Which is better: a focus on staff engagement or clinical outcomes?

Two maternity teams have taken two different approaches to improving quality in maternity services: one aims to improve staff engagement, the other aims to reduce stillbirths. At onsite Quality Improvement Workshops*, multi-disciplinary teams worked in small groups to design quality improvement initiatives, using the Model for Improvement and the plan-do-study-act (PDSA) cycle.

Here, I’ll explore the merits of an approach to improving quality that focuses on staff engagement versus one that focuses on clinical outcomes. How well does each approach fit with local and national priorities?

Staff engagement

Western Sussex Hospitals NHS Foundation Trust has a perinatal mortality rate (stillbirths and neonatal deaths) that is lower than average (MBRRACE-UK 2016) and work is ongoing to reduce the rate still further.

Recognising the “clear links between improved staff experience and better care for patients” (NHS Employers 2014), Bronwyn Middleton and staff from the Women’s & Children’s Division chose to address the theme of improving staff engagement. Delegates at a Quality Improvement Workshop held on 12 May worked in small groups to review the results of the NHS Staff Survey 2016. The trust's HR department supplied a detailed breakdown of key safety questions (by department and staff type) so delegates benefited from a rich local evidence base. The groups wanted to make their huddles more relevant, engaging and snappy and used resources about Hospital Huddles from NHS Scotland.

The Western Sussex team discovered a range of local drivers important for successful huddles: looking at the organisation as a system made them think about involving staff from other departments; thinking about psychology - how to motivate staff effectively – led to ideas about including good news items (to reinforce behaviours and outcomes that are valued).

Perinatal mortality

The Royal Cornwall Hospitals NHS Trust has an extended perinatal mortality rate that is higher than average (MBRRACE-UK 2016). So the maternity team set out to reduce stillbirths, informed by the national aim to reduce the stillbirth rate (by 20% by 2020 and 50% by 2030) and the ‘Saving Babies Lives’ care bundle. During a Quality Improvement Workshop held on 2 February, each group drew a driver diagram to understand the key factors which help to save lives and then used local data and a quality improvement tool to select the most promising areas and ideas for improvement.

Clare Sizer, who hosted the Workshop at Truro, emailed to say:

“It was a brilliant morning and all of the attenders have contacted me to say they really enjoyed it.”

What did delegates say?

All delegates completed an evaluation survey at the end of each workshop. The survey comprises of nine Likert scale questions and two open ended questions (asking what was good about the workshop and what could be improved).

100% of the delegates agreed or strongly agreed that they would recommend the Quality Improvement Workshop to others.

This was encouraging as every time I deliver a workshop I look to improve the service and make it relevant to the local circumstances for each maternity team.

Delegates’ comments from both workshops are shown in the word cloud.

Adapting the workshop to meet local circumstances is rewarding for me as a facilitator. Tracking down different data sets and resources, so delegates have evidence to inform their quality improvement efforts, keeps the format fresh and interesting.

Delivering the workshops onsite helps me to understand teams better. At a time when NHS resources are stretched, it is encouraging to witness maternity teams' enthusiasm for quality improvement. Thank you to the teams at Western Sussex and Royal Cornwall Hospitals for welcoming me!

Is a focus on outcomes more valid than a focus on staff engagement?

According to Developing People – Improving Care, the national framework for developing NHS-funded staff, both are important. The purpose of the framework is to:

'...equip and encourage…[staff to]…deliver continuous improvement in local health and care systems and gain pride and joy from their work.'

The framework aims to ensure staff develop ‘a critical set of improvement and leadership capabilities’. Why?

'Evidence and experience from high performing health and care systems shows that having these capabilities enables teams to continuously improve population health, patient care, and value for money.'

Supporting staff to make a difference

It’s clear that improving staff engagement is necessary for high performing health and care systems. High performing health and care systems are ultimately measured by their impact on population health (such as mortality, morbidity and health improvement). Learning and putting into practice quality improvement tools such as the Model for Improvement or PDSA cycle - which has the flexibility to be used to help teams design, implement and assess improvement ideas to improve both staff engagement and patient outcomes – should be a core skill that all staff are supported to acquire and practise.

* Two Quality Improvement Workshops were given away to celebrate the anniversary of Every Birth a Safe Birth. The competition ran during June 2016; winners were drawn at random.