Medical Engagement Scale

Transcription

1 Ltd NHS Grampian (Acute) August 2014

2 Contents Contents... 2 Executive Summary... 3 Introduction... 5 Structure of the Responding Sample... 9 Response by Division... 9 Response by Speciality Response by Grade Response by Length of Service Perspective 1: Overview of Relative Levels of Medical Engagement Perspective 2: Levels of Medical Engagement by Directorate, Speciality & Grade Relative Levels of Medical Engagement by Division Relative Levels of Engagement by Speciality Relative Levels of Engagement by Grade Relative Levels of Engagement by Length of Service Relative Levels of Engagement by Managerial Responsibility Perspective 3: The Profiles of Medical Engagement Perspective 4: Alignment of Medical Ratings and Managerial Perceptions Perspective 5: Responses to Local Questions Perspective 6: Engagement and Suggested Intervention Strategies Page 2 of 37

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 In all 326 Medical staff completed the (MES) survey at Aberdeen Royal Infirmary part of NHS Grampian. The Survey was commissioned by Health Improvement Scotland. A comparison of these survey results with the previously-surveyed Trusts in the normative database (currently comprising over 70 Trusts and over 8000 medical staff) indicated the following: The overall results show that not only in respect to the overall lndex of medical engagement but also for all the meta and sub scales were in the lowest two bands of relative medical engagement i.e. at least in bottom 40%. Meta Scale 2: Having Purpose & direction was in the lowest ranking as was the Sub Scale 2: Good Personal Inter-Relationships and Sub Scale 4: Participation in Decision Making. Results at a Divisional level compared to the organisation wide show pockets within certain scales that fall within the middle range of relative medical engagement. When the results are examined by Speciality they become far starker with particular specialties being entirely in the lowest range of medical engagement, whilst others are in the highest. The results by grade show a diverse pattern of results but perhaps not as diverse as one might expect between for example trainees (29% of responses) and Consultants (60%). It would not appear that grade is not the defining factor, although Consultants exhibit lower levels of relative medical engagement than others. Analysis of results by length of service shows a low level of relative medical engagement regardless of length of service. Although it is at it s highest in first year of service and reaches a peak between 10 and 15 years of service. Whilst it could be argued that the pattern is unsurprising as cynicism and inertia develops it is a cause for concern. It likely that medical staff with longer service could be significant influencers (whether formal or informal) in the organisation. Respondents were asked whether they held a position of managerial responsibility, those holding such a position comprised 16% of responding sample. 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 37

4 Perhaps unsurprisingly those holding position of managerial responsibility were considerably more positive, that said they were still in the lowest ranges of relative medical engagement for two sub scales. It is only in respect of Meta Scale 3: Being Valued and Empowered and the two associated Sub scales were they in the highest band. It could be argued those are the scales most directly influenced by your managerial position within the organisation. Unsurprisingly given the result reviewed to date a higher proportion of respondents than would be expected compared to norms are in the lower categories (D&E) with a lower than expected proportion compared to norms in the higher band (A&E). However the results are perhaps not as unevenly distributed as might have been anticipated although what does mark them is the consistently high proportion in the lowest (E) band and a lower proportion in the highest band. In other words NHS Grampian (Acute) has a low proportion of highly engaged medical staff and a high proportion of very poorly engaged medical staff. Such a result gives cause for concern and suggests that any interventions to address the situation need to be fundamental (i.e. structural and cultural) rather than examining particular processes or functions. The sample of Senior Managers who responded has underestimated the level of medical engagement. It is generally considered positive where managers underestimate levels of medical engagement as this demonstrates an awareness of the importance of the issue and a lack of complacency. It does raise the question however, as to what actions / interventions have been taken to date to address the situation. There were also two free text questions on the survey, formulated locally, allowing respondents to give wider responses. We are grouped the responses and detailed these below. In respect of quality of care, the majority of responses relate to perceived lack of resources, in particular staffing levels, with many raising siginificant concerns about the impact of staffing levels on the quality of care. In terms of improving medical engagement the majority of comments related to two areas. Firstly the perceived style and approach of management that they felt was not inclusive and did not sufficiently taken on board the views and input of medical staff. Secondly was perceptions of thequality of medical leadership within the organisation and was seen as divorced from the wider medical workforce. The comments painted a picture of an organisation with a large divide between its leadership and workforce. That said, a lot of the comments did seem to perceive medical engagement as a one way street in that management ought to engage them and not seeing that they also needed to engage with the organisation for this to be an effective relationship. We have highlighted particular areas where based on the results of this MES survey we believe remedial action ought to be focussed in the first instance. That said, the areas of concern are sufficiently widespread that a fundamental organisation-wide process of cultural change and refocussing would appear to need to take place if the issues are to effectively address. Page 4 of 37

5 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 (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 5 of 37

6 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 6 of 37

7 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 7 of 37

8 To date, MES surveys have been undertaken in over 70 participating health organisations and these have been used to establish a large, valid normative database of over 8500 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. Following a brief description of the responding medical sample, the remaining sections of the report present specific feedback about medical engagement presented from six complementary perspectives. Perspective 1: Overview of Relative Levels of Medical Engagement Perspective 2: Levels of Medical Engagement by Division, Speciality & Grade Perspective 3: The Profiles of Medical Engagement Perspective 4: Alignment of Medical Ratings and Managerial Perceptions Perspective 5: Responses to Local Questions Perspective 6: Engagement and Suggested Intervention Strategies Page 8 of 37

9 Structure of the Responding Sample In all 326 Medical staff completed the (MES) survey at Aberdeen Royal Infirmary part of NHS Grampian. The Survey was commissioned by Health Improvement Scotland. The charts below describe the composition of the responding 326 medical staff at Aberdeen Royal Infirmary with respect to affiliation to Division, Speciality and Grade. Response by Division It is interesting to note that over 90 (29%) respondents did not know within which Division their speciality sat within the new transitional organisational structure. Page 9 of 37

10 Response by Speciality Page 10 of 37

11 Response by Grade Page 11 of 37

12 Response by Length of Service Page 12 of 37

13 The response rate to the organisational survey of a sample of senior managers was 47 responses, the survey is intended for non-clinical managers only a number of clinicians had also completed it, once these were excluded, the sample was reduced to 18 comprising unit and general managers. Page 13 of 37

14 Perspective 1: Overview of Relative Levels of Medical Engagement For each of the 10 medical engagement scales, the average medical engagement scores for organisations in the normative database were ranked and split into five main bands defined in table below, ranging from high (green) to low (red) relative engagement. Based on all medical staff who completed the survey (n = 326), the coloured hierarchical figure and the table below shows where the Board fell with respect to the normative database. s: Relative Normative Feedback for NHS Grampian (Acute) (n=326) Page 14 of 37

15 Key: Low Relative Medical Engagement -Lowest 20% of organisations 2nd Lowest Range of Medical Engagement Medium Relative Medical Engagement - Middle 20% of organisations 2nd Highest Range of Relative Medical Engagement High Relative Medical Engagement - Highest 20% of organisations The hierarchical figure above shows that not only in respect to the overall lndex of medical engagement but also for all the meta and sub scales were in the lowest two bands of relative medical engagement i.e. at least in bottom 40%. Meta Scale 2: Having Purpose & direction was in the lowest ranking as was the Sub Scale 2: Good personal inter-relationships and Sub Scale 4: Participation in Decision Making. Clearly at an organisational level the results can only tell a broad picture as they deal in overall average scores. It is important to examine medical engagement across a number of perspectives. Page 15 of 37

16 Perspective 2: Levels of Medical Engagement by Directorate, Speciality & Grade Relative Levels of Medical Engagement by Division If we examine the results by Division it can be seen more divergence of results appear, with a wider range of perspectives. The Divisions comprise the following specialties: Division Specialities 1 Emergency Department; GMED; AMEIA & Observation Ward, Medical Short Stay, Alcohol Liaison, Anaesthetics, Theatres, Intensive Care Unit, Medical High dependency, Respiratory, Hyperbaric, Acute Geriatrics, Elderly Medicine, Infectious Diseases, General Internal Medicine, Night, Diabetes & Endocrinology; Acute Stroke 2 Cardiology, Cardiothoracic Surgery, Renal, Vascular Surgery, General Surgery (including Short Stay), Gastroenterology, Endoscopy, Rheumatology; Dermatology 3 Obstetrics / Maternity; Gynaecology; Reproductive Medicine; Neonatology; Dr Grays Hospital 4 Laboratory Services, Radiology Services, Pharmacy, Medical Physics, Cancer (Haematology, Oncology, Palliative Care, Radiotherapy) 5 Trauma & Orthopaedics; Neurosurgery & Neurosciences; Urology; Ophthalmology; Plastics; ENT / Audiology; Oral Maxillofacial Unit; Dental Hospital Page 16 of 37

17 The results are set out below and compared to the organisation wide show pockets within certain scales that fall within the middle range of relative medical engagement. Engagement Scale Meta Scale 1: Working in A Collaborative Culture Meta Scale 2: Having Purpose & Direction Meta Scale 3: Being Valued & Empowered Sub Scale 1: Climate for Positive Learning Sub Scale 2: Good Inter Personal Relationships Sub Scale 3: Appraisal & Rewards Effectively Aligned Sub Scale 4: Participation on Decision Making & Change Sub Scale 5: Development Orientation Sub Scale 6: Work Satisfaction Division 1 (n=105) Division 2 (n=57) Division 3 (n=15) Division 4 (n=29) Division 5 (n=28) As we will go onto to see this picture disguises a wide range of levels of engagement between specialties. Page 17 of 37

18 Relative Levels of Engagement by Speciality When the results are examined by Speciality they become far starker with particular specialties being entirely in the lowest range of medical engagement, whilst others are in the highest. Although care must be taken in where there are small numbers within particular specialties. We have not reported specialties that had four or fewer responses. All Scales in Highest 20% All Scales in Lowest 20% Acute Geriatric Neurosurgery & Neurosciences Gastroenterology Cardiology Emergency Department General Internal Medicine General Surgery Gynaecology Plastics Trauma & Orthopaedics In addition Theatres (including anaesthetics) was in the lowest for all but one Sub Scale whilst ENT / Audiology were in the highest for all but one. It is interesting to consider whether it is a factor within the respective responding in these specialties sample grade, length of service or some within their experience such as workload, local leadership, colleagues, working conditions that are resulting in these very different responses. Page 18 of 37

19 Engagement Scale Meta Scale 1: Working in A Collaborative Culture Meta Scale 2: Having Purpose & Direction Meta Scale 3: Being Valued & Empowered Sub Scale 1: Climate for Positive Learning Sub Scale 2: Good Inter Personal Relationships Sub Scale 3: Appraisal & Rewards Effectively Aligned Sub Scale 4: Participation on Decision Making & Change Sub Scale 5: Development Orientation Sub Scale 6: Work Satisfaction Acute Geriatric s (n=7) AMIA & Observatio n Ward (n=13) Cancer (Haematology, Oncology, Palliative Care, Radiotherapy) Cardiolog y (n=9) Dermatolog y (n=6) Diabetes & Endocrinolog y (n=14 ) Emergency Dept (n=23) Page 19 of 37

20 Engagement Scale Meta Scale 1: Working in A Collaborative Culture Meta Scale 2: Having Purpose & Direction Meta Scale 3: Being Valued & Empowered Sub Scale 1: Climate for Positive Learning Sub Scale 2: Good Inter Personal Relationships Sub Scale 3: Appraisal & Rewards Effectively Aligned Sub Scale 4: Participation on Decision Making & Change Sub Scale 5: Development Orientation Sub Scale 6: Work Satisfaction ENT / Audiology (n=5) Gastroenterology (n=15) General Internal Medicine (n=7) General Surgery (n=23) Gynaecology (n=5) Intensive Care unit (n=10) Laboratory Services (n= ) Page 20 of 37

21 Engagement Scale Meta Scale 1: Working in A Collaborative Culture Meta Scale 2: Having Purpose & Direction Meta Scale 3: Being Valued & Empowered Sub Scale 1: Climate for Positive Learning Sub Scale 2: Good Inter Personal Relationships Sub Scale 3: Appraisal & Rewards Effectively Aligned Sub Scale 4: Participation on Decision Making & Change Sub Scale 5: Development Orientation Sub Scale 6: Work Satisfaction Neurosurgery & Neurosciences (n=9) Opthalmology (n=5 ) Oral Maxillofacial Unit (n=6) Plastics (n=5) Radiology Services (n=17) Renal (n=8) Respiratory (n=8) Page 21 of 37

22 Engagement Scale Meta Scale 1: Working in A Collaborative Culture Meta Scale 2: Having Purpose & Direction Meta Scale 3: Being Valued & Empowered Sub Scale 1: Climate for Positive Learning Sub Scale 2: Good Inter Personal Relationships Sub Scale 3: Appraisal & Rewards Effectively Aligned Sub Scale 4: Participation on Decision Making & Change Sub Scale 5: Development Orientation Sub Scale 6: Work Satisfaction Theatres including Anaesthetics (n=36) Trauma & Orthopaedics (n=13) Urology (n=5) Vascular Surgery (n=7) Page 22 of 37

23 Relative Levels of Engagement by Grade The results by grade show a diverse pattern of results but perhaps not as diverse as one might expect between trainees (29% of responses) and Consultants (60%). It would not appear that grade is not the defining factor, although Consultants exhibit lower levels of relative medical engagement than others. Engagement Scale Meta Scale 1: Working in A Collaborative Culture Meta Scale 2: Having Purpose & Direction Meta Scale 3: Being Valued & Empowered Sub Scale 1: Climate for Positive Learning Sub Scale 2: Good Inter Personal Relationships Sub Scale 3: Appraisal & Rewards Effectively Aligned Sub Scale 4: Participation on Decision Making & Change Sub Scale 5: Development Orientation Sub Scale 6: Work Satisfaction Associate Specialist (n=10) Consultant (n=196) Staff Grade (n=9) Trainee Grade (n=95) Page 23 of 37

24 Relative Levels of Engagement by Length of Service Analysis of results by length of service shows a low level of relative medical engagement regardless of length of service. Although it is at it s highest in first year of service and reaches a peak between 10 and 15 years of service. Whilst it could be argued that the pattern is unsurprising as cynicism and inertia develops it is a cause for concern. It likely that medical staff with longer service could be significant influencers (whether formal or informal) in the organisation. Engagement Scale Meta Scale 1: Working in A Collaborative Culture Meta Scale 2: Having Purpose & Direction Meta Scale 3: Being Valued & Empowered Sub Scale 1: Climate for Positive Learning Sub Scale 2: Good Inter Personal Relationships Sub Scale 3: Appraisal & Rewards Effectively Aligned Sub Scale 4: Participation on Decision Making & Change Sub Scale 5: Development Orientation Sub Scale 6: Work Satisfaction Less than 1 Year (n=27) 1-2 Years (n=29 ) 2-4 Years (n=38 ) 4-6 years (n=28 ) 6-10 years (n= 48) years (n=57) More than 15 Years (n=96 ) Page 24 of 37

25 Relative Levels of Engagement by Managerial Responsibility Respondents were asked whether they held a position of managerial responsibility, those holding such a position comprised 16% of responding sample. Perhaps unsurprisingly those holding position of managerial responsibility were considerably more positive, that said they were still in the lowest ranges of relative medical engagement for two sub scales. It is only in respect of Meta Scale 3: Being Valued and Empowered and the two associated Sub scales were they in the highest band. It could be argued those are the scales most directly influenced by your managerial position within the organisation. Page 25 of 37

26 Engagement Scale Meta Scale 1: Working in A Collaborative Culture Meta Scale 2: Having Purpose & Direction Meta Scale 3: Being Valued & Empowered Sub Scale 1: Climate for Positive Learning Sub Scale 2: Good Inter Personal Relationships Sub Scale 3: Appraisal & Rewards Effectively Aligned Sub Scale 4: Participation on Decision Making & Change Sub Scale 5: Development Orientation Sub Scale 6: Work Satisfaction Managerial Responsibility Yes (n=52) No (n=273) Page 26 of 37

27 Perspective 3: The Profiles of Medical Engagement Although average scores can provide a useful summary of how all responding doctors in the organisation 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 8500 medical staff representing over 70 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 organisation, the ten 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. A set of profiles (one histogram for each of the ten MES scales) are included below based on all medical staff respondents (n =326) Page 27 of 37

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30 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 MES Scale Percentage Most Engaged (Bands A & B) Percentage Least Engaged (Bands D & E) MEI: Index of Medical Engagement 30.06% 46.93% Meta Scale 1: Working in a Collaborative Culture 38.34% 43.25% Meta Scale 2: Having Purpose & Direction 33.74% 47.24% Meta Scale 3: Feeling Valued & Empowered 35.28% 42.33% Sub Scale 1: Climate for Positive Learning 43.56% 42.02% Sub Scale 2: Good Interpersonal Relationships 38.96% 38.04% Sub Scale 3: Appraisal & Rewards Effectively Aligned 34.66% 34.66% Sub Scale 4: Participation in Decision Making & Change 35.28% 44.48% Sub Scale 5: Development Orientation 35.89% 44.79% Sub Scale 6: Work Satisfaction 30.67% 44.79% Unsurprisingly given the result reviewed to date a higher proportion of respondents than would be expected compared to norms are in the lower categories (D&E) with a lower than expected proportion compared to norms in the higher band (A&E). However the results are perhaps not as unevenly distributed as might have been anticipated although what does mark them is the consistently high proportion in the lowest (E) band and a lower proportion in the highest band. In other words NHS Grampian (Acute) has a low proportion of highly engaged medical staff and a high proportion of very poorly engaged medical staff. Such a result gives cause for concern and suggests that any interventions to address the situation need to be fundamental (i.e. structural and cultural) rather than examining particular processes or functions. Page 30 of 37

31 Perspective 4: Alignment of Medical Ratings and Managerial Perceptions In addition to medical staff completing the MES, senior managers at NHS Grampian were asked to make an estimate of the percentage of engaged medical staff on each of the ten medical engagement scales. Differences between these estimates and actual percentages of engaged medical staff in this Trust were calculated and they indicate the extent to which managers and medical staff are aligned in their perceptions. The alignment of medical and managers views can be viewed on the basis of the following perspective. M edical & M anagement Alignment - Implications for M anagement Culture HIGH MANAGEMENT PERCEPTIONS OF ENGAGEMENT Unaligned ISOLAT ED SAT ISFIED Aligned LOW MEDICAL RATING OF ENGAGEMENT Unwarranted positive perception of engagement due to 'out-of-touch' misinterpretation of medical culture PASSIVE Justified current feelings of optimism but risk of this becoming future management complacency ALERT HIGH MEDICAL RATING OF ENGAGEMENT Management awareness of low levels of medical engagement but failure to make positive interventions Recognition of vital importance of maintaining high levels of medical engagement to ensure organisational success Aligned Unaligned LOW MANAGEMENT PERCEPTIONS OF ENGAGEMENT The results are shown in the figure below. Page 31 of 37

32 The sample of Senior Managers who responded has underestimated the level of medical engagement. It is generally considered positive where managers underestimate levels of medical engagement as this demonstrates an awareness of the importance of the issue and a lack of complacency. That said, managers will appreciate the Trust is currently under Review and therefore the situation is likely to be less than good. It does also raise the question, as to what actions / interventions have been taken to date to address the situation. Page 32 of 37

33 Perspective 5: Responses to Local Questions There were also two free text questions on the survey, formulated locally, allowing respondents to give wider responses. We are grouped the responses and detailed these below. In your opinion, what are the most important steps that could be taken to improve the quality of care for patients in NHS Grampian? The majority of responses relate to perceived lack of resources, in particular staffing levels, with many raising siginificant concerns about the impact of staffing levels on the quality of care. Page 33 of 37

34 In your opinion, what are the most important steps that could taken to improve medical engagement in NHS Grampian? In terms of improving medical engagement the majority of comments related to two areas. Firstly the perceived style and approach of management that they felt was not inclusive and did not sufficiently taken on board the views and input of medical staff. Secondly was perceptions of thequality of medical leadership within the organisation and was seen as divorced from the wider medical workforce. The comments painted a picture of an organisation with a large divide between its leadership and workforce. That said, a lot of the comments did seem to perceive medical engagement as a one way street in that management ought to engage them and not seeing that they also needed to engage with the organisation for this to be an effective relationship. Page 34 of 37

35 Perspective 6: 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 Board 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. Overleaf, as we usually do in our reports, we have highlighted particular areas where based on the results of this MES survey we believe remedial action ought to be focussed in the first instance. That said, the areas of concern are sufficiently widespread that a fundamental organisation-wide process of cultural change and re-focussing would appear to need to take place if the issues are to effectively address. We have outlined overleaf 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 areas highlighted by the MES Survey. This should be used as a starting point for internal discussion on the underlying causes in the problem areas and the type of interventions that could be considered to begin improving the sense of engagement. 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 35 of 37

36 Collaboration Commitment Satisfaction NHS Grampian (Acute) s Meta Scale 1: Working in a Collaborative Culture Division 1 Division 2 Division 3 Division 4 Division 5 Target state Ensure all staff are willing & able to work together productively & effectively Sub Scale 1: Climate for Positive Learning Sub Scale 2: Good Interpersonal Relationships Meta Scale 2: Having Purpose & Direction 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 Sub Scale 3: Appraisals & Rewards Effectively Aligned Sub Scale 4: Participation in Decision- Making & Change Meta Scale 3: Being Valued & Empowered Recognise and reward doctor s commitment to achieving organisational goals Develop doctors roles to enhance participation in organisational decisionmaking Ensure all staff understand that their contribution is understood & valued Sub Scale 5: Development Orientation Sub Scale 6: Work Satisfaction Facilitate greater opportunities for the professional development of medical staff Provide working conditions & structures for medical staff to become involved in change Page 36 of 37

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