References
Staff wellbeing: a matter for quality indicators or a concern in its own right?
Abstract
Despite assurance measures being developed alongside expanding scopes of practice, poor NHS ambulance staff wellbeing means high-quality job performance and patient care are not guaranteed. The UK's service is struggling to cope with growing demand and is not fully adapting from its historical emergency response role to meet modern-day urgent care needs. This puts unnecessary pressures and risks of stress from exhausting, intense work on to its most valuable resource: staff. Detrimental workplace cultures exacerbate this, along with added target-driven strain from non-evidence-based ambulance quality indicators. With poor support, communication, leadership and mental wellbeing provision, staff are increasingly dissatisfied, demoralised and experiencing a myriad of health problems. Consequences include excessive staff sickness absences and turnover as well as an up to 75% higher suicide risk. Trusts should collaborate to identify and address the causes of demand that cannot be met, and chief executives and boards should work with staff to prioritise structured wellbeing assessment and improvement. Further research is also needed.
Balancing expanding scopes of practice with safe, effective patient care in modern prehospital landscapes can prove challenging (Barody, 2016; Dodd, 2017). In the UK ambulance service, increasing public demand, changing user needs and a growing evidence base has driven the rapid evolution of frontline roles (Harrison, 2019; Newton et al, 2020). In addition, a patient-centred focus has led to more stringent care quality regulation (Santana et al, 2019).
The ambulance quality indicators (AQIs) were implemented in April 2011 to drive service improvement through a framework of system and clinical outcome measures (Association of Ambulance Chief Executives (AACE), 2020). NHS ambulance trusts submit monthly data providing insight into patient safety and success, including ambulance response times and a limited number of clinical outcomes, such as cardiac arrest and stroke (Table 1) (NHS England, 2019a).
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