What employees think of the health service

Maureen Browne looks at the results of the first ever sector-wide survey of employees of the health service and how they feel about their jobs, training, motivation, enthusiasm and the standard of care provided by the health services.

Maureen Browne
Maureen Browne

Over one third of HSE employees feel they did not receive the training to help them to do their jobs properly and more than half believed the health services were not good at developing employees to their full potential, according to the HSE commissioned Ipsos MRBI employee survey.

Over 121,526 employees were invited to participate in the first ever health sector-wide survey conducted by the HSE which took place between September 24 and November 7, 2014. Only 8,627 employees completed the survey, a low response rate but still statistically representative. The majority of respondents (86%) were HSE employees who were contracted to work at least 30 hours a week.

Just over half of HSE employees were satisfied in their job at present.

As far as work opportunities were concerned 35% of employees were satisfied with the opportunities they had for training while 45% were dissatisfied. Twenty one per cent were satisfied with their opportunities for career progression, with 54% of employees dissatisfied in this area. Just under 64% said their job gave them a sense of personal fulfilment, over half considered their work enabled them to improve their skills, while a quarter disagreed.

Among the employee engagement metrics tested, motivation and enthusiasm were the two areas recording the highest levels, at 69% and 68%, respectively. Just over half of HSE employees were satisfied in their job at present. However, only 11% of these claimed to be very satisfied and one in three employees were dissatisfied. Just 38% felt optimistic about their future within the health service and 33% were neither optimistic, nor pessimistic.

Just under 31% stated they worked additional paid hours per week, while over half stated they worked additional unpaid hours per week.

The vast majority of employees (89%) felt their role made a difference to patients/clients. A similar proportion stated they were trusted to do their job (86%), while over eight in ten employees (83%) claimed to go beyond what was required in their job for the health services to succeed.

The majority of employees (62%) appeared to lack confidence in the decisions made by the senior management of the health services.

Many employees (73%) felt they had clear, planned goals and objectives for their job, 72% felt satisfied with the quality of care they gave to patients/clients, while 68% considered their personal targets for their job to be realistic.

While two in three employees stated they were able to make suggestions to improve the work of their team/department, just under three in ten claimed to be actually involved in decisions that affected them in their work.

Only a quarter of employees claimed to have all the equipment, support and resources required to do their job correctly, a level significantly below benchmarking norms.

Just under seven in ten employees claimed satisfaction with the level of responsibility they had in their job, Only half of respondents appeared to be satisfied with the support received from their line manager, with almost three in ten dissatisfied. Four in ten respondents did not feel their work performance was recognised, while six in ten were dissatisfied with the extent to which the health services valued their work. Just under three in ten were satisfied with their level of pay. The majority of employees (71%) intended to be still working in the health services in two years’ time.

Over half of employees agreed that the health services got the best out of them.

Line managers were generally considered to be fair and equitable, with 58% of respondents in agreement.

However, only just under a half agreed that the health services’ top priority was the care of patients/clients, with a quarter disagreeing and one in ten strongly disagreeing that this was the case.

Over one in three employees would recommend the health services as an employer to a friend or family member and a similar would not recommend the health services.

Over four in ten staff would be happy with the standard of care provided by the health services if a friend or relative needed treatment, while three in ten would feel unhappy with the standard provided.

In terms of the overall service level within the health services, two thirds (65%) of employees believed that service levels were deteriorating Just over one in ten (12%) believed that the overall service level within the health services was improving.

When asked about their view on the health services’ overall strategy, almost half of all employees stated that they did not know this strategy well enough to answer, with one in three believing that the overall strategy was heading in the wrong direction.

Just over half of employees felt proud to work for the health services. However, only two in ten claimed to value the culture within the health services, with an even smaller proportion (16%) feeling valued and recognised by their employer. Just under six in ten employees were satisfied with their physical working conditions.

The question of workload however proved debatable for employees, with relatively similar levels showing satisfaction (44%) and dissatisfaction (38%) in this regard.

In terms of the communication between senior management and staff, only a quarter of respondents believed this communication to be effective and 28% strongly disagreed that communication is effective.

Similarly, disagreement was significantly higher than agreement on the topic of senior managers acting on staff feedback, with more than half of respondents disagreeing and a minority of 20% agreeing.

The majority of employees (62%) appeared to lack confidence in the decisions made by the senior management of the health services, with just 12% confident on this topic. Seventy per cent did not agree that change was well managed within the health services.

A much smaller proportion of employees appear satisfied (18%) than dissatisfied (53%) with the quality of internal communication in the health services, which was significantly below benchmarking norms.

The most effective source of communication, perceived by almost eight in ten employees (78%), was information from their work colleagues, followed by information via electronic mail for 68% of respondents. Just under six in ten employees (58%) believed that their line manager was an effective source of information, while half considered the intranet/internet an effective source.

The least effective information source appeared to be the senior management of the health services, a view upheld by a half of all respondents who felt that this source was ineffective. A further three in ten were undecided.

Line managers were generally considered to be fair and equitable, with 58% of respondents in agreement. A similar proportion considered that their line manager encouraged teamwork (57%), listened to their ideas and suggestions (56%) and communicated well with the team (54%).

However, less than half consider that their line manager delegated effectively or that the decisions they make were to inspire confidence. Similar proportions showed agreement (43%) and disagreement (42%) about their line manager motivating them to perform at the highest levels, and one in three (35%) did not feel that their line manager gave them clear feedback on their work.

Less than a quarter of staff believed that the health services truly valued the diversity of its employees. In the previous 12 months, some employees claimed to have personally experienced discrimination at work, with 21% feeling discriminated against by their manager/team leader or other colleague and 15% by patients/clients, their relatives or other members of the public (some may have experienced discrimination from both parties).

Among those who claimed to have experienced discrimination, gender was reported to be the cause for 20%, followed by their ethnic background (17%) and their age (15%). Less frequent grounds for discrimination involved grade/job status (6%) and management/seniority (5%), while general bullying and harassment was also an issue (5%).

Only a small minority (18%) believe that their employer was genuinely interested in the well-being of its employees. Over 73% had come to work in the previous three months despite not feeling well enough to perform their duties. However, the vast majority of these (93%) acknowledged having put themselves under pressure to come to work when not feeling well, with fewer respondents claiming they had felt under pressure from their manager (35%) and from their colleagues (24%).

Extremely high levels of stress (9-10) were reported by one in six employees (16%),

Four in ten employees (40%) felt that the stress caused by their job was in moderately high levels, while a quarter (26%) rated their stress levels to be around average.

In the previous month, 38% reported having seen errors, near misses or incidents at work that could have hurt members of staff, while almost half of respondents reported having seen errors that could have hurt patients/clients. Where such incidences were noticed, the vast majority of those employees (87%) claimed that the error, near miss or incident in question was reported, either by themselves or by a colleague. Seventy five per centfelt that their employer encouraged staff to report these instances. However, only 39% were of the opinion that the health services would treat staff involved in such situations fairly, and 30% reported receiving feedback from their employer about changes made in response to reported errors, near misses or incidents.

When asked about situations of fraud, malpractice or wrongdoing at work, 72% stated that they would know how to report it. Among these, 62% would feel safe raising these concerns, although only 32% would feel confident the health services would address them.