staff satisfaction

Published: 17/04/2003, Volume II3, No. 5851 Page 26 27 28

Research on London trusts has found good relationships with line managers are a key element in job satisfaction, while a lack of training can cause staff to feel undervalued. Sarah Perryman and Dilys Robinson report on the findings and their implications

What makes staff feel valued and involved in the organisation they work for? And are the factors that give them this feeling easily replicated? To find out, we explored the extent to which 34,400 staff felt valued and involved in 59 London NHS organisations in 2001.

The NHS human resources strategy places considerable emphasis on the quality of working life. This theme was deliberately reflected in the design of our survey, which enabled employers to assess how their organisation was doing in relation to the 'test' specified in the Working Together document. This stated: 'The test of whether we succeed in improving the quality of working life for staff will be whether they belong to an organisation which provides:

a fair process for determining reward;

job satisfaction through empowerment and involvement in decision making;

equal opportunities;

skills development;

positive and sensitive management;

wellbeing, in terms of employment security and working environment.'

1All permanent members of staff were included in the survey, covering all occupations except ambulance staff.

There were 34,400 respondents from 50 London trusts: 15 acute, 13 teaching, nine community, six mental health and seven primary care trusts. Between them, these staff have 235,000 years' service, an average of nearly seven years each.

We used an eight-page questionnaire, usually distributed through payroll. To maintain confidentiality, returns were posted direct to the Institute for Employment Studies. Response rates for individual trusts ranged from 17-63 per cent, with most falling between 30-50 per cent.

Taking individual attitude statements, we were able to construct an overall measure for 'feeling valued and involved', using factor analysis. Factors included:

I feel involved in decisions which affect my work.

Managers are keen to hear staff views on key decisions.

I feel valued by senior management.

Good suggestions from staff are not ignored.

We used the same method to develop overall measures of satisfaction with communications, pay, commitment, training development and career, immediate management, performance and appraisal, and equal opportunities and fair treatment. The scores for each factor are listed in the table opposite.

The table shows that, in general, immediate managers are held in high regard and have good working relationships with their staff.However, staff are less satisfied with their managers' approach to managing performance and appraisal.

Staff in London's NHS are committed to the trusts they work for but are very dissatisfied with their pay. They feel their experience and good performances are not rewarded fairly.

Dissatisfaction with pay is a common feature in staff opinion surveys, and is largely beyond the control of immediate managers and individual trusts. Trusts do have greater discretion about their staff development activities, and it was heartening to find that NHS employees in London are satisfied with their trust's approach to training, development and careers.

Similarly, trust efforts to provide equal opportunities and fair treatment have also met with approval.

Staff are also positive about communication in their work places - but only just.

Most interestingly, staff are neutral about the extent to which they feel valued and involved. But what constellation of HR and management circumstances can contribute to staff feeling more valued and involved?

Though the results are useful, what is more interesting about these scales is the way in which they inter-relate. Each factor correlates with every other: greater satisfaction with one aspect of working life is usually mirrored by greater satisfaction with another.

This is an important finding in itself as it implies that if a trust were able to influence one aspect of working life, it would reap the rewards in terms of higher staff satisfaction in other areas - a virtuous circle, if you like.

But if we focus our attention on the strongest links between the factors, we have a much more powerful tool for understanding and influencing the quality of working life for London NHS employees. These stronger links are shown in figure 1.

This model highlights the many influences on what makes employees feel valued and involved. Though it is not possible to determine the direction of these relationships, we can propose some hypotheses, and suggest actions to influence them positively.

It appears that the better the communication system, the more valued and involved staff feel - informing staff when changes in the trust occur, giving them the information they need to do their job, and freeing them from reliance on the 'grapevine'.

Also, the more visible the trust's commitment to an individual's training, development and career progression, the more valued and involved staff feel. This commitment needs to be carried through into actions, for example offering active support for continuing professional development, and ensuring equal access to adequate training and development.

Implementing performance and appraisal systems also generates feelings of value and involvement.

Satisfaction with training, development and careers, and satisfaction with performance and appraisal systems go hand in hand.

Feeling valued and involved can take the sting out of low pay scales. Research has found that the perceived fairness of pay systems is just as important as absolute levels of pay.

2Though most staff are dissatisfied with pay, those who feel valued and involved are less dissatisfied than others.

Staff who feel valued and involved also demonstrate more commitment to their employing trust. They speak highly of it to their friends, would be happy for friends and family to be treated there, and believe the trust is known as a good employer with a good reputation.

Building a culture which values equal opportunities and fair treatment also generates feelings of value and involvement. Trusts which make their commitment to equal opportunities clear and deliver services to patients which are free from discrimination, benefit from greater feelings of value and involvement from staff. Policies need to be backed up with practice - it is important staff feel they are treated fairly as individuals, that they have work environments free from harassment and bullying, that their face need not fit to be accepted, and that they feel they have a fair chance to apply for internal vacancies.

Finally, staff who experience a sympathetic relationship with their line manager are also more likely to feel valued and involved.

Line managers have a pivotal role in staff 's perceptions of how valued they are and how involved they can be. But how does this work in practice?

Our survey shows that employees value managers who are sensitive to work/life issues, who let them know how they are doing and show support when things go wrong. A good working relationship with the immediate manager appears to be central to feeling valued and involved.However, there is a wider role for line managers. Line managers are a crucial channel through which the training, development and career opportunities, and performance and appraisal benefits are delivered on the trust's behalf.

The survey shows line managers have a role in communicating that they take staff development seriously, discussing training needs on a regular basis, engineering time for training and encouraging staff to develop new skills.

Performance and appraisal systems are also heavily influenced by line managers.

We found that the more immediate managers gave regular feedback on performance and took the performance appraisal system seriously, the more valued and involved their staff felt. As with training and development, the commitment of time and effort, on a one-to-one basis, by line managers to the performance and appraisal of individual staff appears to be a worthwhile investment.

A recent experience of a performance appraisal and a formal training episode are associated with feeling valued and involved. Staff who had an appraisal in the last year were satisfied with the extent to which they felt valued and involved, while those who had not been appraised were dissatisfied.

Staff who did not receive any training in the previous 12 months were dissatisfied with the extent to which they felt valued and involved, while those who received training were satisfied.

Employees with a personal development plan felt valued and involved. Employees without one did not. Access to less formal development opportunities also appears to enhance feelings of value and involvement.

We identified at least two experiences which diminish the extent to which staff feel valued and involved. Staff who had experienced either harassment or violence, or an accident or injury, in the previous year were less likely to feel valued and involved.We suggest that these experiences, and in particular the way in which the trust handles them, may dent employees' confidence in the organisation.However, it may also be true that feeling valued and involved may effectively 'shock-proof ' employees.

Ensuring staff feel valued and involved is a worthy objective in itself, but also has practical outcomes which benefit trusts.

Such staff are less dissatisfied with their pay. They also demonstrate greater commitment to their employing trust. This is important as other research has found that commitment is linked to improved performance.

3Feeling valued and involved can prevent retention problems. Nearly half of staff who are dissatisfied with the extent to which they feel valued and involved plan to leave within a year, whereas 80 per cent of those who are satisfied expect to stay a year or more.

Valued and involved employees are also likely to be 'engaged employees', which brings benefits to employers in the form of staff 'willing to go the extra mile'.

Feeling valued and involved is also associated with higher job satisfaction, better working relationships with colleagues, and more co-operation within the workplace.

What are the key messages for other trusts?

Line managers are central. Trusts need to support and assess the training needs of immediate managers, for the task of motivating and empowering staff.

Human resources practices make a difference.

The good news is that such practices can enhance feelings of value and involvement.

However, there is scope to extend performance appraisals, personal development programmes and access to less formal development opportunities within London trusts. In 2001, 42 per cent of staff had neither an appraisal nor a personal programme - that is 14,000 people outside of major career development systems, and one-third of these had no training in the past year.

Patients should also benefit. Research has shown that good HR practices are associated with better patient outcomes.

4nImprove one area of working life, and reap the benefits in other spheres. Improvements to communications are within trusts' influence.

As there was a relatively low score given to this sphere of staff 's working lives, it is an obvious target for attention. As a starting point, carrying out a survey, but not acting on the results, tends to have a demotivating effect.Yet only one in five staff members were confident that the survey would be acted on. Similarly, extending performance and appraisal to more staff will give the personal contact with line managers that staff appear to value. Absolute levels of pay in the NHS are more tricky to handle, but trusts can ensure that the pay system is shown to operate as fairly as possible.

Handle any 'shocks' well.

Though prevention is always better than cure, there is still a place for effective policies and procedures for dealing with incidents of harassment, violence and accidents at work. Ensure staff are equipped to deal with these experiences and their aftermath sympathetically and effectively.

Time well spent.

Time spent enhancing feelings of value and involvement is clearly worthwhile and brings positive returns to trusts and employees.


1Department of Health.

Working together: securing a quality workforce for the NHS. www. doh. gov. uk/pub/ docs/doh/hrstrat. pdf

2Bevan S, Barber L, Robinson D. Keeping the best: a practical guide to retaining key employees. IES Report 337, 1997.

3Barber L, Hayday S, Bevan S. From people to profits: the HR link in the service-profit chain. IES Report 355, 1999.

4West M, et al. The link between the management of employees and patient mortality in acute hospitals, International Journal of Human Resource Management 2002;12(8): 1299-1310.

Key points

A survey of 34,400 staff in 59 London trusts found general dissatisfaction with pay but satisfaction with immediate managers, equal opportunities and communications.

A good working relationship with an immediate manager emerged as key to feeling valued.

The better the communications in a trust, the more staff felt valued.

Forty-two per cent of respondents - 14,000 people - did not have a personal development plan and had not had an appraisal, leaving them outside major career development systems.This left them dissatisfied.

Sarah Perryman is research fellow and Dilys Robinson is senior research fellow, Institute for Employment Studies, Sussex University.