Taking a new direction on staff experience

What the trust faced

NBT is an acute hospital trust with a full range of general and specialist services.  It is one of the largest hospital trusts in the UK with an annual turnover of £100 million. It employs over 13,000 staff, delivering healthcare in Bristol, North Somerset, and South Gloucestershire - a core population of 750,000 people. The trust is spread over several sites which creates challenges for communication.

The trust had average NHS Staff Survey scores historically, but these saw a decline post pandemic, which was in-line with national trends. The response rate was just above average. The trust wanted to change direction and make progress on staff experience to support the NBT patient first strategy improving quality of care for patients through effective staff engagement. It wanted to create a virtuous circle of improvement rather than managing a slow decline. 

What the trust did

North Bristol Trust aimed to improve its staff survey response rate to be more representative of its workforce, and to demonstrate to staff how it used the staff survey results to identify and act on key issues.  

To help improve its NHS Staff Survey response rate the trust:

• improved communication of the survey including enhanced communication on social media channels
• reviewed Staff Survey communication leading to the theming of the communication style and using local staff from all divisions to promote the survey
• undertook direct face-to-face outreach across a range of sites
• introduced target-driven incentives for teams taking part. 

The trust had a focus on understanding data by division showing staff in each area how the results had been used to address division-specific issues.  

This included the development of divisional infographics with divisional headlines and areas of focus to make NHS Staff Survey results more relatable. It embedded divisional areas of focus into performance reviews to improve visibility and accountability in the improvement areas.

The organisation implemented a series of initiatives to enhance staff experience with a particular focus on the overall wellbeing and support of its staff. These initiatives included: improving the appraisal process to assess performance and provide feedback, offering a financial wellbeing programme to reduce the cost of employment and help employees manage their finances effectively, and providing menopause support to address the specific needs of those experiencing menopause. 

Other measures included the introduction of anti-racism training for all staff to promote a more inclusive and equitable workplace. It also established a staff health and wellbeing strategy group to address various aspects of employee health and wellness more sustainably.

Following these actions, the trust sought staff feedback by a range of channels in addition to the NHS Staff Survey including local pulse surveys, wellbeing champions network, organisational development culture conversations and via Staff Networks. NBT sees the NHS Staff Survey as one part of an ongoing cycle of listening to and acting on feedback from staff. 

Results and benefits

The trust improved its response rate from just above average to one of the highest in its group. It also secured an above average response rate for its bank staff survey.  

Improvements were seen on all key People Promise themes. It was one of the ten most improved organisations for the staff engagement score with over 70 per cent of staff agreeing they would recommend the trust as a place to work and one of the most improved on health and wellbeing. NBT also improved its scores on flexible working and scored especially well on compassionate and inclusive culture.

There is still scope for further improvement as the trust is scoring above average in all areas however is not yet achieving best in benchmark group results in any of the People Promise areas. The trust has identified inequality in staff experience as a key issue and has introduced three key equality, diversity, and inclusion objectives:

• anti-racism training to be delivered for all staff
• 12 per cent representation of ethnic minority staff in roles at band 8a and above
• improved quality of appraisals for all ethnic minority staff. 

There has also been a focus on the quality of appraisals and retention. Both areas have seen significant improvement through the delivery of a new electronic appraisal system which has resulted in a 92 per cent completion rate in 2024.  Through a variety of measures turnover also been successfully reduced to under 12 per cent in October 2024.

The trust has improved its vacancy, and absence rates, which has helped to reduce workload pressure. This has resulted in an improvement in these scores, however there are still more improvements to be made in relation to creating a culture of staff wellbeing, reducing burnout, and increasing opportunities for flexible working. 

Overcoming obstacles

The trust identified some key obstacles in delivering the staff survey. Making staff survey results more relatable to managers teams and staff is a key issue. Although more work has been done to work closely with divisional management teams. There is still improvement work to do including the delivery of a staff survey dashboard which will enable greater accessibility and understanding of staff survey results for teams, managers, and individuals. 

NBT has recently implemented the NHS England wellbeing diagnostics self-evaluation tool. The tool assesses organisations against each section of the NHS health and wellbeing framework (for example, personal health and wellbeing, relationships, fulfilment at work, environment, managers and leaders, data insights and professional wellbeing support), and evaluates the trust’s progress across these elements. In five out of seven elements, the trust scores had shown significant progress with only two areas narrowly missing this level, and the trust is now making improvements to address these areas. 

Next steps

The key focus for the trust over coming months will be to sustain its 2023 NHS Staff Survey improvements, close the gaps in staff experience and to build on its current positive trajectory.  The trust is working towards forming a hospital group with University Hospitals Bristol and Weston NHS Foundation Trust. This will lead to more collaborative work and the opportunity for this work to have greater reach and impact.

Top tips

• Backing from senior and clinical leadership essential to ensure that messaging is clear across the organisation.
• Make NHS Staff Survey results relatable for managers and staff with local-level analysis and clear communication.
• Focussed promotion and contact in areas that are struggling can help boost participation and is a worthwhile investment.
• Identifying and focusing on key areas of staff experience and ensuring equality are central to your approach.
• Keep going: changing culture takes time and all organisations will always still have more to do.

Contact

If you would like to find out more please contact Anisa Patel, head of staff experience at North Bristol NHS Trust, via: anisa.patel@nbt.nhs.uk.