Health and social care staff experience: report 2019

No Report

With the higher overall response rate in 2019 the number of Boards with No Report has reduced from nine in 2018 to four this year. Whilst this is a considerable improvement it is still one Board more than in 2017.

The table below shows the 10 Boards that have had one or more ‘No Report’ over the three years of iMatter. Of these, two have never had a report (NHS Greater Glasgow and Clyde, NHS Western Isles) because their response rate has remained below 60%, though both have improved year on year. Two Boards have had No Report for two of the three years (NHS Borders and NHS Highland).

This is the first year that the Scottish Ambulance Service has not received an EEI Report as their response rate dropped 5 percentage points to 59%.

No Report	2017	2018	2019
Health and Social Care		No Report
NHS Ayrshire & Arran		No Report
NHS Borders		No Report	No Report
NHS Dumfries & Galloway		No Report
NHS Fife		No Report
NHS Greater Glasgow & Clyde	No Report	No Report	No Report
NHS Highland	No Report	No Report
NHS Shetland		No Report
NHS Tayside		No Report
NHS Western Isles	No Report	No Report	No Report
Scottish Ambulance Service			No Report

Of the 4 Boards that did not receive a report this year, NHS Borders were a considerable volume of responses short, as their response rate has remained at 53%.

To reach the 60% threshold three Boards only needed a small number of additional completed surveys:

NHS Greater Glasgow and Clyde - 336 surveys

NHS Western Isles - 33 surveys

Scottish Ambulance Service - 3 surveys

Teams with No Report

Note: From 2020 it is expected that the reported metric will be the % of Teams Receiving Reports, rather than the current ‘No Report’ metric. This is designed to bring this metric in line with the format of the other KPIs.

Overall the proportion of teams with No Report in 2019 has decreased to 34% (down 4 percentage points from last year). However, at individual Board level there are some considerable movements in the proportion of teams not receiving reports. 

	Teams with No Report		Change 2018 – 2019 (pp)
	2018	2019
Health and Social Care	38%	34%	+4
Golden Jubilee Foundation	31%	29%	+2
Healthcare Improvement Scotland	15%	19%	-4
NHS 24	34%	43%	-9
NHS Ayrshire & Arran	33%	34%	-1
NHS Borders	44%	47%	-3
NHS Dumfries & Galloway	39%	25%	+14
NHS Education for Scotland	15%	10%	+5
NHS Fife	47%	36%	+11
NHS Forth Valley	35%	26%	+9
NHS Grampian	37%	35%	+2
NHS Greater Glasgow & Clyde	41%	37%	+4
NHS Health Scotland	0%	0%	0
NHS Highland	51%	37%	+14
NHS Lanarkshire	35%	30%	+5
NHS Lothian	34%	34%	0
NHS National Services Scotland	16%	13%	+3
NHS Orkney	11%	30%	-19
NHS Shetland	44%	33%	+11
NHS Tayside	44%	38%	+6
NHS Western Isles	50%	43%	+7
Scottish Ambulance Service	33%	42%	-9
The State Hospital	23%	8%	+15

Geographic Boards

All but three of the Geographic Boards have reduced the percentage of teams not receiving reports considerably, typically reflecting the increase in response rate they have achieved. Those with the largest improvements in teams with no report are:

NHS Highland reduced the percentage of teams with no report by 14pp to 37%, reflecting the 9pp increase in their overall response rate (to 60%). They typically have larger teams with an average of 13 people. The number of teams has increased only marginally from 2018 to 818 teams in 2019.

NHS Dumfries and Galloway reduced the number of teams with no report to 25% (down 14pp from 2018), again reflecting the 7pp increase in overall response rate. They have the largest average team size with 16 people per team and the total number of teams has increased 10% this year from 259 to 285. 

An example of action taken in one team to increase engagement and response rate is illustrated here:

Case Study 7: Improving Response Rate

The iMatter Operational Lead and Trainee Improvement Advisor worked with a senior charge nurse and her team to improve their engagement with the iMatter questionnaire and action plan.  The project had a specific measure of increasing engagement from 43% to over 60% in line with the Workforce 2020 vision of staff engagement.  This was achieved – they reached 64% and obtained a team report for the first time.  The engagement work included a number of actions to improve staff health and wellbeing including peer and team reporting of positive achievements and developing a stronger team ethos.

NHS Dumfries and Galloway

In NHS Fife the proportion of teams with no report reduced by 11pp, to 36%, reflecting the 9pp increase achieved in overall response rate. The average team size is 13 people and the number of teams has remained almost constant from 2018.

NHS Shetland also reduced the percentage of teams with no report by 11 percentage points to 33%, reflecting the 7pp increase in response rate in 2019. The number of teams in NHS Shetland reduced from 150 in 2018 to 135 in 2019 and the average team size is now 11 people.

In contrast, 30% of NHS Orkney teams did not receive a report in 2019, up 19pp from only 11% in 2019. As noted earlier, NHS Orkney has faced challenges this year that have impacted their overall response rate (down from 83% in 2018 to 66% in 2019) that is then reflected in the reduced share of teams receiving reports.

National Boards

Across the 8 National Boards, four have reduced the proportion of teams not receiving a report and three have a higher proportion of teams with no report in 2019. NHS Health Scotland has maintained its 100% record with all teams again receiving a report in 2019. It has an average team size of 10 and it has just one more team from 2018 (now 31 teams).

The State Hospital has improved the most, reducing 15pp from 23% of teams not receiving a report in 2018 to only 8% in 2019. It is noted that their overall response rate increased by 2%, but that the number of teams reduced in 2019 to 63 from 92 in 2018 (down 32%) and the average team is now 10 people.

The two National Boards with the largest increase in the proportion of teams not receiving a report are:

NHS 24 is up 9pp to 43% of teams not receiving a report. Their overall response rate dropped 5pp to 65% which will have impacted teams’ potential to receive a report. NHS 24 increased the number of teams from 196 in 2018 to 214 in 2019 (an increase of 9%). The average team size is 7 people.

Scottish Ambulance Service is also up 9% in 2019 with 42% of teams not receiving a report this year, reflecting the drop of 5% in their overall response rate. The average team size is 12 people and the number of teams has increased only marginally from 2018.

The absence of a report, be that at Board or Team level, should not be a barrier to focusing on iMatter topics and striving to provide the best possible working environment for staff. One Team Story stands out as illustration of this point. Although Golden Jubilee as a Board has reached the response rate threshold each year, 29% of the teams within it did not receive a report in 2019. Golden Jubilee Conference Hotel team is one of those and the following Team Story demonstrates how Action Plans can still be effectively developed and implemented:

The NHS Golden Jubilee Conference Hotel Team is a large team, working shifts, that have been through many changes of personnel and management structure. The team have not received an iMatter report for the last two years. However, the team have fully engaged with the Action Planning process. They have identified 4 focus areas:

• Role clarity
• Visible and consistent leadership
• Valued as an individual
• Effective team work. 

The team have been actively engaged in focus groups and have senior management commitment to valuing staff. This year they held a motivational staff appreciation day. For the future, staff will be given dedicated time to complete the iMatter survey in a safe environment

“The hard work will not stop there as we now look forward to ways we can continue to improve as a team and also how we continue deliver and improve the hotel experience to our guests and customers.”

NHS Golden Jubilee, Conference Hotel Team

Impact of Team Size on No Report

Across Health and Social Care team sizes vary considerably from teams of just 1 person through to teams with more than 20 people. The distribution of team sizes below shows that of the 14,388 teams in 2019, 29% consist of 5-8 people.

	1 – 2 people	3-4 people	5-8 people	9-12 people	13-20 people	More than 20 people	Total
Number of Teams	869	1,998	4,174	2,567	2,350	2,430	14,388
Percentage of Teams	6%	14%	29%	18%	16%	17%	100%

The chart below illustrates that National Boards are more likely to have smaller teams with 26% of their teams having 4 or less people in them, compared to only 19% of Geographic Boards. In contrast, at the other end of the spectrum 18% of Geographic Board teams have 20 or more people in them, compared to only 10% of National Board teams.

For teams with 4 or less people in, a 100% response rate is required for them to receive a report and for teams of 5 or more people a 60% response rate is required. Therefore, whilst the analysis that follows compares response rate across team sizes, it is important to bear this difference in threshold in mind when considering the results.

	1 – 2 people	3-4 people	5-8 people	9-12 people	13-20 people	20 or More	Total
Total Number of Teams	869	1,998	4,174	2,567	2,350	2,430	14,388
Number of Teams with No Report	256	899	898	713	816	1,320	4,902
% of Teams with No Report	29%	45%	22%	28%	35%	54%	34%

Among teams with 5 or more people (i.e. 60% response rate requirement) the percentage of teams not receiving a report increases as the team size grows, from 22% of teams with 5-8 people to 54% of teams with more than 20 people. 

Among teams requiring 100% response rate, 29% of teams with 1 or 2 people have No Report compared to 45% of teams with 3-4 people.

These patterns are reflected in both the National and Geographic Boards, though typically at higher levels for Geographic Boards, reflecting the lower overall response rates.

Summary

The volume of No Report at Board level has reduced with only 4 Boards not receiving and EEI report in 2019. Overall there is also a reduction in the proportion of teams not receiving a report from 38% in 2018 to 34% in 2019. These improvements reflect the overall increase in response rate. However, there are 6 Boards (3 National and 3 Geographic) that have an increase in the percentage of their team with No Report.

It is positive to see Team Story and Case Study examples of teams that have still developed an Action Plan despite not having a report, demonstrating their commitment to iMatter and to improvement.