Staff engagement: an essential ingredient for good management

Trusts around the country are using staff engagement to help them handle mergers, produce sustainable savings, improve patient experience within existing resources, and drive up quality.

“It’s about integrating staff engagement as an approach rather than a separate initiative,” says Steven Weeks, policy advisor to NHS Employers.

A King’s Fund report published on 23 May 2012 makes the case for engaging staff, patients and boards and for building relationships across systems of care. ‘Leadership and engagement for improvement in the NHS: together we can’ includes sections on how to engage clinicians including doctors, nurses and allied health professionals. Mr Weeks says: “What really engages them is the idea of improving services.”

The NHS has done a lot of positive work on staff engagement. NHS Employers is sharing that learning through its involvement in the Employee Engagement Task Force. This government sponsored body was launched in March 2011 and is made up of public and private sector employers. It is developing good practice on employee engagement across the economy and is set to produce a report later this year.

There are a number of approaches that can be used in staff engagement and resources are available to help employers on this journey. The Listening into Action programme, for example, is a systematic approach for aligning strategic goals with sustainable staff engagement. The programme aims to make improvements for staff and patients by asking them about their experiences and what needs to change.

‘Engaging your staff: the NHS staff engagement resource’is now available for local NHS organisations to use. Produced by NHS Employers and the Department of Health, this online click and go guide brings together a number of tools, tips and resources. A section on mergers was recently added, and materials centred around engaging clinicians are on the way.

When the decision was taken to merge three trusts to create Barts Health Trust, there was a big debate about whether to engage staff in the aspirational culture and values aspect of the merger straight away. One school of thought said it was going to be bumpy for awhile and staff would only want to hear the hard facts. In the end they opted to do both.

“We combined the hard message and soft message,” says Michael Fidler, the trust’s staff engagement lead. “The hard message – and this is what interested all of the teams – was that the very first big transactional thing on the merger was going to be the TUPE transferring of terms and conditions.”

The soft message was a merger update with timelines, vision and goals, and why the merger was happening.

The engagement team created a log of meetings held by managers and frontline staff. With six hospital sites and no central register of meetings, it was no mean feat, but the meetings were an effective way of engaging with managers and staff on the two messages.

They also recruited merger advocates from large engagement events for all staff held at West Ham football ground. Mr Fidler says: “When we go into the next stage of the values and culture development we have a body of people already on board.”

“Engagement starts with leaders and managers,” says Nicky Ingham, director of workforce and organisational development at Bolton Foundation Trust.

The trust runs a half day engaging manager programme which outlines the qualities and benefits of staff engagement and then shares practical approaches to how managers can engage with their team.

In another initiative, managers ask staff who report to them to complete a 180 degree leadership management style questionnaire. There are 21 questions, such as my manager ‘can be approached when required’, ‘welcomes and responds constructively to my ideas’, and ‘encourages team work’. For each question, staff rate their manager from a range of ‘never’ to ‘more than 80 per cent’. The results are collated and fed back to the manager who is then provided with a coaching session to reinforce their good points and identify areas for improvement.

In April Bolton launched a quarterly staff temperature check to monitor and measure engagement levels. The workforce team then intervenes in areas with a low engagement score.

Trusts can get line managers on board with staff engagement work by presenting the business case for engagement. “[The business case] speaks for itself,” says Ms Ingham. “The more engaged your workforce feels the less likely they are to leave, the more motivated they will be, therefore they will go the extra mile, hence [they will be] more efficient [and] more productive.”

Another hook is to present trust data showing the impact of having a demotivated workforce – for example correlating high sickness absence and low appraisal rates with higher levels of patient pressure ulcers. And then showing how engagement work can turn that data around. Before any engagement event the trust identifies which productivity measures will prove that the engagement work has been a success. Being able to show reduced lengths of stay, for example, is a good way of silencing the cynics who dismiss staff engagement as soft and fluffy.

Bolton has hit the headlines for failing to achieve A&E and 18 weeks targets, but in difficult times staff engagement is even more important, says Ms Ingham. “Don’t throw out all the engagement work you were doing because staff will make the turnaround possible.”

Staff engagement can be used to improve quality, as seen at Salford Royal Foundation Trust. Frontline staff have been asked what they think can be done to improve outcomes – for example how to reduce infection rates – then encouraged to introduce tests of change in their own clinical areas and measure the impact. Ideas that produced benefits were pooled to reveal common threads that could be scaled up and spread across the whole organisation over time and eventually become trust policy.

Staff were also asked to define the behaviours they should be assessed on to demonstrate they support the trust’s values. After meeting with several hundred staff through focus groups a performance framework was created.

David Wood, the trust’s executive director of organisational development and corporate affairs, says trusts can engage staff by developing a compelling vision that the vast majority of people would sign up to - something that’s worth getting up for in the morning and worth coming to work for. Then ask staff what they think it will take to get there, rather than imposing the will of the centre on them.

Show staff what has been done with their ideas. Seeking people’s opinions and then seemingly ignoring them is a sure fire way of losing that engagement. And remember that there will always be further improvements to strive for.

“As long as that vision remains [and] you don’t change that to accept something second best, then I personally think staff will subscribe to it and work with you,” says Mr Wood.