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Why your trust will be listening to your views

Organisations that want a good CQC rating will soon have to make extra efforts to engage with staff. This is good news for nurses who want to see problems fixed or services improved.

Organisations that want a good CQC rating will soon have to make extra efforts to engage with staff. This is good news for nurses who want to see problems fixed or services improved

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How many nurses would recognise their own organisation as well-led? Does what happens at board level filter down to wards and clinics – and do concerns and good practice examples filter back up? And are nurses enabled to make improvements to their area – or are they pushed to one side?

Many nurses find it a struggle when they attempt to sort out problems or make changes that would benefit patients. But in future, organisations should be more receptive to their ideas. The Care Quality Commission (CQC) has changed its ‘well-led’ framework – leadership is one of five areas it assesses organisations against – to put more focus on staff engagement.

From this autumn the CQC will ask a number of questions including:

  • Do staff feel supported, respected and valued?
  • Do staff feel positive and proud to work in the organisation?
  • Are staff actively engaged so that their views are reflected in the planning and delivery of services and shaping the culture?

Good news

The increased emphasis on these areas is likely to be good news for nurses, who may see senior managers out and about more – and actively seeking opinions and input from even the most junior of staff. Christine McKenzie, RCN professional lead for the executive nurse network, says: ‘It’s a good thing. There is going to be a tightening up and a rigour around this, and that can only be good. It will allow staff to contribute more.’

In some organisations, the answers to these questions from the CQC will already be yes, at least in part. NHS Employers policy adviser on workforce Paul Myatt says: ‘Trusts have been focusing on staff engagement now for a number of years. The back story to this is the link to quality care for patients.’

But many will have work to do to improve on them. The annual staff survey is often a good indicator of how a trust is doing in these areas. Generally, NHS organisations score well on pride and reasonably on staff feeling supported by immediate managers and colleagues when compared with other sectors. However, there is enormous variation between trusts, and lower scores in areas such as involvement in broader organisational decisions.

Ms McKenzie says it will be a matter of ‘progress not perfection’. However, she believes the changes to the framework will have an impact. CQC ratings matter to boards, and many chief executives and chairs have had to fall on their swords in light of a poor rating. She also points to the links to quality improvement.

‘We have evidence that where there is increased visibility and profile of senior managers they are much more responsive over small things,’ she says.

‘When senior staff are responsive to minor concerns then staff feel they have really been heard and that the senior staff understand what is important to them. People feel that someone is really interested in their experiences and that they are supported in making changes.’

Creating champions

She suggests that the CQC is trying to move away from box ticking and will be looking for proof of real engagement. Such engagement and encouragement of front-line staff will also help build ‘leadership and followership’ within organisations, she says. Trusts may look at creating ‘champions’ in different areas and using more senior front-line nurses to drive quality improvement. NHS Improvement has already produced guidance on developmental reviews for organisations wanting to improve leadership and governance.

Some trusts may find this shift hard initially, she says. ‘But in the long term it will be better for staff, patients and service users.’ Even organisations that have quite poor engagement are likely to have departments or units where it is better – and where staff feel they are enabled and supported to make changes. Building on such examples both from within the organisation and more widely could be a starting point for improvement.

Ms McKenzie cites North East London NHS Foundation Trust as one she is impressed by. ‘I was struck by how the behaviours of the board enable staff in the organisation to believe in their own possibilities. They know they can talk to the board and the board is listening – but that has not happened overnight,’ she says.

‘When senior staff are responsive to minor concerns then staff feel they have really been heard’

Christine McKenzie

It’s early days and it is uncertain how all organisations will respond. But a briefing by NHS Employers has suggested that improving staff engagement in quality improvement will mean staff need protected time and training in quality improvement techniques. It says staff involvement has been shown to be a key factor in success but that day-to-day pressures on staff are the greatest challenge in developing sustained staff involvement.

While many trusts have adopted a range of quality improvement methodologies, some of these tend to focus on a small group in the organisation rather than the workforce as a whole. A few are adopting a ‘shared governance’ approach where patients and service users are engaged as well.

Whatever model individual trusts adopt, it seems likely that nurses and other staff members will start seeing changes – and their views will help shape the rating the CQC gives their organisation.


Alison Moore is a freelance health journalist

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