary task of the organisation.  Extraordinary, privileged opportunities to relieve suffering, to relieve suffering and transform lives for the better. A highly intelligent workforce made up in the main of people who are proud of what they do and want to do a good job. Rock solid evidence that shows that support for staff and staff engagement is the key to good patient outcomes. And so on.

NHS England is providing national leadership through the Five Year Forward View, which commits to providing safe, inclusive, non-discriminatory opportunities and supporting employees to raise concerns and ensuring managers act quickly on them. Since what gets measured gets managed, should measures of staff well-being and staff satisfaction be included in the national Outcomes Framework as goals for the system as a whole? That would begin to set the agenda nationally but what we need now is local leaders – the boards and executives of NHS trusts and commissioners – to act on the strong consensus  about how to engage and support staff in the valuable work they do with and for patients. We need NHS organisations to take action on the evidence that caring for the providers improves care for patients.

Tell us what you think. Should measures of staff well-being and staff satisfaction be included in the national Outcomes Framework?