The dozen dos of staff engagement: guidance on good practice

Introduction

About this guidance

The national framework for improving staff experience is set out in the NHS People Promise and this includes commitments to ensuring that staff have a voice that counts and to foster staff engagement. Improved staff engagement assists organisations to retain staff, improve productivity and deliver better care. 

This guidance has been created to highlight the dozen dos - effective actions you can take at local level to improve staff engagement in your organisation. 

These actions highlighted in this document are recommended based on:

• evidence from an analysis of NHS Staff Survey data on the links between staff experience and improved staff engagement
• learning shared by NHS organisations that improved their staff engagement scores in 2023
• approaches identified in the NHS trusts scoring most highly on staff engagement in the NHS Staff Survey.

These actions will have most impact if pursued as part of an overall staff experience approach. Most organisations will already be addressing these issues, therefore these recommendations will build on your existing experience. Review your NHS Staff Survey and other locally collected data to identify the areas to focus most on. 

Evaluation and an evidence-based approach

Evaluation should be built into your approach; impact is likely to be cumulative, with significant shifts taking up to two years to show up in the overall NHS Staff Survey results.

An analysis of the links between the full range of staff experience NHS Staff Survey scores and the overall staff engagement score has demonstrated strong correlation on key elements. This analysis has looked at which themes in the NHS Staff Survey are most strongly associated with an improvement in the staff engagement score.

In addition, learning has been identified from approaches in both the highest scoring and the most improved NHS trusts. It is based on this analysis that the twelve suggestions are made for areas of action. 

The dozen dos

What are the dozen dos?

Based on this analysis the top twelve dos for staff engagement are:

1. Give people a voice, one that is heard and that counts. Giving staff a voice and showing that it counts has the most impact on staff engagement levels.
2. Build a compassionate culture. Compassion may be the most important overall factor in health and social care.
3. Support line managers to lead their teams in a supportive and compassionate way and strengthen team working. Line manager behaviour is the single greatest driver of engagement.
4. Increase involvement: when people feel listened to and involved in decision making. Involvement should happen at all levels within the organisation.
5. Give people autonomy, agency and control over their working lives. When people experience freedom and autonomy, their level of engagement improves.
6. Provide staff with support to develop in their job role and progress in their career. Where staff feel supported to develop their skills or career they tend to feel more engaged.
7. Ensure senior leaders are visible, approachable and communicate well. Two-way communication leads to greater engagement.
8. Build psychologically safety. The degree to which people feel psychologically safe to speak up and raise concerns has a key impact. 
9. Value, recognise and celebrate staff regularly. Where staff feel appreciated and valued staff engagement is fostered.
10. Reduce people’s work pressures and ensure staffing levels are safe. Looking at and addressing pressures in the workplace is a key factor for staff experience and can enhance staff engagement.
11. Provide improved health and wellbeing support. Health and wellbeing and staff engagement are closely connected; and higher levels of staff engagement can have a positive impact on staff absence.
12. Work in partnership with staff side. Staff representatives and bodies can be a key factor in engaging fully with your employees. 

Give people a voice

Some organisations have successfully placed focus on demonstrating that feedback from staff is listened to and acted on. 

A range of different techniques are used including you said, we did communications about the NHS Staff Survey results. Other trusts seek to ensure action on survey results is led by and communicated through local managers, rather than it being seen as a HR issue. These organisations ensure that it takes place on an ongoing basis rather than in response to the publication of the NHS Staff Survey results. 

It is important that communication is clear about what it has not been possible to act on as well as those where it has. 

In addition to the national survey, trusts should have mechanisms through which staff can share feedback and voice their views throughout the year. Mechanisms for doing this include:

• the quarterly National Pulse Survey
• the widely-used NHS England People Pulse survey
• other locally-developed surveys
• large scale in-person feedback events such as big conversations and town hall discussions, which some trusts organise on regular basis with senior leaders. 

A small number of NHS trusts have also used continuous online feedback tools to gather views from staff. Data from staff comments known as free text data can be a useful source of staff insight and it is now possible to analyse this more effectively than in the past. More information on these approaches is available from NHS Employers.

Build a compassionate culture

A number of organisations have focussed on improving organisational culture as a key building block for successful staff engagement. 

Organisational culture change has been a key focus for trusts including Liverpool University Hospitals and Shrewsbury and Telford Hospitals. In other organisations, culture issues have included equality, bullying and harassment and freedom to speak up. 

Many trusts have used the model of volunteer groups of staff acting as advocates for change.

Support line managers to lead and engage

Improved support and training for line managers has been developed by a number of organisations with an emphasis on developing engaging leadership styles. 

Line managers play a key role in ensuring that voices are not only heard, but responded to. By developing line managers as compassionate leaders, trusts can help to improve lines of communication with staff and increase levels of overall engagement.

A range of tools have been developed by trusts to support managers foster engagement such as the Team Engagement and Development Tool at Lancashire Teaching Hospitals Trust.

Increased involvement

Increasing staff involvement is a key element of successful engagement. A number of organisations have worked to ensure that staff feel included in decision-making and that they have a sense of ownership, all of which can help to build trust and lead to improved results in the NHS Staff Survey. 

The more positive staff experience that comes from involvement can also lead to better outcomes in quality improvement. The NHS Impact Futures Platform has a number examples of improved involvement in quality improvement.

Staff representatives can also be involved in an overall organisational culture change programme. The Liverpool Women's Hospital involved staff representatives in a working group to help develop ideas for its overall change programme. 

Give people autonomy, agency and control over their working lives

Where staff have the maximum degree of autonomy in their job roles and work in teams where responsibility is shared between colleagues, staff engagement levels will tend to be higher. This can be influenced by job design and organisational context. 

A range of approaches such as Job design/crafting, operational devolution and, in some contexts, self-managed teams have the potential to support this. 

Provide staff with support to develop

Giving staff support for learning and development to enable them to enhance their skills also has an indirect impact on engagement. Traditional models such as continuing professional development have been limited to clinical staff. Support for skills development should be open to all staff.

By demonstrating commitment to staff in their professional development and growth, organisations can engender a deeper feeling of trust and connection leading to more positive responses in the NHS Staff Survey. 

Ensure senior leaders are visible

Visible senior leadership is another key element of sustained engagement and there are a good number of examples that can be drawn upon from across the NHS. 

Methods for demonstrating this range from ward based presence through walkabouts to regular open question and answer sessions.

During the COVID-19 pandemic, many organisations introduced regular virtual catch ups with senior leaders to discuss any issues and concerns. Today, online meetings with a large number of staff can still be an effective way to increase feedback and show visibility. 

In smaller or single site organisations, focusing on individual teams or departments, it is worth exploring face-to-face conversations or briefings. This can be done in larger trusts, but the logistics can prove to be a challenge. Some trusts have favoured a café-style approach to gain useful feedback from groups of staff.

Build psychological safety

Support for staff to speak up and ensure they feel safe to do so has been strengthened in many organisations helping to build a culture of openness and honesty.

By ensuring that staff understand how they can raise concerns within your organisation can help to ensure that they feel confident and safe to do so. In turn, this sense of trust can lead to more positive outcomes around staff engagement and the NHS Staff Survey.

Value, recognise and celebrate staff regularly

Ensuring staff feel recognised and valued has a positive impact on engagement and has been taken forward in many trusts as a priority.

Staff recognition can take place at any level, from weekly ward-based team time to appreciate colleagues, right up to organisation-wide annual celebrations. 

By celebrating contribution and success, NHS organisations can reinforce a sense of belonging and help to improve engagement. 

Reduce people’s work pressures and ensure staffing levels are safe

Addressing workload and other pressures can be obstacles to sustaining staff engagement.

Not only can you improve levels of engagement, you can also improve patient safety and staff wellbeing by ensuring that your workforce is not overloaded or feeling under pressure to deliver above its capacity. This can also reduce burnout. 

United Hospitals Leicester was able to address workload through improved staffing levels as a key part of its overall approach to staff experience and staff engagement. 

Provide improved health and wellbeing support

Analysis of the NHS Staff Survey and People Pulse data suggests a strong link between health and wellbeing support for staff and levels of staff engagement.

Most organisations that have improved staff engagement have also improved support for health and wellbeing support. 

Addressing inequalities in staff experience on issues such as bullying and harassment and violence has also been part of successful approaches.

Work in Partnership with staff side

Staff engagement in the NHS should be based on the principle of partnership working with employers developing approaches in consultation with staff side organisations. 

By building strong relationships with bodies such as trade unions and staff networks, organisations can identify where issues and concerns are before they develop into wider problems.

Evidence, evaluation and steps to success

Evidence based approach

NHS Employers has drawn on a statistical analysis of NHS Staff Survey data undertaken by Rob Fordham of East Kent Hospitals Trust to develop these recommendations. This looked at the strength of links between staff experience questions in the NHS Staff Survey and staff engagement improvements. Existing available research evidence has also been drawn on. 

In addition,  NHS Employers reviewed the experience at the most improved and the most successful trusts on staff engagement measures. By taking a comprehensive approach which focusses on the areas of staff experience with most impact organisations should be able to develop effective interventions. More information on the evidence base is available on request.  

Local evaluation

Organisations should regularly evaluate and review their approaches using locally collected data on staff views as well the results of the NHS Staff Survey. 

It should be taken into account that interventions may take time to have an impact. Some individual questions such as those on involvement or line manager support can be expected to respond to interventions in shorter time period. Whereas, overall theme scores are likely to take year to 18 months. In addition, in the medium-term it should be possible see an impact on measures such as absence levels and outcomes such as retention. 

Steps to success

The experience of those trusts that have managed to improve staff engagement over the past year suggests the following elements are key:

• Consistent and visible support for a focus on staff experience from the board and the senior leadership of the organisation. Improved staff experience needs to be seen and supported as fostering overall improved patient experience and organisational effectiveness. Staff experience needs to be a focus for managerial action across the organisation not just an issue for people teams. Staff experience data should be analysed and integrated with other performance data.
• Persistent commitment to improved staff experience. Shifts in organisational culture take time and major improvements in the overall score are unlikely in one year. Organisations need to allow time for changed behaviour to have an impact and not abandon initiatives before they have had time to have an impact.
• Statistics in themselves do not shift sentiment. A convincing narrative or story needs to be communicated about why change is needed and how it can be achieved.
• Partnership working is needed with staff side organisations both on overall aims and how they are implemented.
• Visible leadership from senior managers is necessary but will only be effective if staff are fully involved in change and also become advocates for it.

For more information on approaches to staff engagement across the NHS please contact NHS Employers via staffengagement@nhsemployers.org