An organisation’s workforce wellbeing strategy must be integral to its quality, innovation, productivity and prevention programme, says the Health and Safety Labratory’s board champion for health, work and wellbeing Andrew Curran.

Trying to establish consensus on a definition of “wellbeing” is notoriously difficult – a Google search can pull up anything from colonic irrigation to companies selling vitamin supplements.

Dame Carol Black’s 2008 report into the health of the UK workforce, Working for a Healthier Tomorrow, espoused the business benefits of wellbeing. Occupational health expert Steve Boorman’s report followed, looking at the health and wellbeing of the NHS workforce.

Boorman found that many NHS staff were not convinced their wellbeing was viewed as important by their employer, despite evidence that prioritising staff health and wellbeing led to “improved patient satisfaction, stronger quality scores, better outcomes, higher levels of staff retention and lower rates of sickness absence”. 

Broader thinking

Understanding that the workforce, work environment and organisational culture interact to influence patient safety outcomes broadens thinking in addressing patient safety challenges.

But how do you measure something as ethereal as “wellbeing”? Many people start with an obvious measure: sickness absence rates. A CBI report has estimated the annual cost to the UK of sickness absence at £14bn.

However, wellbeing is not just the absence of ill health but, according to Boorman, is the presence of physical, mental and social contentment.

Sickness absence alone does not provide a full picture of the impact of poor wellbeing. Presenteeism, when staff attend work but have reduced productivity due to physical or mental ill health, can reduce business performance without impacting on absence rates.

At a time when the tectonic plates beneath the NHS are shifting and budgets are being squeezed, there is a danger that the wellbeing of staff can suffer. So, how can NHS managers develop sustainable wellbeing programmes that contribute to their organisation’s quality, innovation, productivity and prevention strategy?

Translating wellbeing into improved commitment, engagement and, from a QIPP perspective, improved innovation and productivity can be helped by considering wellbeing not as an initiative that is “done to” employees, but as something that is an integral part of “the way we do things around here”. 

Smoking cessation campaigns, healthy eating weeks and cycle to work schemes, for example, are useful only if they form part of an integrated approach to address organisational, individual and job/environment related issues. This has to include strong leadership and good internal communication otherwise the momentum will be unsustainable (see diagram).

Our own organisation implemented a wellbeing strategy that addressed these issues and has seen rolling sickness absence rates drop from 6.4 days per employee in 2007-08 to a predicted level of 3.1 days in 2010-11. 

The programme was established three years ago when we recognised that several, isolated initiatives were delivering some small benefit – for example we had a stress management group, the occasional healthy eating initiative – but that integrating these into a holistic programme could bring more tangible business benefits.

The first action was to supersede the stress management group with a health, work and wellbeing group and agree that wellbeing, to us, would not be an initiative but would be “the way we do things around here”.  The group has representation from trade unions, senior management and scientific disciplines across the organisation. 

Initial teething problems were around ensuring that everyone in the organisation was made aware of the new approach, and had the opportunity to engage with the programme. The group has been fundamental in laying the foundations for our wellbeing programme by communicating the importance, actions, outcomes and business benefits in a consistent way and joining the initiatives together in a single programme.

The programme is not static, and we change the emphasis of our approach based on our business needs. For example, our current focus is on the “leadership” arm of our windmill and improving the line management of technical experts. However, in the future, the focus might shift to physical or mental health issues. We are also running a series of “let’s talk” workshops to enable all staff to discuss in an open forum what they perceive as barriers to us achieving our business aims.

We estimate that our drop in sickness absence results in a productivity benefit of around £600,000 per annum. The savings are potentially greater for organisations within the NHS, which may have to replace absent staff with agency employees.

Practical tips for sustainable success

  • Visible leadership: have a board champion – someone who has the leverage to look across the organisation and see how activities can be integrated under a wellbeing umbrella. For example, does your trust see the impact on patient safety of staff wellbeing? Are your line managers assessed for their line management competence? Who manages the technical experts? Is there a stress working group stuck out on a limb somewhere?
  • Worker involvement is critical: develop and stick to a communications plan that allows input from everyone. Recognise that not everyone will want to be involved – but you need enough momentum to change the direction of the oil tanker. Top tip: Level the playing field by having a steering committee with representation from across the business that includes a board champion (but not chairing the meeting). Make sure the meeting is sacrosanct in people’s diaries
  • Embed the wellbeing strategy across the organisation: make sure line management chains, professional groups, unions and so on understand what wellbeing means to your organisation and how it will be measured. The board champion can lead this and help nudge parts of the organisation that are resistant to change
  • Base the strategy on evidence: use practical resources such as the occupational health climate tool to benchmark current attitudes and understanding of wellbeing. Know what success will look like to you and how it will be measured, for example sickness absence rates, employee engagement, patient satisfaction.
  • Action plan: once you know what the landscape is, and enough people are on board, develop a clear action plan that is kept in a visible place in the organisation. Top tip: Make sure the plan details who is leading the programme, how progress will be communicated, and how people can get involved 
  • Tackling wellbeing is not simple: it requires commitment, engagement, clear, strong leadership and a willingness to look critically at what the organisation currently does. However, the benefits can be reaped across the organisation and by the patients that come through the doors

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