In the first of a series of articles, we look at some of the top performers from this year’s Healthcare 100. Here, Alison Moore examines the importance of engaging staff to deliver tangible results - and says there are no shortcuts to achieving it

There is growing evidence that staff engagement and patient experience in healthcare are linked, which makes effective staff engagement more important than ever in the current financial climate.

Successful staff engagement needs support from leaders at all levels, as well as top leadership

Releasing up to £20bn in efficiency savings while introducing the changes in organisational structure announced in the white paper will be a challenge to every organisation.

Staff engagement will be one of the ways to meet it, by enabling employers to harness their staff’s discretionary effort and improve productivity while also keeping patients happy. Case studies from NHS organisations show tangible results from better staff engagement, such as lower absence levels. There is also some evidence that organisations with high levels of engagement tend to perform better overall.

Research into staff and patient surveys by Aston Business School has identified a link between negative patient experiences and staff reporting high levels of bullying, harassment and abuse.

In this year’s Healthcare 100 awards, staff engagement was measured by a number of questions. Overall, non-NHS organisations scored higher than NHS organisations, though this is probably a reflection of their typically much smaller size. Small organisations often score better on engagement, possibly because workers feel closer to managers and more involved in the organisation.

Strategic health authorities, mental health trusts and primary care providers scored better than the NHS average. Given the uncertainty that primary care providers have worked under for some years, this is a tribute to how those organisations have coped.

Fostering engagement

But how can organisations improve staff engagement? The short answer is there is no single approach that provides a complete answer, but tackling elements of organisational culture is an important first step.

Talking to and listening to staff is vital, but staff may also need to be involved in changing their own working practices or immediate environment in a way that affects patient care.

At St George’s Healthcare Trust, for example, staff helped to define what contributed to good patient experience and, inevitably, then began carrying these positive behaviours into their own daily practice.

NHS Employers policy manager Steven Weeks says: “Staff engagement is most successful where it is linked in wider work programmes, rather than a separate one-off initiative. In particular, it is an approach that can be used to help in dealing with efficiency savings, productivity improvements and improving patient experience.”

“The recent review of the Releasing Time to Care programme has shown it was most successful where there was strong staff engagement. Where staff were engaged, able to generate and implement ideas for change, they could make sustainable changes and improve productivity,” he adds.

“Successful staff engagement needs support from leaders at all levels, as well as top leadership. It is especially important that frontline clinicians are supported to develop an engaging leadership style and find ways to empower their teams.”


The Healthcare 100 for 2011 will be launched early next year, with the results out in September. To register your interest in the survey, email

Form fighters: Islington PCT

Islington PCT is known for being a good employer and for engaging staff - so HR director Ian Fuller was keen to act when the numbers of staff being appraised started to fall.

In 2008, 88 per cent of staff said they had an appraisal. In 2009, 78 per cent did, probably reflecting a period of transition when the HR arrangements for the trust were changing.

The paperwork surrounding appraisals was identified as a problem and the form was redesigned from 30 pages to six. It was also made clear throughout the organisation that appraisals had to be carried out and a deadline set. Personal development plans now have to be copied to the training team - confirming that an appraisal has taken place - while the old system relied on management self-reporting without any evidence.

By the end of August, the trust had already appraised 70 per cent of employees, with figures rising daily - a considerable achievement given the widely dispersed staff.

Mr Fuller says that, during the time when appraisal rates were lower, there was an increase in work-related stress and staff feeling under pressure at work. This could indicate appraisals were helping them to cope with this.

Happy and committed

Open staff meetings and acting on the results have helped specialist psychotherapy provider Efficacy to keep its 26 employees happy and committed.

Efficacy works across five sites and the majority of its staff are highly experienced cognitive behaviour therapists. It has responded to concerns raised at its regular meetings by employing two extra administrative staff to help with the paperwork and sort out payment.

Another response has been to create a “hub room” at one of its London sites to give staff a shared space. Therapists spend a lot of time alone with clients and isolation can be an issue.

Joint clinical director Jane Muston says Efficacy wants to be the employer of choice for CBT therapists. “It is very important they feel valued and they influence the development of Efficacy,” she says.

“The key thing is that we maintain effective communication with all members of the team.”

The one team approach

Disappointing staff survey results, especially around bullying, put the need for improved staff engagement on the agenda at St George’s Healthcare Trust in south London.

With the help of £100,000 from NHS London, staff-side representatives and managers set up “one team”, a programme aimed at improving engagement through finding out what staff thought of the organisation and how it could be improved.

Staff helped identify six behaviours that epitomised the “right” attitudes for staff and helped them to see how their work contributed to patient experience. These values then trickled down through three departments - estates and facilities, outpatients and theatres. Around 40 volunteers in bands one to four were trained as “service partners” to spread the approach.

Feedback was positive, with managers reporting happier staff and fewer complaints from patients in those departments. The approach is now being spread across the trust, with staff involved in the teaching.


  • I choose the right attitude
  • We are all saving lives
  • I listen and share
  • I show I care
  • I am a professional
  • I make a difference.