How can promoting a positive NHS culture promote an increased quality of patient care?

The National Health Service is the universal medical care provider for residents of the UK. The principles it was originally developed upon ensured the service was provided free to meet everyone's clinical need (NHS, 2013). This ethos is still at the core of its delivery, but additional principles have been added to its constitution to improve quality standards and to provide the public with rights as an NHS patient (Department of Health, 2012). Thus, for health professionals and the wider NHS workforce to achieve these principles, the patient needs to be central to the delivery of their healthcare. Therefore, the focus of this essay will be to explore the relationship between a positive NHS culture and increased quality of patient care. In this essay the phrase 'positive NHS culture' has two definitions: 1) its internal organisational structure and the working environments of staff 2) the public and patients' perception and experiences of the NHS as service users. Due to the limited word count of this essay, the following factors will only be discussed: multi-disciplinary working, patient engagement and the role of the media.

Within an organisation, a positive work culture is the key to successful delivery to its customers, clients, service users or patients. An inclusive workplace is constantly promoted by governing bodies, trade unions and human resource professionals because it allows for greater happiness to be achieved at work through the creation of a positive working environment (Equality and Human Rights Commission, 2010). This is because when professionals are respected and their skills are valued, they feel a sense of autonomy and purpose (West et al, 2011). Furthermore, this supportive environment can create trusting relationships amongst colleagues, which can result in a positive internal work culture. Oppositely, within an organisation where there is a lack of respect and trust, the service of the quality being delivered can become compromised. For example, cases have been identified where clinicians did not trust the medical judgments of fellow clinicians and this resulted in clinical assessments being repeated on patients (NHS Institute for Innovation and Improvement, 2010). This mistrust can result in creating more worry for the patient, a negative relationship between clinicians, an increased waiting time for the result of the assessment and possibly delaying NHS services to another patient and wasting NHS money.

It can be argued that this critical approach by one clinician can ensure the diagnosis of a patient is correct; however as the UK has a high standard in its medical education progammes, the knowledge of another clinician should be respected. Also, there are other processes to ensure the diagnosis and treatment/care of the patient is suitable and of a high quality through regular discussions with allied health professionals who have been trained in a varied way to meet specific service areas. This allows alternative methods and treatments to be discussed and leads to better quality decisions on patient care (Borrill et al, 2002).

Multi-disciplinary working is essential for a large organisation like the NHS, who aim to provide healthcare for everyone regardless of what health and well-being support or treatment is needed by the patient (NHS Institute for Innovation and Improvement, 2010). It allows professionals to efficiently manage their times and reduce patient waiting times, and more importantly it ensures the patient is receiving care from the relevant expert. Multi-disciplinary working could in the future challenge the entrenched feature of 'waiting times' in the NHS healthcare system. It is often accepted by NHS professionals that it is normal for a patient to wait to be seen: this indirectly disrespects the status and clinical need of the patient, suggesting that their time is less valuable than the healthcare professional's time (Leape et al, 2012).

Over time, a blame culture has developed within the NHS when poor quality of care has been delivered, or more extremely when a number of fatal cases have been reported within one trust. Multi-disciplinary working is used to promote a team effort in high quality care and it is also used to challenge and prevent poor quality care (Berwick and Department of Health, 2013). To ensure poor standards are not accepted, patient partnerships need to be created to allow patients to participate in planning future NHS care improvements. Furthermore, if healthcare professionals communicate with patients in a method which allows them to understand jargon and medical information related to their health condition, this can then empower them to make suitable decisions in regards to their healthcare (Leape et al, 2012). Furthermore, the patient may become confident enough to comment on their healthcare and also feel respected and comfortable in the medical environment which they are being treated within, hence positively influencing their perception of the NHS.

To further support the comfort patients' feel when using the NHS services, practitioners need to have a level of emotional intelligence as well as the intellectual ability to provide high quality care. This is because 'good health' is a combination of mental, physical and social well-being (WHO, 1946). Intellectual ability is usually identified and revisited often in a practitioner's healthcare training because it is thoroughly assessed. However, emotional intelligence differs within training depending on the role of the practitioner. Also, trainers of technical skills would argue it is not easy to teach emotional intelligence because it is often connected to an individual's personality/character and the events they have experienced throughout their own personal life (Tapia and Hyter, 2015). Nursing staff initially deal with difficult patient situations where emotional intelligence is essential to solve or ease the patient's situation. Therefore, showing care and compassion towards the patient often shows the patient they are being supported, hence improving the patient's satisfaction towards the support offered by the nurse (Ruddick, 2015).

Media are used globally to reach a mass audience. Therefore, the NHS uses the mass media to reach a national audience for their health campaigns. Cutting down the number of smokers in the country is still a high priority to improve public health (NICE, 2015). The NHS using media campaigns for smoking cessation services, and the advice these provide has resulted in an overall positive effect for the incentive, due to the campaign reaching a mass audience (NHS Institute for Innovation and Improvement, 2013). This has been due to the development of diverse and creative advertisements being produced and made available freely to healthcare professionals, organisations and the public (NHS, 2015). These advertisements are not for online or television use only: they are often displayed or given in physical environments where patients and practitioners are present, hence making the delivery of patient care more interesting and more effective in tackling negative habits such as smoking. The extent of influence that the media has on its audience, and their thoughts and beliefs on specific topics, depend on a variety of factors; hence one single theory cannot sum up the impact of media.

Using the media to acknowledge successful NHS services is important because often the media report investigations or organisational changes. For example, the BBC reported that over 40% of NHS investigations are not carried out adequately (BBC, 2015). This suggests that the culture of the NHS is one that fails to handle a large number of patient complaints appropriately; the complaint of a patient often suggests that there was a negative event when receiving healthcare within the NHS such as medical negligence. Therefore, failing to acknowledge this can further deteriorate the perception of the NHS to the patient. Furthermore, due to the NHS being a healthcare provider it is expected by society to have a high standard service, yet the demands on the staff to provide this service is often forgotten (Griffin, 2014).

The NHS Practitioner Health Programme Team received the 'Innovation in Mental Health in Primary Care' award in 2014; this recognition of high quality practice was reported by various forms of media (NHS, 2014). The public were shown that these practitioners were successful and passionate individuals who were working to improve the Mental Health service within the NHS. Despite this not having a direct impact on the quality of patient care, it positively promoted the NHS and it also recognised that the mental health service in primary care was being recognised as innovative. Healthcare professionals can further promote the NHS culture as positive by using social media to engage with a larger public audience and also to connect with other healthcare professionals by increasing their participation in discussions on healthcare knowledge and alternative techniques (Cooper and Craig, 2013). This engagement can promote self-help techniques to patients and support them to manage their conditions. Self-help and self-care of conditions can reduce hospital admissions, hence directly impacting the number of patients waiting in Accident and Emergency departments, which can then allow clinicians to have more time with patients (The King's Fund, 2010).

To summarise, patient experience is central to the quality of patient care. It seems a positive NHS culture is at the core of positive patient experience because it supports the development of relationships between the patient and the healthcare professional: this then can allow the patient to express their thoughts on the healthcare being delivered to them. In addition to this, trusting and respectful relationships can be created between professionals, who can then apply successful multi-disciplinary working to make the quality of care sufficient to meet service demands yet of a high personalised standard for each patient. Sadly, there are constraints in creating a highly positive NHS culture due to the demands put on the NHS service, diverse training of staff and the influence of the media. 

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