Future hospitals: what staff want

What should future hospitals be like as workplaces?
30 March 2021

Interview with 

Mary Dixon-Woods, THIS Institute Cambridge University


Close up of a doctor's coat, with a stethoscope and a pocket full of pens


Critical to the functioning of any hospital are the staff. And too often, when budgets are tight and space is tighter, staff wellbeing, and the productivity benefits of a pleasant working environment, can be overlooked. Mary Dixon-Woods is a social scientist; she directs the THIS Institute that works to improve the scientific evidence base that informs how we improve healthcare. Katie Haylor spoke to Mary...

Mary - There's very much a relationship between quality of care and outcomes and the wellbeing of staff. Why it doesn't get the attention it possibly deserves is linked to the challenges associated with producing an evidence base for how you do improvements, and linked also to the level of investment that's needed in it.

Katie - Okay. So what evidence do institutions like yours have for what people who work in hospitals want from their future workplace?

Mary - We've actually got a really clear evidence base. They want clear goals. We know that teams function much better when they're very clear about what they are trying to achieve, we also know that teams in the NHS often aren't optimised in that respect. A second thing that they want is really good management systems actually. So functions like human resources need to function really, really well so staff know that their wellbeing is taken into account in planning. They know things like rotas and annual leave and occupational health are well-planned. They want appreciation and respect as we all do. They want respect particularly for aspects of diversity, and they want opportunities to contribute to improvements. And they also want, very importantly, to work in well-designed operational systems.

Katie - Tell me a bit more about the actual buildings. What about space for, say, somewhere to take a break?

Mary - It's very important. We've discovered this repeatedly that having a space to take a break is very important for all kinds of reasons. Some of them are to do with addressing fatigue, which is a major problem in hospital workers. And some of it is actually social and the opportunity to create connections with your colleagues is a very important part of team building. It's also very important to patient safety because this is an opportunity to create informal learning opportunities, to share knowledge, and often to anticipate problems and trap them in relation to individual patient care.

Katie - So how do you know all of this? What kind of evidence can you gather and how do you do it?

Mary - We can use a whole range of techniques. Sometimes they are surveys of staff and the NHS has been running very successfully for a number of years the NHS staff survey, which tells us an awful lot about what matters to staff and how well their needs are met. We can also use time and motion studies and these directly observe staff as they're going about their daily work. And we can identify, for example, how often they're interrupted. And I can tell you, nurses are interrupted every six minutes. We can tell you how much of their time is wasted on operational defects, and that's about 12% of their time. So huge opportunities for addressing frustration and time waste there. And we can use trials, we can use experiments to assess what kinds of interventions seem to make improvements. We can also learn a lot from industrial technique, including in particular engineering, which is very highly skilled in analysing and improving work systems.

Katie - So is that sort of applying an engineer's mindset, tackling some sort of process?

Mary - That's right. So we would often use social science techniques to analyse where the weaknesses might lie in a system and what matters to the people involved. So it's very important to build a vision of what good looks like from the perspective of patients and staff. Engineers are very good at using techniques, particularly in a discipline called human factors, which combines engineering, psychology, and a number of other disciplines into design of solutions that are well suited to addressing the problems that we can identify. And some of that will be to do with physical design, designing systems, as you were talking to your colleagues earlier, for example, ensuring that you've got smooth processes for say delivering medications to wards, smoothly operating equipment that minimises infections. Other times it will be to do with improving teamwork, communication, and other processes that rely on human interaction.

Katie - Is there anything else you think that the hospital of the future should look like in terms of being a workplace?

Mary - I think the hospital of the future should be constantly seeking to improve constantly learning from its own staff, and its own patients about what good looks like, how to make those improvements through continuous experiments and rapid cycles of change.



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