Scottish Inpatient Patient Experience Survey 2014 Volume 1: National Results

8. Results - Staff

Summary

• Overall patients were largely positive about their experiences of hospital staff. Where comparable, results had generally improved from the previous survey.
• This is reflected in the patients' overall rating of staff; 91 per cent of patients rated staff they came into contact with as either excellent or good, up by four percentage points since the 2012 survey.
• A particular area of improvement was around patients' rating of nursing staff on both nurses knowledge of and explanations around condition and treatment.
• Results also suggested that more could be done to improve some areas of communication, particularly with doctors. Ten per cent of patients agreed or strongly agreed that doctors had talked in front of them as if they were not there.

Overall rating of staff

8.1. Survey respondents were asked to provide an overall rating of the staff they came into contact with. Ninety-one per cent of respondents rated the staff as either excellent or good, up by four percentage points since the previous survey in 2012 which followed no change between 2011 and 2010 (Chart 9).

Chart 9 Overall, how would you rate all the staff you came into contact with? (%)

General questions

8.2. Four general questions on staff were introduced in 2014 questionnaire. These related to how well patients' care was organised, whether staff took account of the things that matter to patients, emotional support, and compassion and understanding.

8.3. Overall results show that almost three quarters of patients said that staff had 'always' treated them with compassion and understanding (74%), a further 22 per cent indicated that this was 'to some extent' while the remaining four per cent reported staff hadn't done so. Similarly 73 per cent indicated that staff had 'definitely' worked well together in organising their care while 23 per cent indicated that this happened 'to some extent' and the remaining (4%) that it didn't happen.

8.4. However patients were less positive about whether staff had taken into account of things that mattered to them and about emotional support. Around two thirds (64%) indicated that staff had 'definitely' taken account of the things that mattered to them. A similar proportion (67%) indicated that they 'always' received emotional support from staff (Table 10).

8.5. These questions use a response scale different from most of the questions mentioned previously in the report, which may have had an effect on the way patients responded, lowering the response rate to the positive option and increasing the percentage of options 'to some extent' or 'sometimes', which would typically be considered as neutral.

Table 10 Summary of general staff questions (%)

	Yes, definitely or Yes, always	Yes, to some extent or Yes, sometimes	No
Did you think that the staff worked well together in organising your care?	73	23	4
Did you feel that staff took account of the things that matter to you?	64	31	5
Did you feel that you got enough emotional support from staff during your stay?	67	26	7
Did you feel that staff treated you with compassion and understanding during your stay?	74	22	4

Doctors

8.6. Patients were asked how much they agreed or disagreed with six statements about doctors and the results are shown in Table 11.

8.7. The percentage of patients answering positively ranged from 80 per cent ('Doctors did not talk in front of me as if I was not there) to 91 per cent ('I had confidence and trust in the doctors treating me' and 'as far as I was aware doctors washed/cleaned their hands at appropriate times').

8.8. Improvements were seen across most statements, but particularly on those relating to doctors washing their hands, and doctors knowing enough about, and providing adequate explanations on, the patients' condition and treatment (Table 11).

Table 11 Summary of doctor-specific questions (%)

	Negative	Neither positive nor negative	Positive	Change in Positive Per Cent from 2012
Doctors knew enough about my condition and treatment.	4	6	90	+3
Doctors discussed my condition and treatment with me in a way I could understand.	4	5	90	+3
Doctors didn't talk in front of me as if I was not there.	10	10	80	-1
Doctors listened to me if I had any questions or concerns.	4	6	90	+1
As far as I was aware doctors washed/cleaned their hands at appropriate times.	2	7	91	+3
I had confidence and trust in the doctors treating me.	3	6	91	n/a1

Note:

1. New question added to the 2014 survey.

Nurses

8.9. Patients were asked how much they agreed or disagreed with six statements about nurses and the results are shown in Table 12.

8.10. The percentage of patients responding positively ranged from 83 per cent ('Nurses didn't talk in front of me as if I was not there') to 93 per cent ('As far as I was aware nurses washed/cleaned their hands at appropriate times').

8.11. Where comparable there were significant improvements across all statements. This is in contrast to earlier years where there had been little change. Improvements were particularly evident on nurses knowing enough about, and providing adequate explanations on, the patients' condition and treatment.

Table 12 Summary of nurse-specific questions (%)

	Negative	Neither positive nor negative	Positive	Change in Positive Per Cent from 2012
Nurses knew enough about my condition and treatment.	5	8	87	+6
Nurses discussed my condition and treatment with me in a way I could understand.	6	10	84	+4
Nurses didn't talk in front of me as if I was not there.	7	10	83	+2
Nurses listened to me if I had any questions or concerns.	4	6	90	+2
As far as I was aware nurses washed/cleaned their hands at appropriate times.	1	6	93	+3
I had confidence and trust in the nurses treating me.	3	6	91	n/a1

Note:

1. New question added to the 2014 survey.

Releasing Time to Care^[19]

8.12. The Releasing Time to Care (RTC) Programme was offered to all NHS Boards in April 2009 and its final report^[20] recommended that all fifteen boards adopted the recommendations for sustainability and spread. One of the aims of the programme is to increase the proportion of time nursing staff spend on direct patient care. Patients were positive (90%) about nurses listening to them if they had any concerns or questions. This percentage has increased by two percentage points from 2012, whereas it had not changed between 2011 and 2012.

Hand washing

8.13. The practice of staff routinely washing and cleaning hands after contact with patients is essential to control the spread of infection within hospitals. As part of the National Hand Hygiene campaign NHS boards undertook bi-monthly audits of hand hygiene between 2007 and September 2013. From 1^st October 2013 individual NHS Boards have been responsible for monitoring and reporting of compliance data^[21].

8.14. The results of the survey show that patients thought that nurses and doctors washed their hands at appropriate times; only one and two per cent of patients disagreed that nurses and doctors respectively washed their hands. These results show an improvement from the last survey, with an increase this year of three percentage points for both doctors and nurses washing their hands. (Table 11 and Table 12).

Nurses in charge of care

8.15. A new question was added on whether patients knew who was in charge of their care. Nearly half of all patients (47%) indicated that they knew 'all or most of the time' which nurse was in charge of their care. Over one quarter (26%) indicated that they knew 'some of the time', while a similar proportion indicated that they didn't know who was in charge of their care. (Chart 10). There was considerable variation between NHS Boards in response to this question, with positive results ranging from 34 to 69 per cent.

8.16. Of those patients who did not know which nurse was in charge of their care, 37 per cent would have liked to know and 63 per cent were not bothered.

8.17. Compared to results for knowing which nurse was in charge of the ward (reported in section 4), it seems that patients are more able to identify which nurse was in charge of their care rather than the ward (47% of patients indicated they knew 'all or most of the time' which nurse was in charge of their care compared to 42% for in charge of the ward).

Chart 10 Did you know which nurse was in charge of your care? (%)

Adequate nurses on duty

8.18. In response to feedback from patient workshops, a new question was added to the questionnaire addressing whether patients thought there were enough nurses on duty.

8.19. Nearly two thirds of patients (64%) thought there were 'always or nearly always' enough nurses on duty to care for them in hospital. Around one quarter (26%) thought there were 'sometimes' leaving 9 per cent who said 'rarely or never' (Chart 11).

8.20. There was considerable variation between NHS Boards for this question, with positive results ranging from 54 to 92 per cent.

Chart 11 In your opinion, were there enough nurses on duty to care for you in hospital? (%)

8.21. Further analysis was undertaken to assess how patients' responses to the question about adequate nurses on duty correlated with their responses to the following questions about staff and care and treatment:

• Overall, how would you rate your care and treatment during your stay in hospital?
• Nurses knew enough about my condition and treatment.
• Nurses discussed my condition and treatment with me in a way I could understand.
• Nurses talked in front of me as if I was not there.
• Nurses listened to me if I had any questions or concerns.
• I had confidence and trust in the nurses treating me.
• Did you feel that you got enough emotional support from staff during your stay?
• Did you feel that staff treated you with compassion and understanding during your stay?

8.22. The results of this analysis are presented in Table 13 and show that those who answered positively about there being enough nurses on duty were more likely to answer positively about other aspects of care and treatment and staff.

8.23. The differences can be seen across all the questions we compared but are particularly noticeable in those relating to person-centred care: 83 per cent of the patients who thought there were 'always or nearly always' enough nurses on duty indicated that they were 'always' given enough emotional support compared to 47 per cent of the patients who thought that there were only 'sometimes' enough nurses on duty.

8.24. Similarly, 87 per cent of patients who thought there were 'always or nearly always' enough staff on duty indicated that they were always treated with compassion and understanding compared to 57 per cent of those who thought that there were only 'sometimes' enough nurses on duty.

8.25. Although these differences are pronounced, there may well have been other factors influencing these results beyond simply the level of nurses on duty. The upcoming variations report will help establish whether these differences in experience are a genuine result of the number of nurses on duty or not.

Table 13 Care rating by level of nurses on duty(%)

	Positive answers (per cent)
	There were always or nearly always enough nurses	There were sometimes enough nurses	There were rarely or never enough nurses
Overall, how would you rate your care and treatment during your stay in hospital?	96	84	57
Nurses knew enough about my condition and treatment.	95	81	60
Nurses discussed my condition and treatment with me in a way I could understand.	92	78	57
Nurses talked in front of me as if I was not there.	89	77	61
Nurses listened to me if I had any questions or concerns.	96	85	61
I had confidence and trust in the nurses treating me.	97	86	62
Did you feel that you got enough emotional support from staff during your stay?	83	47	27
Did you feel that staff treated you with compassion and understanding during your stay?	87	57	34

Note: Due to the absence of certain sampling strata amongst respondents selecting the last option (rarely/never enough nurses on duty), the percentages for this option are not directly comparable with those for the other two options (always/nearly always and sometimes enough nurses on duty).