St. Helens and Knowsley Hospitals NHS Trust
Executive Summary for Submission of Paper to the Public Board
Paper No. NHST(13) 026Subject: Fit, Healthy & Motivated Workforce – Attendance Management
Purpose:
The purpose of this paper is to provide the Board with an update on outcomes and deliverables from a suite of Workforce Strategies all with the purpose of supporting and developing our workforce so that they are able to deliver the Trust’s vision for 5 Star Patient Care and corporate objectives. In particular this relates to staff engagement, leadership development, health and wellbeing, attendance management and organisational culture. In addition it describes the requirement forbusiness cases to be developed for investment in order to support a healthy and motivated workforce.
Summary:
The Attendance Management policy has been fully implemented. Audits confirm that thepolicy is, in the main, being adhered to by managers.
The Talent Management & leadership development programme 2011-13 has been delivered with measurable outcomes
The Trust has developed a model for Occupational health over the last 2 years that has met the SEQOHS, but now needs further development to address current & future workforce needs
Staff Engagement achievements and how the Trust proposes to ensure deeper listening in line with the Francis report
The outcomes from the Valuing our People Steering Group and proposals on how the Trust can development the culture to increase the motivation and resilience of staff
Achievement against the Trusts People Development framework and proposals for specific competency training programmes to support Healthcare Assistants
Corporate Objectives met:
Developing organisation culture and supporting our workforce
Financial performance, efficiency and productivity
Financial Implications:Future business case to be developed identifying investment required.
Stakeholders:All Staff, managers, trade union representatives
Recommendation(s):
The Trust Board are asked to note the content of the report and the progress towards the milestones plan
Review Date: July 2013
Author (name and title):Claire Scrafton, Deputy Director of HR
Presenting Director (name and title): Anne-Marie Stretch, Director of HR
Board date:27th March 2013
TRUST BOARD REPORT
Fit, Health & Motivated Workforce – Attendance Management
Wednesday 27th March 2013
1.0Purpose
The purpose of this paper is to update the Trust Board on the progress to improve the level of sickness absence in the last 12 months and to provide assurance to the Board that while there has been a 0.23% increase in the cumulative figure from February 2012 to February 2013,significant work has taken place to understand the reasons for this increase as part of the Corporate Objective to “developing the organisational culture and supporting our workforce.” In addition the paper describes what actions are required in 2013/14 to ensure that the level of sickness absence improves and how this aligns with the broader HR & Workforce Strategy for 2013/14 and the implementation of the Francis report recommendations.
2.0Background and Context
2.1Attendance Management
The current Attendance Management policy was implemented following robust engagement with staff side, staff, line management, Human Resources and Occupational Health colleagues and research across the NHS and the private sector for best practice. In the two years following implementation, the Trust decreased sickness absence levels by more than 1%. Latterly however, the sickness absence levels have begun to rise. A deep dive analysis into the potential reasons for the increase in sickness absence has taken place over the last 3 months involving staff side colleagues and groups of staff, particularly those from the staff groups with the highest levels of sickness. Feedback indicates that the Attendance Management policy remains fit for purpose and is generally being implemented consistently, however there are other organisational, cultural and external factors that are impacting on staff morale and motivation that if addressed could result in reduction in sickness. The analysis included focus groups with staff employed by the Trust under the retention of employment arrangements, but managed by Medirest, (Compass) whose sickness levels are in some areas 2% higher than other staff groups across the Trust.
2.2Health, Work & Well Being Programme
The assessment of the Trust’s Health Work & Wellbeing Service (HWWB service) against the new Safe Effective & Quality Occupational Health (SEQOH) Standards and accreditation with commendations in December 2012 indicate that the range of services and operational model is in line with the Boorman recommendations and national standards
The deep dive analysis exercise as described above however, indicated that the capacity for rapid access to services to support staff suffering from stress and muscular skeletal (MSK) problems (accounting for c.20% of all absence), is insufficient to ensure that all staff requiring support have access to services in a timely manner that prevents multiple absences from these conditions. In respect of stress and MSK, access to counselling, psychological support and physiotherapy is via management referral only due to the current resources available. The analysis exerciseidentified that only approximately 25% of staff with stress and/or MSK conditions have accessed the Trust’s HWWB service for support in the last 12 months. This may be because they feel they are self managing their condition, seeking support from the their GP or have not realised that they could manage their condition better with rapid access to support within the Trust to ideally prevent further sickness absence. .
2.3Talent Management & Leadership
During the last 2 years, the Trust’s Talent Management and Leadership Strategy has delivered positive outcomes for staff satisfaction, improved leadership capability with measureable improvements in sickness absence in areas with traditionally higher than average levels of sickness absence. There are two notable case studies where the Robertson-Cooper Motivation, Morale and Leadership Styles Toolkit has been used; these are in the Emergency Department (A&E) where sickness absence has reduced by 1% and also Patient Booking Services, St Helens.
2.4Valuing our People Steering Group – Listening to Staff
The Valuing our People Steering Group has been meeting bi-monthly for the last 18 months. This is a group of staff representatives and managers from across all staff groups who take themes and discuss how improvements can be made. Often, solutions are simple and can be implemented quickly. An area reviewed in 2012 was incidents relating to violence and aggression against stafffrom patients and members of the public. Anonymous datix reports were shared with the group and an analysis completed of where staff had reported this had caused work related stress. As a result, the content ofconflict resolution training has been revised, as too, the staff groups such training is offered to.
2.5Cultural Development - ACE Behavioural Standards
Staff engagement processes indicate that whilst staff are now aware of the Trust’s values via the ACE Behavioural Standards launched at the Start of the year Conference in 2011, further work is required to ensure that these are embedded in all parts of the organisation and need to be refreshed on a regular basis. Specific work is required with our Medirest colleges to ensure all staff are treated with dignity and respect. Catering, Domestics and Porters feel part of the Trust and have organisational and cultural development plans that are aligned with those of the Trust, e.g. recruiting for values, supervisory and leadership training.
2.6People Development
The final area of feedback from listening to staff was relating to staff development of core skills. The achievement of Appraisals/PDP’s and Mandatory training during 2012/13 has not been as consistent as in previous years and feedback indicates this has been due to the unprecedented activity within the Trust making it difficult to release staff and managers from departments and wards. This has been stated by staff as another contributory factor towards motivation, morale and ultimately the increased sickness absence levels in the last 12 months. The re-design of clinical leadership role to release time for increased supervision of e.g. Healthcare Assistants, student nurses will not only improve patient care but also increase staff engagement and ultimately improve levels of attendance in groups of staff with traditionally higher levels of sickness absence.
3.0Developing the Organisational Culture and Supporting our Workforce
The overarching corporate objective for workforce in 2012/13 has been as follows:
“We will develop a management culture and style that empowers, builds teams and recognises and nurtures talent through learning and development. We will be open and honest with staff, provide support throughout organisational change and invest in Health and Wellbeing. We will promote standards of behaviour that encourage a culture of caring, kindness and mutual respect.”
The Trust has endeavored to deliver its workforce corporate objectives using the integrated staff engagement model illustrated below. It is proposed that in 2013/14 a targeted programme of support is provided to the 6 top wards/department with the highest levels of sickness absence/known teams who require intensive action in many of the areas described in the model all of which are known to have an impact on the level of engagement in the workplace, sickness absence and ultimately the consistent quality of patient care.
Fit, Health & Motivated Workforce – Staff Engagement Model
3.1The Aims of the Fit, Health & Motivated Workforce Action Plan 2013/14
Following the analysis described in section 2 of this report, targeted interventions are proposed to tackle the root causes of some of the sickness absence across 6 wards/departmentsto include Medirest staff groups. The outcome expected will be 0.3% decrease in the Departments’ cumulative sickness absence rates and significant decrease within the targeted areaswith savings also on bank and agency costs.
The metrics to measure success factors will include:
Increase in staff satisfaction from improved work relationships ( respect at work) This will be measured through staff survey, additional surveys to target staff groups, focus groups, listening events and use of the cultural barometer. Feedback will be both quantitative and qualitative.
Reducedsickness absence for the Trust and in those targeted areas
Achievement of higher levels of appraisals and PDP’s
Improved levels of staff engagement and motivation
Improved core skills and competencies for HCA’s through increased supervision
Embedding of the Attendance Management Policy & retraining managers where necessary including escalating cases more quickly
3.3Robertson Cooper
Overview of Motivation/Morale Staff Survey & Leadership Styles Profile
All staff in the targeted departments willreceive an invitation, via email, to complete a questionnaire about their well-being (ASSET); All leaders above a band 6 or 7 (band dependent on the department) receive an invitation, via email, to complete a leadership style questionnaire (Leadership Impact). The Robertson Cooper psychological profile tool analyses the impact of the managers’individualleadership style on the motivation and morale of their team of staff so that personal and team development solutions can be delivered to address training needs or cultural issues as they arise.
Milestone Plan – Robertson Cooper
April 2013 Targeted wards department receive communication about the questionnaires and surveys.May 2013 Questionnaires are distributed with a return date by the end of May
June 2013Questionnaires and surveys are analyzed and one to one feedback sessions with leaders and scheduled.Bespoke action plans are developed based on the needs of the team
June/July 2013 Feedback session commence to leaders and teams.Bespoke action plans are developed based on the needs of the team
August/Sept 2013Feedback sessions are concluded with development interventions be implemented ongoing as issues arise from the process
A business case will be developed and discussed at Executive Team meeting to support these proposals.
3.4.Deep Dive into Work Related Stress
The Trust is required as part of its Stress Management policy to carry out an annual audit of stress and in particular work related stress for compliance with NHSLA standards and the Health and Safety Executive (HSE). In 2011/12 a review was carried out on all instances of work related stress and managers were required to ensure that stress risk assessments had been carried out with each employee or team reporting work related stress in line with the policy.
It is proposed that this exercise is repeated in the quarter one of 2013/14, however, extending the scope to all reasons for stress as often stress can often not be split from domestic issues/ work when staff coping strategies and resilience are challenged by life in general.
3.4.1Milestone Plan – Stress & Supporting Staff Resilience
April 2013 Line managers issued with reports from ESR of staff in the team who have taken time off work with stress in the last 12 months. Where not already completed stress risk assessments to be sent to the HWWB service for review.
Annual promotion campaign of HWWB support services via appropriate channels of communication.
May 2013Stress surveys issued to all staff with a period of absence in 2012/13 relating to stress to be returned to confidentially HWWB for analysis.
Self Care training course offered to staff suffering from stress (HR Business Partner to deliver the nationally recognised programme in-house)
HWWB meet with line managers to agree packages of support where stress within teams has been identified
June 2013HWWB cross referencing of Stress surveys against Cohort records for staff who have accessed e.g. Counselling in the last 12 months.
HWWB write to staff to invite them into HWWB for a stress management/resilience support session with the HWWB service and personal action plans with purpose of avoiding future absence due to stress.
A business case will be developed and discussed at Executive Team meeting to support these proposals.
3.5Deep Dive into Muscular Skeletal Conditions (MSK)
In February 2013, the HWWB Service commissioned an external Physiotherapy organisation to carry out a review of the current service model for the management of MSK conditions. The organisation was requested to make recommendations on alternative models of service provision that would allow greater number so staff absence from work due to MSK conditionscan access appropriate services, reduce time off from work and reduce associated costs to the Trust.
3.5.1Current Occupational Physiotherapy Provision
The Physiotherapist currently runs 2 in-house sessions per week andstaff currently receive 4-5 sessions of physiotherapy following referral by the HWWB service. This is usually as a result of an absence due to a MSK injury. There is currently no waiting list for physiotherapy except for periods of holiday where this could increase to 2-3 weeks.The current in-house physiotherapy service receives positive feedback from the staff who use the service.
It is proposed that a 6 month pilot exercise is carried out similar to that on absence due to stress with a deep dive into MSK cases to understand more about the reasons for injuries, how many of those are effectively self managed, the balance between work and domestic MSK conditions and if changes are required to working practices or moving and handling training to improve to support staff in the work environment.
4.0 Recommendations & Next Steps
The Trust Board is requested to note the content of this report and support the development ofa business cases to support targeted interventions.
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Top 6 Areas in the Trust / Number of staff / Total Leaders (for 121) / Total Headcount (for Asset) / Cumulative Absence RateBand 2-5 / Band 6-8 / Doctors Consultants
Wards 5A and 5C Care of the Elderly plus
Care of the Elderly Med Staff / 94 / 5 / 12 / 17 / 118 / 8.73%
Wards 4a, 4b, 4c General Surgery plus
General Surgery Medical
Urology Medical Staff / 126 / 11 / 29 / 40 / 181 / 6.72%
Ward 2b & 2c Respiratory
Plus
Respiratory Snr Medical / 80 / 7 / 10 / 17 / 100 / 7.28%
Theatres
All staff / 191 / 34 / 37 / 71 / 263 / 9.29%
ICU/HDU Nursing
Plus
Specialist Nursing ICU
ICU Medical staff / 57 / 46 / 7 / 53 / 114 / 7.58%
Total / 548 / 103 / 95 / 198 / 776 / 7.84%
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