Openness in the NHS: a secondary longitudinal analysis of national staff and patient surveys

Abstract

Background Improving openness—including candour when things go wrong, and willingness to learn from mistakes—is increasingly seen as a priority in many healthcare systems. This study explores perceptions of openness in England before and after the publication of the Francis report (2013), which examined failings of openness at one English hospital. We examine whether staff and patients’ views on openness, and experiences of giving voice to concerns, have changed since the report’s publication for better or worse. Methods Organisational-level data was collated for all trusts from the NHS National Staff Survey (2007–2017), NHS Acute Inpatient Survey (2004–2016) and NHS Community Mental Health Service User Survey (2007–2017). Survey items related to openness were identified and longitudinal statistical analysis conducted (piecewise growth curve and interrupted latent growth curve analysis) to determine whether there was evidence of a shift in the rate or direction of change following publication of the Francis report. Results For some variables there was a discernible change in trajectory after the publication of the Francis report. Staff survey variables continued to rise after 2013, with a statistically significant increase in rate for “fairness and effectiveness of incident reporting procedures” (from + 0.02 to + 0.06 per year; p < .001). For the patient surveys, the picture was more mixed: patient views about information provided by accident and emergency staff rose from a 0.3% increase per year before 2013 to 0.8% per year afterwards (p < .01), and inpatients being involved in decision making increased from a 0.4% rise per year before 2013 to 0.8% per year afterwards (p < .01); however, there were not rises in the other questions. Mental health patients reported a decrease after 2013 in being listened to (decreasing at a rate of 1.9% per year, p < .001). Conclusions Data suggest that the Francis inquiry may have had a positive impact on staff and acute inpatients’ perceptions and experiences of openness in the NHS. However such improvements have not transpired in mental health. How best to create an environment in which patients can discuss their care and raise concerns openly in mental health settings may require further consideration.

Encouraging openness in health care: Policy and practice implications of a mixed-methods study in the English National Health Service

“…Results of the secondary survey analyses presented a mixed picture of progress in terms of staff and patients’ experiences of openness over time. 16 , 17 There was a trend towards more positive responses to several of the questions on the staff survey and the acute inpatient survey from the mid-2000s to the mid-2010s. For example, there were improvements in respondents’ views of the quality of communication between managers and staff, and on their ability to contribute positively towards improvements; for acute inpatient survey respondents, there were improvements in views on the information provided about their care, and on their involvement in decisionmaking.…”

“…More extensive expositions of these findings are available elsewhere. [16][17][18]21,22 We then build on these findings, particularly those from the fourth substudy, to propose four conditions that appear necessary for achieving sustained changes in culture and behaviour. We highlight four persistent challenges that continue to frustrate efforts at improvement.…”

“…To answer this question, our first substudy comprised a series of analyses of existing survey data from 2004 to 2017 on the views and experiences of NHS staff, acute hospital patients and community mental health service users. 17 We identified a subset of items within each survey that related most closely to culture around openness. For each item, we used longitudinal statistical methods to identify changes in responses and trends between the periods before and after the publication of the Mid-Staffordshire public inquiry report in 2013.…”

A decade after Francis: is the NHS safer and more open?

“…But not all the signs are positive. Service users report a stagnating or worsening picture of openness in community mental health services 8. The proportion of staff indicating problems around openness remains worrying: two fifths are not confident they will be treated fairly if they report concerns 7.…”

“…Service users report a stagnating or worsening picture of openness in community mental health services. 8 The proportion of staff indicating problems around openness remains worrying: two fifths are not confident they will be treated fairly if they report concerns. 7 Patient satisfaction is falling, 7 mirrored by declines in indicators of staff wellbeing and morale, and in staff views on their organisations' responsiveness to safety issues.…”