We need to be cautious before accepting that there is a simple choice between believing that managers should be assessed either on the quality of staff experience or on patient outcomes and experience.
To focus on staff engagement purely as an end in itself would be grossly irresponsible for any NHS manager or organisation, implying a fundamental misunderstanding of the rationale behind “engagement”. This is not simply to support the wellbeing of staff and increase morale, but to do this with the express purpose of increasing discretionary effort in how people apply themselves in their work roles.
Extraordinary pressures placed on managers to achieve targets will lead to shortcuts in their leadership behaviour
Engagement is about being absorbed in what one is doing at work, so that the very activity of performing one’s role enables the individual to achieve a sense of purpose, fulfilment and ownership of what they do, which results in paying far greater attention to the quality, safety, and effectiveness of one’s performance. But, critically, leadership responsibility is to explain and make explicit what the ultimate goal is; leaders don’t create products, they create meaning.
Numerous studies have provided unequivocal evidence that engagement is good for people, good for organisations, and good for customers. Engaged staff - who are treated with respect, dignity, and made to feel they are of crucial importance to their organisation - are significantly more likely to treat customers, clients and patients in the same way.
We have shown by our own research in the NHS that a culture of engaging leadership affected the productivity, morale and wellbeing of teams. Teams that were most effective in delivering patient care were those in which there was shared ownership of the vision of high quality patient centred services, challenging goals were identified, along with responsibility for supporting each other in achieving them. They were successful not just because they knew they would be assessed on achieving targets, but because they had been given ownership of determining the means of achieving them.
The problem with the argument that “leaders have enough targets and that good leaders anyway generate high levels of engagement” is that it ignores what we know about human behaviour. We know from academic studies, and recent experience in the NHS, that people tend to devote the most attention to what gets measured. What better illustration than Mid Staffordshire Foundation Trust, where staff described the culture as one of fear and bullying and of being sacked if targets were not met?
Extraordinary pressures placed on managers to achieve targets will lead to shortcuts in their leadership behaviour; chances are high this will lead to the “command and control” style, because that is the natural default position of most people when under pressure to “deliver”. If this style is adopted, it might achieve short term gains, but it will definitely not sustain them. It is guaranteed to increase staff stress, which will, as we know from the Boorman review, undoubtedly damage the quality of care given to patients.
Finally, let’s not be misled by the patronising belief that patients won’t understand the importance of staff engagement in affecting the quality of care offered. As part of a new study, funded by NHS Yorkshire and the Humber, we asked mental health services users whether they thought staff engagement affected patient care; their response, in essence, was “surely that’s a no-brainer!”
NHS Leadership Spring Debates: Patient and staff experience
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Viewpoint: 'Don't focus on staff engagement as an end in itself'