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Because of a perceived decline in staff morale, the UK National Health Service has begun to routinely assess the extent to which commitment to the National Health Service may aid staff retention. While a number of studies have investigated the role of employee commitment in relation to staff turnover, no research to date has empirically tested if staff commitment to the NHS could protect job satisfaction from the effects of high job demands, and if this varies according to age. Using latent variable path analysis, this novel study examined this question among a national sample of Healthcare Professionals Allied to Medicine in the National Health Service. The results indicate that the negative effects of high job demands on job satisfaction were fully mediated by commitment to the National Health Service, but age mattered. Among the over 45s and over 55s, commitment to the National Health Service acted as an effective buffer against the negative effects of job demands on job satisfaction, but this effect was not as strong among the 35–44 age group. The broader policy implications of these findings are that age sensitive policies to support NHS workforce retention are needed. Also, pro-social institutions who employ Healthcare Professionals Allied to Medicine should develop policies for inspiring commitment to that institution, as it could help them with the demands of the job, and may even encourage more skilled workers to work longer.

BackgroundThe Covid-19 pandemic has imposed unprecedented demands on NHS staff and resources, during which time ambulance staff have been working at consistently high levels of operational pressure. This study explores the impact of prevailing conditions on NHS staff experiences, future employment intentions and key factors in decisions to remain in the NHS or leave.MethodsThe study was undertaken in two ambulance trusts using an online survey (n=500) and qualitative interviews (n=20) between April 2021 – December 2021. Two rounds of survey data collection captured information at different time points in the pandemic. Interview participants were sampled purposively to include frontline staff, line managers and senior managers. Survey analysis was undertaken in SPSS and interviews were analysed thematically.ResultsThe majority of survey respondents were frontline staff: Paramedics (44%); Emergency Medical Technicians (25%) and call-handlers (10%). Mean length of service was 13 years. Compared with prior to the pandemic, staff perceived things were worse in terms of staffing levels (80%), stress (77%), workloads (76%), morale (73%) and their mental health (66%). Key concerns related to abnormally high levels of staff absence, the impact of work on mental and physical health, inadequate time to do the job and making mistakes because of workloads. Almost one-in-five respondents had applied for a non-NHS job in the last six months, including 25% paramedics, and 27% wished to be working elsewhere in 5 years time. The interviews provided complementary detail on experiences and employment intentions, with key issues relating to staffing pressures, work demands and conditions, and burnout.ConclusionThe Covid-19 pandemic has had and continues to have a detrimental effect on workload, morale and both mental and physical health, with implications for staff retention and NHS care delivery. Insights provided by this study are intended to inform approaches to staff retention.

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A case study is presented that systematically examines how L’Oreal builds upon compliance to prevent unsafe behaviour globally. It does so by using a gap analysis methodology to compare the content...

Objectives: To explore and portray the perspectives of National Health Service Ambulance personnel related to the latest rise in the National Health Service occupational pension age. Methods: Data gathering took the form of 35 in-depth interviews. A thematic analysis was used to characterise and articulate key concepts and meanings. The analysis applied interpretive techniques, as views expressed were from personal experiences, and allowed for an in-depth analysis of shared meanings. Results: The themes reported captured the desire of many Ambulance personnel to exit their employment well in advance of their retirement age, despite satisfaction gained from patient care. This early exit is being driven by increased worry that the work demands of the job are unsustainable, especially for older workers, as clinical responsibilities increase and their social support diminishes. Also, Ambulance personnel feel betrayed by their employers, because their retirement is being delayed further by another change in their pensionable age. Conclusion: There is an increased orientation for ‘living for today’ and indications of a willingness to sacrifice salary and pension income in order to protect their health in older age, which has implications for long-term financial and general well-being in retirement.

Purpose Staff shortage in the UK National Health Service has a long history, but is widely predicted to become acute over the next decade. Falling enrolment rates in health professional training and restrictions to migrant labour recruitment have brought the, traditionally neglected, issue of staff retention into sharp relief. The purpose of this paper is to represent the first large scale systematic appraisal of the relative salience of recognised headline drivers of employee exodus from the NHS. Design/methodology/approach The data were collected from an opportunity sample of 1,594 health professionals, managers and administrators employed by the NHS. Participants completed a paired ranking task (Case V method of paired comparisons, Thurston, 1927) to determine the relative importance of eight widely cited reasons for exit. The item set was derived from focus groups conducted as a component of the wider study. Findings Findings revealed almost universal consensus regarding the primacy of shortage of resources, job demands and time pressure. Pay was ranked lower than predicted. Flexible working arrangements do not presented as a key solution, and there is no support for claims of generational differences. Research limitations/implications Survivor population effects could constitute a source of sample bias, i.e. all participants were current NHS employees. It is possible that those who remain may be more resilient or hold different dispositions to leavers. Thus, comparisons by age and grade may not be comparing like with like. Tapping respondent beliefs about the actions of peers can embody some degree of inaccuracy and attribution bias. However, effects can be considered to operate as a source of common, rather than systematic, error across the demographics compared. The medical and dental sample was too small to give confidence in detected differences. Practical implications Findings challenge the claim that wider availability of flexible working hours will significantly reduce exit rates. Pay, being a source of dissatisfaction, does not constitute a key push variable in itself, rather its salience reflects the effort reward-imbalance produced by rises in job demands. Social implications Staff shortages in the NHS represent a threat to: public well-being – waiting lists and demand for care; the well-being of who continue to work in the NHS – job demands and resources; the employment prospects of staff who leave involuntarily, e.g. on grounds of incapacity and threats to health and well-being – extending to impacts on their dependents. Originality/value Issues of staff retention within the NHS are topical and under researched. The findings provide an up to date picture of the relative influence of headline drivers of early exit from the NHS. The study draws upon a more diverse and comprehensive sample of NHS employees that any other known previous studies of early exit. Findings are of potential international relevance to other State health systems. The authors believe this to be the largest (sample) known application of the method of paired comparisons.

This chapter articulates contemporary insights into non-clinical considerations that impact on paramedic decision-making over patient treatment and (non-)conveyance to hospital emergency departments. After introducing the concept and role of choice architecture, it moves on to provide a flavour of tensions surrounding extrinsic influences on decision-making over care destinations for patients, in the context of rising demand for services, scarcity of resources and professional and institutional worries over blame and accountability.

Little is known about the perspectives of health-care workers when it comes to prolonging their working lives. This exploratory paper focuses on physiotherapists and aims to offer new insights into the underlying processes that may influence perceptions of ageing and how they impact on motivation to work longer. Data gathering took the form of focus groups with 43 National Health Service physiotherapists. A thematic analysis was used to characterise and articulate key concepts and meanings. The analysis applied interpretive techniques. The six headline themes to emerge were: worry over physical capability and ability to cope; the need to maintain a professional image; work, retirement and exit norms; beliefs about ageing; extrinsic job demands; organisational support – line management; and organisational support – career progression. The key findings suggest that the current unchanging context of high job demands is very salient, consequently resulting in negative and pessimistic feelings about capabilities when it comes to being an older worker and having an extended working life.

We find that British and Korean governments have legislated in favour of extended working lives and, hence, the retention of ageing workforces. In the United Kingdom, pension eligibility ages are being increased and in Korea mandatory retirement age has been raised to age 60. While changes to the UK pension systems leave individuals with the (financial) risks associated with extended working lives, the Korean government tries to protect individuals from financial hardship by enabling them to remain longer in their primary career. However, whether and how government regulation plays out depends on how organisations react to it. The Korean discussion, in fact, shows that there might be leeway: organisations might continue to externalise their employees early framed as honourable, or voluntary, early retirement, which might not be in the interest of the individual but very much in the interest of the organisation. It therefore appears as if the retention of ageing staff is not (yet) considered to be of strategic importance by many organisations in these countries.

Reviewing the collective findings from investigations into a range of major events in high hazard industries has led to the conclusion that there is a need to develop greater resilience to their organisational and cultural causes. This requires more rigorous methods for identifying disaster precursors and also to support intervention design. A study of the organisational and cultural precursors relating to twelve major events across several high hazard industries revealed many shared disaster precursors in areas such as leadership, operational attitudes and behaviours, communication, risk analysis, learning and, oversight and scrutiny. This has enabled statements of good practice ('expectations') to be developed, together with draft 'penetrating' question sets that can be used by industry and regulators to profile organisational risk management resilience and thereby drive organisational learning. The research shows that the processes of incubation and evolution of disaster events can be complex, and to exercise control therefore requires the development of more sophisticated 'tools' than are currently available. It has revealed repeating patterns of failure and the importance of psychological and behavioural factors which have led to poor decision making. Causal loop modelling is being used to capture these patterns and factors to facilitate the design of more informed interventions. The emerging issues and new approaches being developed are discussed and examples given.

PurposeThe purpose of this paper is to discuss contemporary approaches to workplace health and well‐being, articulating key differences in the intervention architecture between public and workplace health contexts and implications for intervention design.Design/methodology/approachContemporary practice is discussed in light of calls for a paradigm shift in occupational health from a treatment orientation to an holistic approach focused on mitigation of the causes of ill health and the promotion of well‐being. In practice, relatively few organizations have or seem able to engage with a broader perspective that encompasses challenges to health and well‐being associated with contextual organizational drivers, e.g. job design/role, workload, systems of reward, leadership style and the underpinning climate. Drawing upon insights from public health and the workplace safety tradition, the scope for broadening the perspective on intervention (in terms of vectors of harm addressed, theory of change and intervention logic) is discussed.FindingsThere are important differences in scope and options for intervention between public health and workplace health contexts. While there is scope to emulate public health practice, this should not constrain thinking over intervention opinions. Increased awareness of these key differences within work organizations, and an evidence‐based epidemiological approach to learning has the potential to strengthen and broaden the approach to workplace health and well‐being management.Originality/valueThe authors argue that approaches to workplace well‐being interventions that selectively cross‐fertilise and adapt elements of public health interventions offer promise for realising a broader change agenda and for building inherently healthy workplaces.

Background Paramedics make important and increasingly complex decisions at scene about patient care. Patient safety implications of influences on decision making in the pre-hospital setting were previously under-researched. Cutting edge perspectives advocate exploring the whole system rather than individual influences on patient safety. Ethnography (the study of people and cultures) has been acknowledged as a suitable method for identifying health care issues as they occur within the natural context. In this paper we compare multiple methods used in a multi-site, qualitative study that aimed to identify system influences on decision making. Methods The study was conducted in three NHS Ambulance Trusts in England and involved researchers from each Trust working alongside academic researchers. Exploratory interviews with key informants e.g. managers (n = 16) and document review provided contextual information. Between October 2012 and July 2013 researchers observed 34 paramedic shifts and ten paramedics provided additional accounts via audio-recorded ‘digital diaries’ (155 events). Three staff focus groups (total n = 21) and three service user focus groups (total n = 23) explored a range of experiences and perceptions. Data collection and analysis was carried out by academic and ambulance service researchers as well as service users. Workshops were held at each site to elicit feedback on the findings and facilitate prioritisation of issues identified. Results The use of a multi-method qualitative approach allowed cross-validation of important issues for ambulance service staff and service users. A key factor in successful implementation of the study was establishing good working relationships with academic and ambulance service teams. Enrolling at least one research lead at each site facilitated the recruitment process as well as study progress. Active involvement with the study allowed ambulance service researchers and service users to gain a better understanding of the research process. Feedback workshops allowed stakeholders to discuss and prioritise findings as well as identify new research areas. Conclusion Combining multiple qualitative methods with a collaborative research approach can facilitate exploration of system influences on patient safety in under-researched settings. The paper highlights empirical issues, strengths and limitations for this approach. Feedback workshops were effective for verifying findings and prioritising areas for future intervention and research.

This paper reports on two comparative ranking tasks performed by a sample of the British citizens (N = 304). The first was designed to compare levels of relative trust vested in a sample of UK risk regulatory bodies and associated stakeholder groups. The second sought to elicit a ranking of a range of previously identified facets of social trust referenced to their desirability as attributes of a government funded risk regulatory body. The ranking tasks were embedded within a broader programme of research focused on “Evaluating public understandings of and trust in the Health and Safety Executive” (Pidgeon et al., 2003). It is argued that deriving rankings of multi‐faceted phenomena using the method of paired comparisons offers a more robust approach to rating social trust entities than the direct ranking techniques used in previous studies in this area. Results are discussed with reference to qualitative findings from the broader programme of work on public trust in HSE (Pidgeon et al., 2003) and the wider literature on public trust in risk regulation.

Bedside safety rails are used extensively throughout hospitals and residential care environments as a safety device to protect people against the risk of falling out of bed. However, several adverse incidents involving body entrapment have been linked to their use, which have resulted in serious injury to the bed occupants and, in more extreme cases, fatalities. Internationally agreed standards (i.e. European Committee for Standardisation (CEN) standards) for the design and testing of bed rails have recently been developed and are targeted at improved safety requirements (European Committee for Standardisation 19972000). The purpose of the present study was to: 1) determine whether the CEN test procedure for assessing bed rail strength and rigidity requirements is consistent with human force exertions to which bed rails may be exposed; 2) carry out loading tests on bed rails currently in use throughout the UK to determine whether they comply with the current safety recommendations proposed by the CEN standards.A laboratory study was conducted to determine the force exertions of 20 participants performing seven tasks (including activities of both bed occupants and care providers), which were considered representative of the forces to which bed rails could be exposed during normal use. Forces exerted by participants were measured using a force platform and distortions of the bed rails leading to potential entrapment zones were measured using linear displacement transducers. Static load tests were then conducted, in which incremental point loading was applied at the most adverse points on each of nine different bed rails (commonly used in UK nursing and residential care homes) in accordance with the test procedure detailed in the current CEN standards. Maximum static forces exerted by participants were found to range between 250 N and 350 N, which were within the 500 N force tolerance requirements set by the standards. Dynamic tasks involving 'rolling aggressively' against the bed rail produced the highest peak force of 722 N. None of the bed rails included in this study met the requirements of the CEN test procedures, principally due to horizontal lateral displacements being in excess of 50 mm for a 500 N applied force and/or the bed rails' inability to withstand inward horizontal forces of 500 N. Bed rails used with divan beds were often unable to withstand forces greater than 300 N due to turning moments exceeding the bed rail's restraining mechanism. Current CEN standards for assessing the strength and rigidity of bedside safety rails appear to be consistent with the human forces that might arise as a consequence of the normal movement and activities of a bed occupant or care provider. Although compliance with existing standards is not compulsory, findings from the tests carried out on the selection of bed rails in current use throughout the UK highlight the need for improvements in the design and manufacture of bed rails.

The binary opposition of trusting or not trusting is inadequate to understand the often ambiguous and contradictory ideas people possess about risk regulators, particularly when knowledge and experience of such institutions is limited. The paper reports qualitative and quantitative data from a major study of public perceptions (n = 30 focus groups) of UK risk regulators. We compare the complex and widely different ‘trust profiles’ of two regulatory organisations which are institutionally related (the Health and Safety Executive and the Railways Inspectorate) but very separate in the minds of our participants. The paper develops the notion of critical trust to interrogate the various ways in which people make sense of such organisations, as well as discussing the modes of reasoning that people deploy. The paper argues that views of participants are the outcome of a reconciliation of diverse perceptions concerning the role of the organisation, structural factors and the nature of the regulated risk.

This paper details a survey of coal miners’ views on the bases for risk-taking. While literature exists on the subject of risk-taking in mines, comparatively few studies have sought to elicit the views of mine personnel themselves. An 83-item questionnaire, grounded upon insights from an earlier qualitative study, was developed and distributed to a sample of mine personnel (N=932). Results were analysed by means of principal components, factor analysis, an iterative refinement of the data set resulting in the development of a three-factor model that was considered to reflect potentially important dispositional influences on risk-taking amongst operational staff in mines. Derived constructs, identified as time pressure, management commitment and confidence in ability to control risk, were found to possess moderate to high levels of internal consistency (α statistic) and high face validity. Findings are discussed with reference to insights from both cognitive risk research and more recent work within the sa...

The authors replicated O. Ostberg's (1980) study of forestry workers using a range of personnel groups in coal mines. Findings demonstrate a high level of consensus between a range of personnel groups for a set of pictorially depicted behavioral risks, at the level of rank order, but significant differences in terms of relative magnitudes. Magnitudes of perceived risk were found to be greater for those closest to the point of hazard than for members of more geographically and experientially distal groups. Findings are interpreted with reference to experiential influences associated with organizational role. Revealed differences between personnel groups are explained in terms of cognitive availability, specifically effects associated with habituation and familiarity with risk, these sources of perceptual bias appearing to interact with organizational role.

Conducting a well-designed observational study within a dynamic and vibrant workplace presents unique challenges. In the case of musculoskeletal symptom reporting, difficulties of identifying appropriate interventions are amplified by the multifactorial nature of contributory risk factors. We report on our own observations of how seemingly well-matched work sites can suffer unintended and differing psychosocial consequences from implementing “ergonomics” interventions. Despite the apparent similarity in the four garment manufacturing companies included in this study, one stood out in terms of its musculoskeletal reporting rate; approximately seven times higher than any of the other sites. After conducting extensive assessments of work systems and work practices, it was evident that management and organizational culture was having a significant impact on the legitimacy and likelihood of symptoms reporting. Barriers to reporting were evident at the low incidence sites, but whether the high incidence site was a social amplification of symptom reporting or stemmed from a more receptive climate of reporting remains unclear.

Exposure to biological agents in the workplace can cause infection, allergy or toxicosis. Health effects caused by biological agents in the workplace are related both to incidental exposure and to deliberate work with microorganisms. A small but significant percentage of occupational allergy is associated with biological agents in organic dusts, and a new reporting scheme recorded more than 1000 new cases of occupational infection in its first year. Assessing risks from workplace biological agents in the UK forms part of the Control of Substances Hazardous to Health (COSHH) regulations. Legislation (Schedule 9) and guidance which deals with biological agents were added to implement EC Biological Agents Directives and to emphasise the position of biological agents in COSHH. We evaluated the impact of COSHH Schedule 9 by interviewing representatives of workers in laboratories deliberately handling microorganisms and discussing in a Focus Group format with representatives from industries where incidental exposure to microorganisms could occur. This paper describes the outcome of that evaluation and examines the tools available to assess risks from exposure to workplace microorganisms.

Objectives Paramedics routinely make critical decisions about the most appropriate care to deliver in a complex system characterized by significant variation in patient case-mix, care pathways and linked service providers. There has been little research carried out in the ambulance service to identify areas of risk associated with decisions about patient care. The aim of this study was to explore systemic influences on decision making by paramedics relating to care transitions to identify potential risk factors. Methods An exploratory multi-method qualitative study was conducted in three English National Health Service (NHS) Ambulance Service Trusts, focusing on decision making by paramedic and specialist paramedic staff. Researchers observed 57 staff across 34 shifts. Ten staff completed digital diaries and three focus groups were conducted with 21 staff. Results Nine types of decision were identified, ranging from emergency department conveyance and specialist emergency pathways to non-conveyance. Seven overarching systemic influences and risk factors potentially influencing decision making were identified: demand; performance priorities; access to care options; risk tolerance; training and development; communication and feedback and resources. Conclusions Use of multiple methods provided a consistent picture of key systemic influences and potential risk factors. The study highlighted the increased complexity of paramedic decisions and multi-level system influences that may exacerbate risk. The findings have implications at the level of individual NHS Ambulance Service Trusts (e.g. ensuring an appropriately skilled workforce to manage diverse patient needs and reduce emergency department conveyance) and at the wider prehospital emergency care system level (e.g. ensuring access to appropriate patient care options as alternatives to the emergency department).

Background As part of a study examining systemic influences on conveyance decisions by paramedics and potential threats to patient safety, stakeholder workshops were conducted with three Ambulance Service Trusts in England. The study identified seven overarching systemic influences: demand; priorities; access to care; risk tolerance; training, communication and resources. The aim of the workshops was to elicit feedback on the findings and identify perceived areas for future intervention and research. Attendees were also asked to rank the seven threats to patient safety in terms of their perceived importance for future attention. Methods A total of 45 individuals attended across all the workshops, 28 ambulance service staff and 17 service user representatives. Discussions were audio-recorded, transcribed and thematically analysed. A paper based paired comparison approach was used to produce an ordinal ranking to illustrate the relative prioritisation of issues. Analysis included testing for internal consistency and between-rater agreement for this relatively small sample. Findings The two highest ranking priorities were training and development, as well as access to care. The areas for intervention identified represent what attendees perceived as feasible to undertake and relate to: care options; cross boundary working; managing demand; staff development; information and feedback; and commissioning decisions. Perceived areas for research specifically address conveyance decisions and potential threats to patient safety. 17 areas for research were proposed that directly relate to six of the systemic threats to patient safety. Conclusions Feedback workshops were effective in the validation of findings as well as providing an opportunity to identify priorities for future interventions and research. They also facilitated discussion between a variety of Ambulance Service staff and service user representatives. Ongoing collaboration between members of the research team has enabled some of the research recommendations to be explored as part of a mutually agreed research agenda.

Describes the development and effects of behaviourally‐based management techniques in improving construction site safety. In phase one, goal‐setting and feedback methods were developed and tested on six sites in the North West of England. A 40‐week longitudinal research design was adopted in which measures of safety performance were taken before, during and after the application of these methods. The measures included four categories of measurement: access to heights; site housekeeping (site tidiness); scaffolding; and use of personal protective equipment (PPE) – with PPE used as a control. The results showed that: safety behaviour can be objectively and reliably measured; goal setting and feedback can produce large improvements in safety performance; the commitment of site management appears to enhance their effectiveness. Eleven major contractors have provided us with 22 sites which are participating, or have participated, in a larger follow‐up study that aims to assess whether contractors are able to implement these techniques themselves. Early results are highly encouraging, though analysis indicates that the mechanism by which the intervention influences behaviour is less direct than classical goal‐setting theory would suggest.

Well-being & Work–Challenges to Intervention in the Workplace Research on well-being at work is flourishing, reflecting the perspective that a strategic and proactive investment in developing healthy organisations can bring benefits to employers, employees and the wider society. Claims regarding the importance and benefits of enhanced employee well-being have strong intuitive appeal. However, there is currently a lack of clarity, or consensus, over even basic elements, to the extent that an agreed framework for measurement remains elusive.

Decisions made by ambulance staff are often time-critical and based on limited information. Wrong decisions could have serious consequences for patients but little is known about areas of risk associated with decisions about patient care. We aimed to examine system influences on decision making in the ambulance service setting focusing on paramedic roles.

Organizational safety culture reflects the attitudes and behaviors that individuals share in considering and reacting to hazards and risks. We first argue that trust is an underdeveloped and important concept in relation to theories of safety culture and high-reliability organizations. The article then reports findings from a two-year qualitative study of train operating companies (TOCs) in the United Kingdom, which sought to explore in detail the linkages between safety culture and the postprivatized railway industry. In-depth interviews and focus groups were carried out with a sample of over 500 employees, from four organizations, and representing all key functional levels. Our analysis suggests that the 1993 privatization, and subsequent organizational restructuring of the U.K. railway industry, has had important repercussions for both safety culture and trust relationships. We explore our findings in relation to three key constructs within “safe organizations” theories (namely, flexibility, commitment, and learning), and discuss how the safe organization model might be usefully supplemented by a consideration of trust issues.

Arguably the key finding on pension investment and retirement decision making is that most UK citizens are not active planners. Rather, they are more disposed to react to options they are presented with. Although there is almost universal acceptance of the need to make financial provision for retirement, there is significant inertia and reticence over active engagement. Most people have limited knowledge or understanding of options or their implications and those are motivated to engage tend to become bewildered by the complexity and unknowable elements. People are also being asked to make their choices against a background of unprecedented (in the post WW2 period) flux and fluidity in employer and State pension arrangements. Recent rises in State pension age, the prospect of further rises, combined with high profile media reporting of pension failures, tends to interpreted as a system in crisis. Potentially corrosively, there is a risk that the associated uncertainty may feed latent procrastination and inertia, to further inhibit already weak motivations to engage in saving for tomorrow (Pettigrew, et al, 2007; Wicks and Horack, 2009); rather than strengthen motivation to plan. The UK Government’s auto-enrolment pension scheme goes some way towards addressing this, but there are questions over whether its voluntary nature and realised pension value will prove to be sufficient to be meaningful and the impact of planned rises in employee contributions on opt-out rates.