Understanding, measuring and improving the engagement of staff in major change

The health and care system is facing multiple severe challenges, from record waits to chronic staff shortages, growing inequalities to low patient satisfaction. Addressing these challenges will require ​‘major change’: system and service changes that are broad in scope and scale, with collaborative improvement across teams, systems and silos.

In this insight project, we set out to create a new definition of good engagement in major change and to unpack in more detail the principles that sit behind it. We also wanted to provide a framework to help practitioners assess whether staff engagement was being done well in their setting, and practical tools to measure this. 

We worked with Thiscovery to involve more than 300 people working across the health and care sector. 

Participants shared their personal experiences of engagement, good and bad, and ranked their most important features of engagement. This informed development of a prototype measurement tool, that participants also fed back on, before being finalised and tested.

Informed by our participants’ insight, we have produced a how-to guide that describes what good staff engagement looks like and provides flexible tools that you can use to plan and measure engagement. 

The how-to guide includes a set of 10 principles for engaging staff well in major change, rooted in what participants shared with us. These are divided into three themes.

1. Clear rationale: the purpose of the change and its connection to staff and patient experience are clear.

2. Shared ownership: staff can shape and influence the change, including defining the problem.

3. Capacity and capabilities: staff have protected time and are given the skills and knowledge they need to engage in change.

4. Psychological safety: engagement enables staff to share opinions and voice concerns without fear of judgement or consequences.

5. Honesty and transparency: challenges, limitations and risks are acknowledged and there is no hidden agenda.

6. Appreciative and compassionate: engagement builds on staff achievements and recognises emotions.

7. Inclusive and non-hierarchical: there is a core belief that everyone has a valid point of view, and something to contribute, and that no one person has all the answers.

8. Structured: there is a plan for how and when to involve staff, which is followed and made widely available. 

9. Clear and consistent communications: engagement includes regular two-way sharing, including different formats and channels.

10. Continuous learning: staff are involved in open, ongoing reflection, testing and assessment of the change, including its outcomes and any unintended consequences.

The insight report provides greater detail on the project methodology and findings.