by Karen Taylor
Earlier this week I presented the key findings from our February 2017 report, Time to care: Securing a future for the hospital workforce in the UK, at a breakfast meeting at Northern Ireland’s NHS Confederation (NICON) conference highlighting the hospital workforce challenges and potential solutions for hospitals in the UK. In discussing our findings with an engaged audience, a particularly emotive issue was highlighted – the challenges facing our older and more experienced members of staff. Our research suggests that introducing more flexible working and addressing some of the hygiene factors identified in our report could help address this problem. I therefore thought I would use this week’s blog to explore this issue in more detail.
About our workforce report
Our UK report covers healthcare in the four UK countries, and our findings are based on detailed literature reviews of clinical workforce issues in the UK, analysis of UK datasets, structured interviews with executive directors in some 30 UK hospitals, and policy makers and professional bodies. We also drew on the UK cut of our European survey of over 1,300 doctors and nurses working in hospitals across Europe (115 UK doctors and 201 UK nurses), triangulated with NHS staff surveys in the four UK countries and insights from colleagues working with health care clients across the UK.
Overview of key findings
Our findings highlight the significant pressures facing the UK’s hospital workforce, with widespread concern about the unprecedented levels of staff shortages – a situation that many people fear will be worsened by the decision to leave the European Union in 2019. For nurses, this situation has also been affected by the removal of the student bursary in England. Moreover, the UK’s workforce problems have been exacerbated by economic and political decisions over the past six years that have seen pay levels eroded and hospital funding in general failing to keep pace with demand. Notably, the UK has fewer nurses relative to the size of its population than the OECD average, and fewer than most comparator countries in the EU. While the UK has increased the number of hospital nurses and doctors it employs, this has not kept pace with hospital activity. The rising pressures facing the hospital workforce have resulted in insufficient time for hands-on care and increasing evidence of staff burn-out.
Nevertheless, we also identified a huge amount of positivity and commitment from employers and staff, and the adoption of impressive and innovative approaches to address the workforce challenges, including the development of digital, cognitive and other new solutions for tackling training, recruitment and retention. Importantly, we highlighted the need for employers to prioritise employee health and well-being and encourage staff development and empowerment, including supporting staff in developing new skills and competencies in response to advances in scientific knowledge, while enabling them to practice at the top of their license.
On the increasing complexity of care and its impact on older workers
Our analysis shows that having a larger ratio of high-skilled professionals is key to enabling teams to cope safely and cost-effectively with the growing demand from increasingly complex patients. Ironically, while many older staff members will have a great deal of experience, they are also more likely to need the greatest flexibility in workforce patterns, as I’ll explain later.
Although there are a number of workforce models to help determine safer hospital staffing, especially for nurses, most hospitals still struggle to define reliable comparable measures for understanding workload and productivity with insufficient flexibility to act on the evidence at scale. Indeed, many of our interviewees raised concerns about low morale, caused by heavier workloads and limited flexibility for changing shift patterns and working conditions.
Our interviewees’ views were supported by our survey responses, with doctors and nurses in the UK saying their workload had become more difficult to manage compared to five years ago. Over 26 per cent of survey respondents indicated that they were thinking of leaving their job for employment elsewhere; nurses on average showed even less inclination to remain in the profession, while about a third of doctors were considering whether to reduce their working hours to part-time working.
For a robust and financially sustainable hospital system, maintaining a stable supply of well-trained, motivated and high-performing professionals is crucial. Figure 1 summarises the factors impacting the availability of hospital clinical staff. t on the evidence at scale. Indeed, many of our interviewees raised concerns about low morale, caused by heavier workloads and limited flexibility for changing shift patterns and working conditions.
Figure 1. Activities that impact the availability of health care professionals
Maintaining an adequate supply of health professionals requires providers to work together and collaborate with policy makers to establish a sustainable approach for the three key routes to sourcing the health care workforce. While the left hand side activities are largely under the sphere of influence of government and professional bodies, the right hand side are more directly under the influence of hospital employers.
Figures 2a and 2b show how doctors and nurses rate the factors driving job satisfaction and dissatisfaction across four age bands. As in our European report, interpersonal and professional factors were seen as the main drivers of job satisfaction, while factors around the organisation of work contributed more significantly to dissatisfaction. Both doctors and nurses ranked a positive work environment and a sense of accomplishment as the top two drivers of job satisfaction. Older doctors and nurses ranked work-life balance, recognition and ability to use their skills as key drivers. Key drivers of dissatisfaction for doctors were poor management, long working hours and budget cuts, while nurses lamented heavy workload, low salary and lack of recognition. For older doctors and nurses, they both ranked lack of time to engage with patients, pay, work-life balance and flexibility as key drivers of dissatisfaction.
Figure 2. Drivers of work satisfaction and lack of satisfaction across the UK
Figure 2a: Top 5 factors contributing to positive satisfaction; focus is largely on interpersonal and professional factors
Figure 2b: Top 5 factors contributing to a lack of satisfaction; focus is largely on interpersonal and professional factors
On workload, 61 per cent of doctors and 58 per cent of nurses in our survey found their workload difficult or quite difficult to manage. Concerns about their ability to manage their workload has increased over the past five years. In comparison with doctors in the rest of Europe, more doctors in the UK indicated a shift to ‘quite difficult to manage’ levels of workload (17 per cent) compared to five years ago (compared to four per cent of their European counterparts). However, more European nurses reported difficulty in managing the shift to greater workloads (11 per cent) compared to UK nurses (nine per cent). Indeed, 61 per cent of nurses aged 36 or over finding their workload difficult or very difficult to manage, compared with only 56 per cent among younger nurses.
Most interviewees raised serious concerns about the effect on morale of workloads and working conditions, and the impact this can have on staff retention. Many felt they needed better real-time insight into the factors impacting workloads. Employers, however, do have it within their gift to do something about improving flexibility and support, including adopting technology to support staff to work differently, especially technology that helps reduce bureaucracy and helps productivity. Hospital leadership should foster a culture of innovation and collaboration if they are to enable the workforce to embrace the technological revolution and they should seize the opportunity to think creatively and focus on the opportunities that technologies offer to make jobs more meaningful and engaging and health care more efficient, productive and affordable.
Getting the right workforce in place is not merely a numbers game, nor can it be tackled with short-term or silo-based solutions. Without a transformation that enables smarter and more flexible working, the decline in motivation, staff wellbeing and workforce productivity that is all too evident today will become unsustainable tomorrow. Recognising the valuable contribution of older and more experienced staff members and introducing initiatives to reflect this in job planning and more flexible shift patterns will also help address the retention of this important group of staff, whose experience is a valuable asset for any organisation.