Medical Engagement Scale Supplementary Report Specialty Drs

Transcription

1 Ltd Medical Engagement Scale Supplementary Report Specialty Drs Southern Health NHS Foundation June 2013

2 Contents Contents... 2 Executive Summary... 3 Introduction... 4 Perspective 1: Overview of Relative Levels of Medical Engagement... 8 Perspective 2: The Profiles of Medical Engagement Perspective 3: Responses to Local Questions Perspective 4: Engagement and Suggested Intervention Strategies Page 2 of 18

3 Executive Summary Trusts with high levels of engagement perform better on available measures of organisational performance than trusts with low levels of engagement. 1 This is a supplementary report covering only Speciality doctors and builds on a recent report that covered all medical staff. In all 10 (26%) Speciality Drs completed this survey. 81 medical staff responded to the previous survey. A comparison of these survey results with the previously-surveyed Trusts in the normative database (currently comprising over 65 Trusts and over 7500 medical staff) indicated the following: The response rate was low with only 10 out of 38 responding, although this compares with only 4 speciality doctors who responded to the previous survey. Compared to the external normative database, the aggregated average level of medical engagement at for speciality doctors at Southern Health NHS Foundation Trust fell within the low range not only on the overall Index of medical engagement but also on the three Meta-Scales Two the Sub Scales (Sub Scale 1: Climate for Positive Learning and Sub Scale 3: Appraisal & Rewards Effectively Aligned) were in the medium range for relative medical engagement, whilst all the other sub scales were in the lower range. 1 Are We There Yet: Models of Medical Leadership and their Effectiveness Chris Ham, Helen Dickinson, Iain Snelling & Peter Spurgeon National Institute for Health Research April 2013 Page 3 of 18

4 Introduction It is increasingly recognised that improvement in healthcare needs the positive involvement and engagement of doctors who are willing and able to adopt roles that make them highly influential in planning and delivering service change. Although competence may be thought of as what doctors can do, medical engagement requires a will do attitude. The reliable and valid measurement and monitoring of medical engagement is critical since this will inform and shape the effective management of change. Although, many definitions of engagement focus solely on individual and personal aspects the current approach also incorporates organisational conditions and culture. Our definition of Medical Engagement is: The active and positive contribution of doctors within their normal working roles to maintaining and enhancing the performance of the organisation which itself recognises this commitment in supporting and encouraging high quality care. The Medical Engagement Scale (MES) is a simple and short 30 item survey instrument consisting of ten reliable and valid scales. The instrument has a hierarchical structure and provides an overall index of medical engagement together with an engagement score on three reliable meta-scales with each of these three meta-scales itself comprising two reliable sub-scales: Meta-Scale 1: Working in a collaborative culture M E D I C A L E N G A G E M E N T Sub-Scale 1: Climate for positive learning Sub-Scale 2: Good interpersonal relationships Meta-Scale 2: Having purpose and direction m e t a - s c a l e s Sub-Scale 3: Appraisal and rewards effectively aligned Sub-Scale 4: Participation in decision-making and change Meta-Scale 3: Feeling valued and empowered s u b - s c a l e s Sub-Scale 5: Development orientation Sub-Scale 6: Work satisfaction R E C I P R O C A T E ( C o l l a b o r a t i o n ) G I V E ( C o m m i t t m e n t ) R E C E I V E ( S a t i s f a c t i o n ) Page 4 of 18

5 Furthermore, the structure of the MES enables it to contain two types of engagement sub-scale: Three ORGANISATIONAL Sub-Scales (1, 3 and 5) which reflect the cultural conditions which facilitate or inhibit medical staff to be more actively involved in leadership and management Three INDIVIDUAL Sub-Scales (2, 4 and 6) which reflect medical empowerment and confidence to tackle new management and leadership challenges ORGANISATIONAL INDIVIDUAL Sub-Scale 5 Sub-Scale 6 RECEIVE Satisfaction "Development Orientation" Meta-Scale 3 "Being Valued & Empowered" "Work Satisfaction" Sub-Scale 3 Sub-Scale 4 GIVE Commitment "Appraisal & Rewards Effectively Aligned" Meta-Scale 2 "Having Purpose & Direction" "Participation in Decision Making & Change" Sub-Scale 1 Sub-Scale 2 RECIPROCATE Collaboration "Climate for Positive Learning" Meta-Scale 1 "Working in a Collaborative Culture" "Good Interpersonal Relations" MEDICAL ENGAGEMENT Page 5 of 18

6 Brief definitions of each of the MES scales are shown in the table below. MES Scale Scale Definition [The scale is concerned with the extent to which..] Index: Medical Engagement...doctors adopt a broad organisational perspective with respect to their clinical responsibilities and accountability Meta Scale 1: Working in a Collaborative Culture...doctors have opportunities to authentically discuss issues and problems at work with all staff groups in an open and honest way Meta Scale 2: Having Purpose and Direction medical staff share a sense of common purpose and agreed direction with others at work particularly with respect to planning, designing and delivering services Meta Scale 3: Feeling Valued and Empowered...doctors feel that their contribution is properly appreciated and valued by the organisation and not taken for granted Sub Scale 1: [O] Climate for Positive Learning...the working climate for doctors is supportive and in which problems are solved by sharing ideas and joint learning Sub Scale 2: [I] Good Interpersonal Relationships...all staff are friendly towards doctors and are sympathetic to their workload and work priorities. Sub Scale 3: [O] Appraisal and Rewards Effectively Aligned...doctors consider that their work is aligned to the wider organisational goals and mission Sub Scale 4: [I] Participation in Decision-Making and Change...doctors consider that they are able to make a positive impact through decisionmaking about future developments Sub Scale 5: [O] Development Orientation...doctors feel that they are encouraged to develop their skills and progress their career Sub Scale 6: [I] Work Satisfaction...doctors feel satisfied with their working conditions and feel a real sense of attachment and commitment to the organisation Page 6 of 18

7 To date, MES surveys have been undertaken in over 65 participating hospital Trusts and these have been used to establish a large, valid normative database of over 7500 medical staff. This database provides a set of engagement benchmarks for doctors who work in healthcare organisations and this document provides feedback of the relative level of medical staff engagement at each of the participating organisations compared to the norms. In this report the MES survey results are organised as shown below. The remainder of the report is divided as follows: Perspective 1: Overview of Relative Levels of Medical Engagement Perspective 2: The Profiles of Medical Engagement Perspective 3: Responses to Local Questions Perspective 4: Engagement and Suggested Intervention Strategies Page 7 of 18

8 Perspective 1: Overview of Relative Levels of Medical Engagement For each of the 10 medical engagement scales, the average medical engagement scores for Trusts in the normative database were ranked and split into three main bands high relative engagement (coloured green in the figure), medium relative engagement (coloured yellow) and low relative engagement (coloured red). Based on all the speciality doctors who completed the survey (n = 10), the coloured hierarchical figure and the table below shows where the Trust fell with respect to the normative database. Medical Engagement Scales: Relative Normative Feedback for Speciality Doctors (n=10) Page 8 of 18

9 Key: High Relative Engagement (top third of Trusts) Medium Relative Engagement (middle third of Trusts) Low Relative Engagement (bottom third of Trusts) The results of he current survey are shown alongside of those when the survey was previously undertaken. Speciality Dr (n=10) Previous Survey All (n=81) Engagement Scale L H Meta Scale 1: Working in A Collaborative Culture L H Meta Scale 2: Having Purpose & Direction L H Meta Scale 3: Being Valued & Empowered L M Sub Scale 1: Climate for Positive Learning M H Sub Scale 2: Good Inter Personal Relationships L H Sub Scale 3: Appraisal & Rewards Effectively Aligned M M Sub Scale 4: Participation on Decision Making & Change L M Sub Scale 5: Development Orientation L H Sub Scale 6: Work Satisfaction L H Page 9 of 18

10 The hierarchical figure above shows that with respect not only to the overall lndex of Medical Engagement but also for three meta scales relatively low levels of medical engagement. Four out of the six sub scales were in the lower range. The results also show far lower levels of relative engagement amongst speciality doctors compared with other medical staff within the Trust. Despite the fact that the overall average levels of engagement in the low range, further disaggregation of the data (see the table below) revealed the percentage of medical staff respondents who fell into each of the three engagement bands and reveals a pocket of medical staff who were in the medium and higher ranges, this is further examined in Perspective 2 Profiles of Medical Engagement. Percentage of Respondents (n = 10) who fell into High, Medium and Low Normative Bands High Medium Low Medical Engagement Index 20% 20% 60% Meta-Scale 1: Working in a Collaborative Culture 0% 50% 50% Meta-Scale 2: Having Purpose and Direction 50% 10% 40% Meta-Scale 3: Feeling Valued & Empowered 30% 0% 70% Page 10 of 18

11 Perspective 2: The Profiles of Medical Engagement Although average scores can provide a useful summary of how all responding doctors in the Trust have rated the medical engagement scales (see Perspective 1: it is sometimes the case that similar averages may conceal very different underlying distributions of scores. Knowing this distribution is sometimes important in identifying the proportion of doctors who are either strongly or weakly engaged with maintaining or enhancing organisational performance. Perspective 3: provides this information as the following paragraph explains. For each of the ten medical engagement scales in turn, the distribution of scores for all medical staff in the normative database (i.e. over 7000 medical staff representing over 65 Trusts) were split into five bands of scores (labelled A to E) - the upper and lower limits of each band being adjusted so that 20% of staff fell into each one. For this particular Trust, the histograms show the percentage of doctors who fell into each of these five bands of scores and this enables a comparison to be made between the profiles of medical engagement scores within this Trust compared to the group norm. Clearly, organisational efforts to enhance medical engagement should focus on areas where there are more relatively disengaged pockets of medical staff. Whilst the results, in line with the overall scales, shows a high proportion with low levels of engagement (D&E) there are small pockets demonstrating higher levels. A set of profiles are included below based on all medical staff respondents (n =10). Page 11 of 18

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13 The table below summarises the percentages of medical staff who were the most engaged (Bands A and B) and the least engaged (Bands D and E) for each of the ten MES scales. As is demonstrated below generally a high proportion of respondents are demonstrating lower levels of relative medical engagement however in the overall results this hides a small pocket who are in the higher range. MES Scale Percentage Most Engaged ( Bands A & B) Percentage Least Engaged (Bands D & E) MEI: Index of Medical Engagement 20% 60% Meta Scale 1: Working in a Collaborative Culture 10% 50% Meta Scale 2: Having Purpose & Direction 30% 40% Meta Scale 3: Feeling Valued & Empowered 10% 70% Page 13 of 18

14 Perspective 3: Responses to Local Questions Respondents were also asked to respond to a series of local questions suggested by the Trust. They were asked to state on a five point scale the extent to which they agreed with the following statements, with 5 being Strongly Agree, 1 Strongly Disagree and 3 being Neutral. The results are shown in the bar chart overleaf with the higher the score being a higher level of agreement with statement. Page 14 of 18

15 These local results generally mirror the overall low levels of engagement demonstrated within the MES scores. The local question referring to training and development received a positive response (i.e. greater than 3) and this is reflected in the medium rating for Sub Scale 1 Climate for Positive Learning. The only other question receiving a positive response is to the statement I want to influence the way the Trust provides services whilst clearly the MES scores demonstrates they do not believe they are effectively able to at present (note Meta Scale 2: Having Purpose and Direction). However it does provide some positive in that they want to become engaged although do not feel so at present. Page 15 of 18

16 Perspective 4: Engagement and Suggested Intervention Strategies The recently published report from National Institute for Health Research 2 concluded Trusts with high levels of engagement perform better on available measures of organisational performance than trusts with low levels of engagement. It is therefore important that results of this report are not perceived by Trust management as a satisfaction survey of consultants but that it raises fundamental issues that will affect the organisation s ability to be an effective and efficient provider of health care. We have outlined overleaf indicating those areas for priority. A key is set out below. Key: Priority for Improvement Scope for Improvement Monitor & Maintain In the table, on the final page of this report, we have set out potential organisational strategies to address particular areas highlighted by the MES Survey. 2 Are We There Yet: Models of Medical Leadership and their Effectiveness Chris Ham, Helen Dickinson, Iain Snelling & Peter Spurgeon National Institute for Health Research April 2013 Page 16 of 18

17 Collaboration Commitment Satisfaction Southern Health NHS Foundation Trust Medical Engagement Scales Priority Target state Meta Scale 1: Working in a Collaborative Culture Sub Scale 1: Climate for Positive Learning Sub Scale 2: Good Interpersonal Relationships Meta Scale 2: Having Purpose & Direction Sub Scale 3: Appraisals & Rewards Effectively Aligned Sub Scale 4: Participation in Decision-Making & Change Meta Scale 3: Being Valued & Empowered Sub Scale 5: Development Orientation Sub Scale 6: Work Satisfaction Ensure all staff are willing & able to work together productively & effectively Promote a collaborative culture which supports multi-disciplinary working and learning Encourage open & honest communication with a trusting & cooperative work style Ensure all staff share a strong commitment to service quality as a core concern Recognise and reward doctor s commitment to achieving organisational goals Develop doctors roles to enhance participation in organisational decision-making Ensure all staff understand that their contribution is understood & valued Facilitate greater opportunities for the professional development of medical staff Provide working conditions & structures for medical staff to become involved in change Page 17 of 18

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