Leadership will play a decisive role as the NHS retention crisis worsens
Under-resourced and high-pressure emergency hospital departments in the UK are some of the primary reasons for the retention crisis, according to new research
A study from the Royal College of Emergency Medicine and the University of Bath, led by clinical psychologist Dr Jo Daniels in collaboration with colleagues at the University of West England Bristol and the University of Bristol, argues that hospitals need better leadership to help change cultures and support people's basic needs.
In addition to reflections from current frontline doctors, nurses, and advanced clinical practitioners, the research also features exclusive interviews with household names in the UK, which include former doctors turned comedians. Adam Kay, Harry Hill, and Phil Hammond explain why they left and how they hope the National Health Service (NHS) can be better managed to prevent others from doing likewise.
In February 2023, a University of Bath Institute for Policy Research report concluded that as many as one in seven healthcare workers were actively trying to leave the NHS. According to the Royal College of Nursing, almost 27,000 people left the register in the past year, with more than half leaving earlier than planned, citing burnout, workload, and concerns over care quality.
The new study, funded by UK Research and Innovation and published in the Emergency Medicine Journal, investigated perceived barriers to implementing better working practices and conditions for emergency medicine clinicians in the UK.
Building on previous work from the team looking at the toll of Covid-19 on healthcare workers, its analysis highlights multiple issues associated with poor retention. These include a culture of blame and negativity in hospitals, untenable working environments, compromised leadership, and a perceived general lack of support, leading to burnout and low morale. Across the board, participants reported feeling undervalued due to unmet basic demands. These ranged from 'sharing toilets with patients' to poorly functioning Information Technology (IT) systems or the absence of rest spaces and staff rooms. A lack of private space within hospitals meant many also found it hard to decompress.
In an accompanying video to the research, Kay describes a toxic culture where it was a badge of honour to work as hard as possible, where staff felt blamed, disempowered to seek support as they should be 'unbreakable,' and where expectations set were unrealistic.
A lack of formal training for consultants in charge of busy wards was also highlighted by several participants, as was the need for more 'visible, compassionate leadership.' Reflections from people interviewed suggested that leadership training should be embedded as part of medical training. Hammond added that there is a need to tell doctors that one really interesting career pathway for them is to get involved in NHS management and clinical leadership. And not in a way that says, 'It has gone over to the dark side.'
When considering how the staff has continued to work in such difficult conditions for so many years, Hill emphasised the 'force for good' that has traditionally motivated NHS staff. However, after repeated reorganisations and a lack of support, he suggested this was wearing thin. He claimed that society used to hold doctors in some esteem when he was a doctor, but that has significantly decreased since then.
Lead author Daniels of the University of Bath explained that at a time of national crisis in the NHS, with over-stretched resources leading to long waiting times for patients and burnout for staff, their study asked what more could be done to improve the current challenges of staff retention.
A common thread that emerged across the interviews was the critical importance of leadership in hospitals. Those in leadership positions are potent agents of change and have a pivotal influence over team functioning, staff well-being, and patient outcomes. However, lines of accountability and communication with executive management must be clarified, opened up, and improved. A new focus on leadership training and ongoing support for those in leadership roles will be critical. Given its central importance and the scope for leadership to improve well-being at work, there is a prime opportunity now to address the problems that force staff to leave the workforce. Harnessing the potential in the leaders is where the focus should now lie.
Dr Adrian Boyle, President of the Royal College of Emergency Medicine, shared that working in emergency medicine can, by its very nature, be a high-pressure and stressful job. The members and their colleagues, who go above and beyond for their patients day in and day out, should not also have to battle a system that is meant to be there to nurture and support them.
The research reinforces that the NHS must better care for its workforce; its people are its greatest asset, and everything must be done to ensure their welfare. The research will be shared with policymakers. It will form part of the college's advocacy work to help inform and bring about the cultural shift needed in accident and emergency services.
The team involved in the study will work with the professional bodies to help improve training and policies. Daniels concluded that they have outlined specific steps that NHS trusts can take. However, there is a need to start by recognising how important this is and how vital it is for those in leadership positions to be supported to lead. Without solid leadership, poor outcomes for all are expected.