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Annex B: NHS Uniforms Research

Alex Hilliam and Sue Granville, George Street Research

Research Aims

1.1 The aim of this research is to determine how changes to the NHS national uniform may affect patients and to inform the development of the national uniform specification.

1.2 The specific research objectives are to:

• Assess what issues are important to patients in terms of staff's appearance ( e.g. uniform type / colour, general appearance);
• Assess the importance of uniform to patients in terms of identifying staff (for example, how do patients feel about doctors and nurses wearing the same uniform?);
• Consider these in relation to vulnerable patient groups, such as adults with learning disabilities, children, the elderly.

2. Methodology

Overview of Research

2.1 The research was undertaken using qualitative methods. Six focus groups were undertaken with patients to explore their impressions of contact with NHS staff and of patient uniforms. To explore if any vulnerable patient groups had any particular concerns or needs in relation to the appearance of staff and uniforms, a number of telephone depth interviews were conducted with representatives of particular patient representative groups.

Approach to Selecting Respondents

2.2 To ensure that the views of a wide range of patient types and users of NHS services were consulted as part of the research, a cross section of respondents were recruited. Attendance at focus groups was based on consideration of the following respondent characteristics:

• Age, Gender and Socio-Economic Group of respondents
• Different geographic locations
• Nature of care settings recently used, i.e.:
• Primary care ( e.g.GP surgeries; physiotherapy and other services)
• Secondary health care settings ( e.g. Hospital in-patients and out-patients)

2.3 After consultation with the Scottish Government, the following groups were selected to be recruited:

• 1 group with older persons (65+yrs) who had attended primary or secondary care setting in last 12 months
• 1 group with older persons (50+yrs) who had attended primary or secondary care setting in last 12 months
• 1 group with 25-50 year old adults who had attended primary or secondary care setting in last 12 months
• 1 group with 25-50 parents whose children had attended primary or secondary care setting in last 12 months
• 1 group with 16-25 year old persons who had attended primary care setting in last 12 months
• 1 group with 16-25 year old persons who had attended secondary care setting in last 12 months

2.4 Respondents were selected with similar experiences of NHS services and from similar age groups for each group to facilitate discussion amongst respondents and to realise effective qualitative data. Respondents were recruited from a range of different socio-economic groups.

2.5 The groups were held over 11th - 13th March 2008 and each group lasted approximately one hour and included around 8 people. Groups were held in Glasgow, Edinburgh and Falkirk. These locations were chosen to ensure that patients with experience of different health board services (and as a result different types of current uniform) were recruited for the study.

2.6 A topic guide for the focus groups was developed and agreed with the Scottish Government. This is attached as an appendix.

2.7 To access the views of vulnerable patient groups, the Scottish Government provided a list of key contacts to be contacted for depth interviews. These comprised representatives of 6 key organisations ¹. Not all of these organisations were able or wiling to provide a representative to participate in the research, but interviews were held with three organisations and email contact was also made with one other organisation.

2.8 Groups and interviews were audio-recorded and transcribed to facilitate analysis.

3. summary and key findings

The main findings from this research are as follows:

Current Expectations, Appearance and Interactions with NHS Staff

• Good quality communication between staff and patients, and ensuring that patients are spoken to clearly and made aware of staff roles and actions, are of key importance to patients. This is of particular concern for vulnerable patient groups, where understanding and training in relation to particular patient needs ( e.g. learning disabilities, poor sight, poor hearing etc.) by staff is essential to ensure good communication.
• Cleanliness and general good appearance are more important to patients than having co-ordinated uniforms.
• Patients do not expect to see doctors in hospitals or GPs wearing uniforms, although some respondents still expect to see hospital doctors in white coats. However, respondents expressed concerns that despite the fact that doctors do not wear uniforms, that they should still ensure that they are clean and presentable.
• Typically it is expected that nurses wear blue or white uniforms and the non-clinical and auxiliary staff wear green or brown uniforms.
• Many respondents acknowledged that the current high numbers of uniform styles, and differences between styles at different sites has led to confusion or uncertainty by patients over the nature of staff roles.

Comments on Proposed New Uniforms

• In general, respondents indicated that the new uniforms were acceptable and appeared to be comfortable.
• Respondents indicated that it was important that staff were consulted over the suitability of the proposed uniforms and that their perceptions of comfort were at least as important as patients' opinions.
• The proposed reduction in the number of uniforms used was, in general, well received by respondents, in particular if this would generate cost savings for the NHS. The colours proposed were deemed broadly appropriate to the staff types and the prospect of consistency across Scotland expressed as good by many respondents.
• There were concerns by some respondents that simplification may have gone too far and that there may need to be clearer differentiation between certain types or grades of staff to enable identification by patients. In particular, many respondents expressed a desire to differentiate between senior and other nurses (either through different colours or the use of stripes) and expected auxiliary nurses to be in the green uniform rather than blue. Some respondents also suggested that other uniformed clinical staff should be differentiated ( e.g. by another colour), although this was less strongly commented upon. However, this view was not held universally and others felt that a single uniform with clear badges identifying staff was acceptable.
• It is important that the badges to be used on uniforms should clearly state the name and position of the member of staff. These should be presented in large clear text. The inclusion of the NHS Scotland or Health Board logo was desired by respondents.

It is important to note that, although some respondents called for more uniform colours to differentiate staff ( e.g. a dark blue uniform or stripes for senior nursing staff), respondents acknowledged that a large increase in the number of different colours beyond the proposed two may result in similar levels of confusion for patients as present.

It is also interesting to note that respondents typically expected auxiliary nurses to wear the green uniform, and not the blue uniform worn by nursing staff. This differs from the current proposals that would have auxiliary nurses wearing blue.

It is also important to note that although a standardised uniform was felt by respondents to be a good thing, this was a less important issue when compared to cleanliness, professionalism and, in particular, clear communication between staff and patients.

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