Raising energy levels by just a small amount can yield great results for organisations, says Rupert Symons

The topic of organisational energy has not been discussed much in the NHS, yet it preoccupies chief executives. They talk about creating a buzz, lifting vitality and agility, cutting through the undergrowth, making things happen. They are horribly aware how bureaucracy and internal politics stifle drive and imagination and admire organisations such as Pret a Manger, BP and Nokia, which seem to have discovered how to energise their people and direct that energy to results.

The factors that determine organisational energy have also been shown to be important in staff retention, creativity and innovation.

As part of the work led by Helen Bevan at the NHS Institute for Innovation and Improvement on social movement thinking, we set out to see how the huge energy potential of NHS staff could be released and managed.

We define organisational energy as the extent to which an organisation has mobilised the full available effort of its people in pursuit of its goals. It has two dimensions: level and direction. A trust that is continually battling over inadequate resources has lots of energy with little direction. A trust where staff are expected to follow instructions without being involved in improvements has plenty of direction but little energy. In an energised trust, the level of energy is high, but, crucially, everyone is focused on a shared purpose.

Trusts lose energy in many ways:

In friction between parts This includes clinicians who are perpetually at odds with managers, or trusts that have little time for strategic health authorities and vice versa. Energy that could go into serving the patient and improving delivery is instead dissipated internally.

In activity which adds no value People in the NHS often feel deluged by showers of projects and initiatives which seem to divert effort from what really counts. Meetings with no point, reports no-one reads, roles with unclear responsibilities, controls which micro-manage, over-engineered processes and over-layered hierarchies: all these remain familiar enemies.

In failure to engage The discretionary effort of employees is the contribution they can choose to give or withhold. It has been shown to deliver a 19 per cent increase in the value added by low-complexity jobs, 48 per cent by medium complexity jobs and up to an astounding 127 per cent by sales jobs. The district nurse who could squeeze in an extra visit, the technician who could return a call today rather than tomorrow, the manager who could walk round the office to talk to her people - but who does not bother to do so - all take the edge off performance.

In failure to inspire It is one thing to engage people, to help them enjoy their jobs; another to inspire them to discover and realise their potential. Many employees say they would like to be asked to contribute more - that is, that they would like a more demanding and challenging job where they have to learn.

Our research into what energises staff and enables energy to be productively used reveals four sources, the '4Cs'.

  • Connection. Staff's line of sight between them, their work, their values, and the organisation's purpose.

  • Content. How far the actual work people do is stimulating and provides a sense of achievement.

  • Context. How far working practices and the work environment are enabling.

  • Climate. How far the typical 'local weather' of the organisation makes people want to give their best and helps them grow to their potential. This includes elements that are broadly connected to leadership at all levels, such as day-to-day feedback and recognition, the social life of the organisation, being welcoming of diversity, and honesty ofcommunication.

To work with energy you first have to discover the energy in the organisation. You then focus it, and finally release it. As part of the discovery phase, analysis of the 4Cs shows where to look to raise energy. The net effect of the 4Cs determines the overall energy level. We measure this by our 'energy index' score, which shows how much staff feel energised and how much they perceive that energy is being productively used.

Changes in scores predict changes in organisational performance. All things being equal, a trust with a higher score will achieve better results simply because more energy is directed to moving the organisation forward. Once an organisation has the knowledge and baseline data, movements in the score over time can be easily tracked.

The energy index survey starts with a number of statements relating to each of the 4Cs and asks staff to assess both how important the statement is and how much they reflect the reality in their organisation. This enables the organisation to pinpoint, often unexpectedly, how productive energy can be created. The diagram below shows results for a real PCT.

So far pilot trusts have found the results useful in targeting their efforts and initiating improvements. Action areas have ranged from better sharing of stories about patient successes to talent-management strategies to stretch staff.

Out of a perfect energy index score of 100, a typical large organisation will score 50-60. So far the early results from NHS trusts taking part in the pilot programme have ranged from 20-60

In hard financial terms, the people cost of a trust employing 5,000 staff at an average cost of, say,£20,000 is£100m a year. So raising energy in a way that yields even a 1 per cent productivity gain is equivalent to a saving of£1m that could be spent on staff and patients.