Measurement matters: developing core outcome sets for measuring doctor and nurse wellbeing

Klepacz, Naomi and Simons, Gemma (2024) Measurement matters: developing core outcome sets for measuring doctor and nurse wellbeing. HSRUK 2024, , Oxford, United Kingdom. 08 - 10 Jul 2024.

Record type: Conference or Workshop Item (Other)

Abstract

Background/context: poor wellbeing of healthcare staff negatively impacts patient care quality and satisfaction, leading to poor job satisfaction, increased sickness absence and workforce retention issues. There are calls for evidence-based strategies to address healthcare staff wellbeing, but in research and policy, there is currently no consensus on what healthcare staff wellbeing is or how it should be measured. The term ‘wellbeing’ is often used interchangeably with, or to describe, mental health, and consequently, wellbeing has become a measure of the absence of mental health disorders. A salutogenic approach that measures positive determinants, context, mechanisms, and individual and group wellbeing is more appropriate when considering doctor and nurse wellbeing measures [1]. Reaching agreement among NHS staff, policymakers, academics, and those involved in delivering wellbeing services is imperative to inform the future direction of healthcare staff wellbeing policies and interventions. This can be achieved by developing Core Outcome Sets (COS) – a consensus minimum group of outcomes with recommended measurement instruments.

Method: a systematic review of wellbeing outcomes and measurement instruments, a survey of 250 UK doctors, and two doctor engagement workshops informed the creation of a list of 43 wellbeing outcomes categorised into five domains. Two online Delphi studies were used to reach a consensus on core outcome sets for measuring doctor (COS-DR) and nurse (COS-RN) wellbeing. Participants were recruited from four stakeholder groups: i) those who will use the COS in research, ii) representatives of organisations that measure/capture NHS staff wellbeing, iii) professionals with experience managing NHS staff wellbeing, and iv) doctors and nurses working in the NHS. Outcomes were rated on a 9-point Likert scale; consensus was reached when <75% agreed that an outcome was critical for inclusion in the COS.

Results: fifty-nine participants completed two rounds of the COS-DR Delphi, and 45 completed two rounds of the COS-RN Delphi. Seven outcomes met the threshold for inclusion in COS-DR: General wellbeing, Health, Personal safety, Job satisfaction, Morale, Life work balance, Good clinical practice. These same 7 outcomes were also deemed critical for inclusion in the COS-RN, with an additional 6 outcomes (Sleep, Positive relationships, Psychological needs satisfaction, Psychological safety, Compassion satisfaction, Satisfaction with patient care) meeting the threshold for inclusion to create a COS-RN with 13 wellbeing outcomes. Feedback from stakeholders and mapping of outcomes to existing measurement exercises (i.e. NHS staff survey, BMA survey) suggests relevance and acceptability for implementing these COS.

Limitations: further research is required to identify and recommend reliable and valid measurement instruments for use with these COS.

Implications: the use of the COS-DR and COS-RN in research, governance, and service and workforce planning might ensure wellbeing outcomes relevant to NHS staff and key stakeholders are captured and measured. Further, a salutogenic and consensus-based approach ensures that wellbeing is measured/captured, and not mental health pathologies. The common wellbeing outcomes in both the Doctors’ and Nurses’ COS suggest the potential for a harmonised COS for all healthcare staff – this warrants further investigation. Using these COS (for example, in staff surveys) will ensure a consistent and comprehensive focus, generate ‘big data’, make comparisons at organisational, local and national levels easier, and provide decision-makers with the evidence they need to inform future NHS staff wellbeing strategies, interventions and actions. In research, these COS provide a framework for between-study comparison, preventing duplication, and a means by which to identify wellbeing priorities to inform future funding.

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