Since 2001, the NHS Modernisation Agency has been working to identify initiatives that will improve the experience and outcomes for patients across the service. The agency has worked with strategic health authorities (SHAs), ambulance trusts, primary care trusts (PCTs) and their partners, to find and share best practice wherever possible.
The challenge
Retention and recruitment has always been an issue in the NHS as many parts of the service experience high levels of staff turnover. One way of improving retention – recognised in 2003 by NHS director of HR Andrew Foster – is getting staff involved in formulating workplace policies. As a result, the Modernisation Agency’s retention and recruitment initiatives (RRI) team created staff discovery interviews (SDIs) to identify potential improvements in the workplace.
These interviews took the same form as existing patient interviews, which were carried out to gather information about service provision.
“I wanted to ask staff what we could do to make their life better,” says Kath Harris, head of RRI at the Modernisation Agency. “We could then identify things that would improve their sense of worth in the job.”
In 2003, three pilot schemes were created at Wolverhampton PCT, Barking, Havering and Redbridge Hospitals Trust, and Oxford Radcliffe Hospital Trust. In each case, interviews were carried out voluntarily, ensuring both interviewer and interviewee were committed to the process rather than feeling it was an imposition.
Individuals – usually HR staff – received interview training, supplied and funded by the RRI team. Interviewers would record interviews with about 30 staff, sending the resulting audio tapes to the RRI team for transcription and analysis. The only additional costs incurred by the trust were for the extra resources required to cover those staff participating in the interviews.
“The interviews are not structured, but nor are they entirely free-form,” says Harris. “Actually, the word ‘interview’ should be dropped entirely because it has the wrong connotations. It is not an imposition and we are not looking for right answers. Staff are simply invited to talk about their work experiences in their own words. As a result, you get answers to questions you have not even asked.”
Before the SDIs were carried out, the RRI team made sure each trust board was ready to listen to the responses and willing to act accordingly. It was vital that this exercise delivered real change rather than being perceived as a talking shop, where the NHS would listen to staff suggestions without acting on them.
“We gave explicit guidelines on what trusts needed to do before they interviewed the staff,” says Harris. “Everyone had to know what was going on and how the feedback would be used – that included involving staff representatives and the unions wherever appropriate.”
The outcome
At the end of 2004, more than 120 individuals had been trained in conducting SDIs. Within one trust, SDIs revealed that one reason for high staff turnover was a poorly-designed career structure, which meant that nurses who gained a more senior position were no longer entitled to carry out an aspect of the job for which they had trained.
By redesigning job descriptions, the trust was able to reverse the situation in 18 months, moving from a position of near permanent search and selection, to one where there were no vacancies and an applicant waiting list.
Staff in another trust reported lack of parking facilities as a significant issue in the workplace. Through addressing this and other issues, the trust experienced a 17% reduction in turnover and 55% reduction in recruitment advertising costs.
Employee perspective
SDIs have enabled staff to raise issues that would not have been heard in any other way. Morale in the workplace can be affected by many things, such as adequate staff rooms, team spirit, recognition and appreciation from senior staff. SDIs – and critically, the follow-up from the interviews – has given staff a real say in how the workplace is run.
Learning points for HR
“There has been criticism that by using volunteers, we would interview a biased group. People would only come forward if they had an axe to grind,” says Kath Harris. “However, the interviews also identify areas where the NHS gets it right.”
Although SDIs do not provide a shortcut or quick-fix to all the issues, swift changes have been implemented to demonstrate their effectiveness to staff. In one case, the evidence was so compelling that a trust board instigated changes before receiving official feedback from the RRI team.
With the Modernisation Agency about to be restructured, it will be interesting to see whether SDI training continues. Even if it does not, the technique is sure to continue to play an integral part in identifying and inspiring improvements in the NHS.
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