The friends and family test: a qualitative study of concerns that influence the willingness of English National Health Service staff to recommend their organisation

Monitoring work well-being, job confidence and care provided by care home staff using a self-report survey

Background and method

In care homes, staff well-being, job confidence and opinion of the care provided to residents are central to morale and care quality. In this study, care home staff in the East Midlands region of England completed self-reported outcome and experience surveys in two rounds. Mean scores for each home are shown using a scale from 0 (all chose lowest option) to 100 (all chose highest option). High scores are good.

Results

In round 1, 332 staff in 15 homes submitted responses; in round 2, 207 staff in 9 homes. Mean scores in round 1 and round 2 were similar, although those of some homes scores differed significantly, cancelling each other out. Overall, Work Wellbeing mean score was 83 (care home range 48-97), with worthwhileness (92) the highest ranked item and anxiety at work (78) the lowest. Job Confidence mean score was 84 (range 59-94), with able to manage the work (86) highest and involvement in decisions that affect staff (79) lowest. Care Provided mean score was 86 (range 59-97), with treat people kindly (91) highest and well organised (80) lowest. Homes rated as outstanding by the Care Quality Commission had higher scores on average than those rated good, which were higher than those rated as needing improvement.

Conclusions

This study has demonstrated the practicality of measuring staff views of their Work Wellbeing, Job Confidence and Care Provided in care homes. Rather than wait for adverse quality outcomes to be detected, this approach offers a way to track staff morale and declared capability over time.

Influence from organisational factors on patient safety and safety behaviour among nurses and hospital staff

Purpose

Hospital systems are expected to influence patient safety outcomes. The purpose of this study is to explore organisational factors influencing patient safety and safety behaviour among nurses and other hospital staff.

Design/methodology/approach

Based on a theoretical model, six dimensions were selected from the hospital survey on patient safety culture. Moreover, one standardized dimension measuring safety behaviour was included. The data were collected from 1,703 hospital workers completing a cross-sectional survey.

Findings

Confirmatory factor analysis and supplementary statistics supported the use of measurement concepts applied in the study. A two-step statistical approach using structural equation modelling resulted in a satisfactory final model illustrating direct and indirect influence of the explanatory factors used.

Research limitations/implications

The limitation of this study is the use of a cross-sectional survey design.

Practical implications

The study illustrates how organisational factors are interconnected. The theoretical model developed and tested can be applied to improve safety behaviour and patient safety in hospital settings.

Social implications

The social implications of this study include the social relationships within the hospital setting, illustrating how organisational factors influence both safety behaviour and perception of patient safety levels.

Originality/value

A new theoretical model is developed and tested among hospital staff. The paper adds a new perspective on how organisational factors influence perceived safety outcomes in hospital settings.

Understanding the perspectives of health service staff on the Friends and Family Test

Objectives The present study was designed to determine what staff consider when asked to respond to the Friends and Family Test question. Methods Over 300 health service staff responded to an online questionnaire exploring whether they would recommend treatment at their organisation to friends and family (Friends and Family Test). Results Staff identified staff attitudes and behaviours, the busyness of the health service and quality of care as themes that affected their recommendation. A considerable number of staff also identified factors largely outside the control of the health service as influencing their response. Conclusions Majority of respondents based their perceptions on personal expectations, with smaller numbers citing personal experience and hearsay. Staff would need to see changes both in the quality of care and management practice to amend their recommendation on the Friends and Family Test. What is known about the topic? The Friends and Family Test is seen as a useful tool to gather the opinions of patients and staff on the patient experience, yet there has been little validation of this question. What does this paper add? The present study suggests that, as currently worded, the question does not reliably report staff perceptions regarding patient experience. The study illustrates that the relationship with the organisation and perceptions of effective management are linked to staff responses. What are the implications for practitioners? The Family and Friends Test question may need to be more clearly focused to gather the desired information. Improvement on this indicator is only likely to be seen when management teams are meeting the expectations of staff for good management practice.

Challenges Facing Healthwatch, a New Consumer Champion in England

This article engages with debates about the conceptualisation and practical challenges of patient and public involvement (PPI) in health and social care services. Policy in this area in England has shifted numerous times but increasingly a consumerist discourse seems to override more democratic ideas concerning the relationship between citizens and public services. Recent policy change in England has seen the creation of new consumer champion bodies in the form of local Healthwatch. The article describes these new organisational structures for PPI and shows how those who seek to influence planning and delivery of services or comment or complain about aspects of their care face considerable complexity. This is due, in part, to the ambiguous remit set out for newly instigated Healthwatch organisations by government. Drawing on governance theory, we show that it can also be understood as a function of an increasingly polycentric governance arena. Challenges that flow from this include problems of specifying jurisdictional responsibility, accountability, and legitimacy. We review Healthwatch progress to date, then we set out four challenges facing local Healthwatch organisations before discussing the implications of these for patients and the public. The first challenge relates to non-coterminous boundaries and jurisdictional integrity. Secondly, establishing the unique features of Healthwatch is problematic in the crowded PPI arena. The third challenge arises from limited resources as well as the fact that resources flow to Healthwatch from the local authorities that Healthwatch are expected to hold to account. The fourth challenge we identify is how local Healthwatch organisations negotiate the complexity of being a partner to statutory and other organisations, while at the same time being expected to champion local people's views.

Why is patient safety so hard in low-income countries? A qualitative study of healthcare workers' views in two African hospitals

BACKGROUND

The views of practitioners at the sharp end of health care provision are now recognised as a valuable source of intelligence that can inform efforts to improve patient safety in high-income countries. Yet despite growing policy emphasis on patient safety in low-income countries, little research examines the views of practitioners in these settings. We aimed to give voice to how healthcare workers in two East African hospitals identify and explain the major obstacles to ensuring the safety of patients in their care.

METHODS

We conducted in-depth, face to face interviews with healthcare workers in two East African hospitals. Our sample included a total of 57 hospital staff, including nurses, physicians, technicians, clinical services staff, administrative staff and hospital managers.

RESULTS

Hospital staff in low-income settings offered broadly encompassing and aspirational definitions of patient safety. They identified obstacles to patient safety across three major themes: material context, staffing issues and inter-professional working relationships. Participants distinguished between the proximal influences on patient safety that posed an immediate threat to patient care, and the distal influences that generated the contexts for such hazards. These included contexts of severe material deprivation, but also the impact of relational factors such as teamwork and professional hierarchies. Structures of authority, governance and control that were not optimally aligned with achieving patient safety were widely reported.

CONCLUSIONS

As in high-income countries, the accounts of healthcare workers in low-income countries provide sophisticated and valuable insights into the challenges of patient safety. Though the impact of resource constraints and weak governance structures are particularly marked in low-income countries, the congruence between accounts of health workers in diverse settings suggest that the origins and solutions to patient safety problems are likely to be similar everywhere and are rooted in human factors, resources, culture and behaviour. While additional resources are essential to patient safety improvement in low-income settings, such resources on their own will not be sufficient to secure the changes needed.