Health and social care staff experience: report 2018

Part 4: iMatter Results 2018

Staff Governance Standard - Scores

The strands of the Staff Governance Standard were mapped against the 20 components forming part of the Staff Experience Framework (see Appendix 2). The 28 questions were then mapped to the 20 components and Staff Governance Standards to provide a measure of Employee Engagement (see Appendix 3).

Mapping responses to the Staff Governance Standard strands indicate that in 2018 respondents felt that they were: well informed (80%); and treated fairly & consistently with dignity and respect in an environment where diversity is valued (77%). Responses also indicate that respondents felt they were provided with a continuously improving and safe working environment that promotes the health and wellbeing of staff, patients and the wider community (77%). Results relating to appropriate training and development (74%) and feeling involved in decisions (71%) were lower.

Staff Governance Standards - Scores	Weighted Index Value
	2017	2018
Well informed	80	80
Appropriately trained and developed	73	74
Involved in decisions	71	71
Treated fairly & consistently, with dignity & respect, in an environment where diversity is valued	77	77
Provided with a continuously improving & safe working environment, promoting health & wellbeing of staff, patients & the wider community	76	77

Staff Governance Standard - Experience as an individual

Results are aggregated for each question presented under the heading 'As an Individual'.

Experience as an Individual	Weighted Index Value
	2017	2018
I am clear about my duties and responsibilities	88	88
I get the information I need to do my job well	81	81
I am given the time and resources to support my learning growth	71	72
I have sufficient support to do my job well	77	78
I am confident my ideas and suggestions are listened to	75	75
I am confident my ideas and suggestions are acted upon	70	71
I feel involved in decisions relating to my job	71	71
I am treated with dignity and respect as an individual	82	83
I am treated fairly and consistently	81	81
I get enough helpful feedback on how well I do my work	73	73
I feel appreciated for the work I do	73	74
My work gives me a sense of achievement	81	81

Responses to all individual statements achieve scores that fit into the 'Strive and Celebrate' category. The statement with the highest score was: "I am clear about my duties and responsibilities" with an aggregated score of 88. Also scoring highly was the statement: "I am treated with dignity and respect as an individual". Responses to statements that scored less highly are those that relate to development and change:

• I am confident my ideas and suggestions will be acted on (71)
• I feel involved in decisions relating to my job (71)
• I am given time and resources to support my learning growth (72)
• I get enough helpful feedback on how well I do my work (73)

Experience as an Individual - Distribution of responses

The chart below shows the distribution of responses to the questions relating to the 'Experience as an Individual' Staff Governance Standard. This highlights the variation in answers given by staff. For example, 90% of respondents either strongly agreed or agreed with the statement: "I am clear about my duties and responsibilities". This contrasts to only 49% of respondents who either strongly agreed or agreed with the statement: "I am confident my ideas and suggestions are acted upon".

The percentage of strongly agree or agree responses to the statement: "I feel involved in decisions relating to my job" was only 14% indicating this is an area to Focus to Improve. The following statements are also identified as areas to Focus to Improve as they achieved only 12% which was the lowest number of strongly agree or agree responses:

• I am confident my ideas and suggestions will be acted on
• I am given time and resources to support my learning growth
• I get enough helpful feedback on how well I do my work
• I feel appreciated for the work I do

Number of respondents 104,254

Staff Governance Standard - My Team / My Direct Line Manager

Results are aggregated for each question presented under the heading 'My Team / My Direct Line Manager'.

All scores of My Team/Direct Line Manager shown below achieved the Strive and Celebrate threshold. The highest scores were for statements relating specifically to the line manager:

• My direct line manager is sufficiently approachable (87)
• I feel my direct line manager cares about my health and wellbeing (84)
• I have confidence and trust in my direct line manager (84)

The lowest score achieved was for "involvement in decisions relating to my team", which reflect also the lower score for the equivalent statement relating to the individual member of staff (I feel involved in decisions relating to my job).

My Team/My Direct Line Manager	Weighted Index Value
	2017	2018
I feel my direct line manager cares about my health and wellbeing	84	84
My direct line manager is sufficiently approachable	86	87
I have confidence and trust in my direct line manager	83	84
I feel involved in decisions relating to my team	75	76
I am confident performance is managed well within my team	77	77
My team works well together	81	82
I would recommend my team as a good one to be a part of	82	83

My Team / My Direct Line Manager - Distribution of Responses

The distribution of responses for each question in this Standard follow a more consistent pattern than seen previously for Experience as an Individual. However, it is notable that 10% of staff responding either disagreed or strongly disagreed with the statement: 'I feel involved in decisions relating to my team'. This falls into the Focus to Improve category.

Number of respondents 104,254

Staff Governance Standard - My Organisation

Results are aggregated for each question presented under the heading 'My Organisation', where Organisation refers to and includes both the relevant NHS Board and Health & Social Care Partnership(s). 'Senior Managers' refers to the Chair, Chief Executive, Non-Executives and Directors/Chief Officer.

The 'My Organisation' Standard shows the greatest variation in scores across the statements, from the best at 83 (I understand how my role contributes to the goals of my organisation) to the lowest at 57 (I feel involved in decisions relating to my organisation).

Four of the 9 statements are scored as Monitor to Further Improve. As well as the involvement in decisions noted above, the other measures are:

• I feel senior managers responsible for the wider organisation are sufficiently visible (62)
• I am confident performance is managed well within my organisation (64)
• I have confidence and trust in senior managers responsible for the wider organisation (65)

My Organisation	Weighted Index Value
	2017	2018
I understand how my role contributes to the goals of my organisation	82	83
I feel my organisation cares about my health and wellbeing	70	71
I feel senior managers responsible for the wider organisation are sufficiently visible	62	62
I have confidence and trust in senior managers responsible for the wider organisation	64	65
I feel involved in decisions relating to my organisation	57	57
I am confident performance is managed well within my organisation	64	64
I get the help and support I need from other teams and services within the organisation to do my job	71	72
I would recommend my organisation as a good place to work	74	74
I would be happy for a friend or relative to access services within my organisation	78	79

My Organisation - Distribution of Responses

This Staff Governance Standard shows the greatest variability in response both within and across the individual questions. In particular, only 24% of staff responding either agreed or strongly agreed with the statement: 'I feel involved in decisions relating to my organisation' whilst 28% of respondents either disagreed or strongly disagreed with the statement.

Number of respondents 104,254

Health and Social Care iMatter Components

The 28 questions were then mapped to the 20 components and Staff Governance Standards to provide a measure of Employee Engagement (see Appendix 3). From 2017 to 2018, 13 of the questions have improved by 1 point and 15 of the questions have shown no movement

Comparisons between individual, team and organisation

A number of the questions are asked both of the team and the wider organisation. Differences are evident between the two with direct line managers/own teams scoring higher than the organisation.

There is a 19 point gap in 'confidence and trust' between line manager and senior managers in the wider organisation. A similar gap exists between feeling involved in decisions relating to team and those relating to the organisation. Interestingly, the score for feeling involved in decisions relating to my job, scores 5 points lower than team decisions.

The chart below summarises the relevant questions from the components report shown above.

Overall, working within my organisation is a ...

The thermometer question is a numeric question asking staff to rate working in the organisation. The mean score is up slightly from 6.73 in 2017 to 6.79 in 2018.

Almost two-thirds of the staff taking part, score 7 or more (62%), though within that only 20% rate 9 or 10. However, 13% rate their experience at 4 or less.

Number of respondents 104,254

iMatter Question Analysis by Board

The two tables below show the rank order of each of the components for each Board compared with Health and Social Care overall. By focusing on rank order rather than absolute score the difference in relative performance within each board can be seen.

Table 1: Geographic Boards

It is immediately evident that there is less variability across the geographic Boards, with the Top 3 always containing the same 3 questions in every Board.

• I am clear about my duties and responsibilities
• My direct line manager is sufficiently approachable
• I feel my direct line manager cares about my health and wellbeing

There are only two individual questions that are ranked notably lower than average:

• Ranked fourth overall - "I have confidence and trust in my direct line manager" for NHS Dumfries & Galloway ranked seventh
• Ranked fifth overall - "I am treated with dignity and respect as an individual" for NHS Shetland ranked ninth

Similarly, the questions ranked within the bottom 4 are the same across all geographic Boards.

Table 2: National Boards

Across the National boards there was much greater variation in the rank order of questions: In particular the top ranked statement "I am clear about my duties and responsibilities" is only ranked fifth for Health Scotland, seventh for Education for Scotland and eighth for Health Improvement Scotland. It is notable that "My work gives me a sense of achievement is the third highest ranking statement for the Scottish Ambulance Service. There is however, much greater consistency on the questions ranked lowest in each Board.

Comparison between higher and lower scoring Boards

It is notable that across the Geographic Boards, there is considerable consistency in EEI scores, with the range only going from 75 for NHS Forth Valley to 78 for NHS Lanarkshire.

However, there are much larger differences across the National Boards: This analysis compares the score of 3 Boards that represent the highest and lowest EEI scores among Boards that received a Report in 2018.

While all three are National Boards, it is noted that the Scottish Ambulance Service is over ten times the size of the others in terms of response volume.

	Scottish Ambulance Service	Health Improvement Scotland	NHS Health Scotland
EEI	67	80	81
Response Rate	64%	86%	91%
Response Volume	4,571	474	289

Differences between iMatter questions

The EEI scores with the biggest differences are all in the Experience as an Individual strand and relates to a feeling of involvement and inclusion:

• I get enough helpful feedback on how well I do my work
• I feel involved in decisions relating to my job
• I am given the time and resources to support my learning growth
• I am confident my ideas and suggestions are listened to

In contrast the questions that have the least difference are also in this strand, but relate to the individual's personal role:

• I am clear about my duties and responsibilities
• My work gives me a sense of achievement

Also showing considerable differences between the high and lower scoring Boards are two of the statements in My Organisation;

• I feel my organisation cares about my health and wellbeing
• I feel senior managers responsible for the wider organisation are sufficiently visible

Dependency between questions

Using Pearson correlation analysis we can look at the relationship between the individual questions.

High dependency between questions

The strongest correlation is between:

• I am confident my ideas and suggestions are listened to
• I am confident my ideas and suggestions are acted upon

This is logical given the similarity in the statements, however the overall average score for being 'listened to' is higher (75) than the score for 'acted upon' (71). These two questions then also correlate strongly with 'I feel involved in decisions relating to my job'.

There is a cluster of high correlation around the relationship staff have with their direct line manager:

• I feel my direct line manager cares about my health and wellbeing
• My direct line manager is sufficiently approachable
• I have confidence and trust in my direct line manager

There is a correlation also between the visibility of senior managers and the level of trust that staff have in them:

• I feel senior managers responsible for the wider organisation are sufficiently visible
• I have confidence and trust in senior managers responsible for the wider organisation

These two statements also correlate strongly with 'I am confident performance is managed well within my organisation'.

Two other pairs of statements that correlate highly are:

• I am treated with dignity and respect as an individual
• I am treated fairly and consistently

And

• I get enough helpful feedback on how well I do my work
• I feel appreciated for the work I do

The highest correlations with the Overall thermometer question are:

1. I would recommend my organisation as a good place to work

2. I feel my organisation cares about my health and wellbeing

3. I would be happy for a friend or relative to access services within my organisation

4. I am confident performance is managed well within my organisation

5. I have confidence and trust in senior managers responsible for the wider organisation

6. I feel appreciated for the work I do

Statements 1. and 3. above might be seen as the 'outcomes' i.e. if staff say working in their organisation is a 'very good experience' then they are very likely to recommend it as a good place to work and be happy for a friend or relative to access its services.

The other statements may be seen as 'inputs'. i.e. staff who agree strongly with those statements are most likely to say the overall experience is very good. Equally those who rate low for these statements will typically describe the overall experience as bad. Three out of these four statements relate to the organisation rather than the team.

Low dependency between questions

Two questions have low correlations with almost all other questions including the overall thermometer:

• I am clear about my duties and responsibilities
• I understand how my role contributes to the goals of my organisation

The overall lowest correlations are between 'I am clear about my duties and responsibilities' and:

• I feel senior managers responsible for the wider organisation are sufficiently visible
• I feel involved in decisions relating to my organisation

As might be expected there is generally very little correlation between the Team statements and those about the wider Organisation.