The latest NHS Staff Survey results present a challenging picture of the NHS and the wellbeing of its staff. Commentary on the results has, rightly, focussed on signs of staff burnout, growing concern over patient care and safety standards, dissatisfaction with pay and the toll on staff wellbeing. But less attention has been paid to stubbornly low staff engagement scores.
The survey measures engagement through three categories: motivation, involvement and advocacy. Overall, engagement scores are lower now than they were between 2018 and 2020.
These trends led us to partner last year with Thiscovery, an online platform for collaboration, innovation and improvement. Over the last six months we’ve used this exciting new technology to work with over 200 people in quality improvement to codesign a new definition of good staff engagement, one that reflects the challenging context we face now. We believe this will give a more sophisticated view of the most important ingredients of successful engagement, how they interconnect and the role that improvement approaches can play.
The research ends in April, and we’ll share our findings in the coming months. For now, we believe there are five key learnings about what may be needed to improve engagement, drawing on the latest staff survey results and our own emerging insight.
Successful change begins with honesty and transparency
People who took part in our codesign project emphasised the importance of honesty and transparency within change processes, from the outset. The message was clear: staff need to feel there is no hidden agenda and that leaders are open about the potential limitations, disbenefits and challenges of change.
The NHS Staff Survey only measures trust in the sense of being trusted to do your job. But we found that staff believe there should be a measure for capturing trust in leaders too. We think this could provide a useful way to identify more underlying issues around engagement.
Emotions triggered by change need to be recognised
Psychological safety was consistently identified by our participants as important to being able to bring their whole self to work, and to taking interpersonal risks. Many Q members are working in this area, building on Amy Edmondson’s foundational work, and exploring how evidence-based psychology can guide organisational improvement approaches.
Research participants told us lots about the need for a ‘philosophy’ or ‘feel’ of engagement that empowers staff.
We believe this requires an appreciative and compassionate approach, particularly from leaders, where emotions provoked by change are truly recognised.
And yet, the NHS Staff Survey measures for compassionate culture, and confidence around the standard of care have fallen. A clear sign is the drop in staff who agree that if a friend or relative needed treatment, they would be happy with the standard of care provided by their organisation (this has fallen by five percent since 2021). This is especially problematic given strong evidence that links staff engagement to quality of care.
Co-ownership is the gold standard
Staff often don’t feel able to do simple things that can make a big difference in pressured and change contexts. Indeed, the latest staff survey results show only 54% of staff agreed they can ‘make improvements happen in my area of work’.
Our research participants told us that co-production and even co-ownership is needed to fully engage and represent staff in change processes. This is important in its own right and existing evidence also shows that organisations that really hear and act on staff (and patient) perspectives are more likely to improve quality and safety.
Diverse perspectives enable better change
We already know that feeling included can boost staff satisfaction.
Research participants told us that change is successful when there is a philosophy that ‘no one individual has all the answers’ and when diverse skills and perspectives are brought together for collaborative change.
The NHS Staff Survey tracks whether staff feel their work is valued. But it lacks a clear measure on whether different staff perspectives are valued and actively embraced to find the best solutions.
Our research project has also helped us to explore how we can measure and understand different staff experiences of engagement at work based on their personal background. We don’t believe this has received sufficient attention yet. But it’s particularly important given worrying increased levels, in the staff survey, of discrimination experienced by staff from minority ethnic backgrounds. Q hopes that any guidance we share can make a positive contribution to this space.
An improvement approach should guide change
Finally, our research has highlighted the importance of improvement capabilities throughout the change process. We already know that insufficient focus on the complexities and hard work of spread and adoption can squeeze innovation out of the NHS. Research participants suggested improvement tools in problem definition are needed, and that learning from the change process itself should be applied.
Participants also stressed the need for protected time for staff to engage in different ways. Creating space for staff involvement in the testing and iterating of changes before wider implementation was seen as crucial to success.
What next?
Our codesigned work with the improvement community, which we’ll share in the coming months, is designed to build on what’s already good in the NHS Staff Survey. The survey offers a rich overall picture of staff wellbeing and perceptions. But it’s only done annually and, as we’ve discussed, it doesn’t fully cover some key areas so may not support the ambitions of organisations that need regular, detailed and actionable insights to drive change.
Later this month, Q will use the Thiscovery platform to test a set of individual measures to understand staff experience in relation to engagement and a self-assessment ‘checklist’ tool that organisations and leaders can use to guide them when navigating change processes.
We’d love to know whether our emerging themes reflect your experience of what’s needed for a better approach to staff engagement in health and care. And it’s not too late to take part in the research. You can join the hundreds who’ve already come together to improve staff engagement in change, at a time when it’s perhaps needed most.
Have your say in our final research task, which closes on 19 April 2023: simply log in or register on Thiscovery.