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This might hurt a bit: staff engagement and care standards in the NHS

Brendan Martin, 15 January 2014

Almost every NHS Foundation Trust says it has the systems in place to engage effectively with staff. Yet only a third of NHS staff report effective communication with management.

These facts highlight a “disconnect” between NHS leadership and staff that is harming patient care, says an important report from the Point of Care Foundation, published today.

As a member of its advisory group, obviously I am not surprised by the findings of Staff Care: how to engage staff in the NHS and why is matters.

Then again, no-one who has taken even the vaguest interest in the NHS for the last year, from the Francis Report into the Mid Staffs scandal onwards, will be surprised by them either.

Only yesterday came further evidence of the vital relationship between staff engagement and service standards, in the Care Quality Commission’s report on the Bart’s NHS Trust, which found:

“Staff feel disconnected from the trust’s Executive and feel undervalued and not supported. The culture was not sufficiently open and some staff felt inhibited in raising concerns.

“Morale was low across all staffing levels and some staff felt bullied. This must be addressed if the trust’s Executive Team’s vision is to be successful.”

It’s not all gloom. Staff Care reports success stories from Oxleas, Walsall, Derbyshire and elsewhere. They underline the correlation between staff engagement and care quality as positively as the Barts report does negatively.

But understanding the importance of staff engagement and wellbeing is one thing; fixing the disconnect and achieving the desired cultural change is another.

The Staff Care report provides a useful resource list that includes Public World’s report of our Best Workplace approach, which has been tried, tested and developed over 20 years in Sweden and is now available in Britain.

Unlike some approaches to staff engagement, we do not start from the pretence of entirely shared interests and priorities among NHS leaders, managers, staff and patients.

On the contrary, our approach is based on acceptance that common purpose can be undermined by differences and conflicts that need to be acknowledged even if they cannot easily be eradicated.

A problem with some employee engagement methodologies is that they emphasise top-down rather than bottom-up communication. Leadership has a vital role, of course, but too many managers fool themselves into believing that when staff reflect back their own narrative it is because they “own” it.

In fact, when staff display an understanding of the message their bosses want to hear it can conceal a toxic culture in which they have little confidence that their voices are really being heard.

The evidence in Staff Care suggests, indeed, that a key disconnect comes from many staff feeling that nothing changes even when they do speak up.

That is why a defining characteristic of our Best Workplace approach is to enable staff not only to be heard but to act, collectively, on their own decisions.

Of course that brings risks, both to leaders who fear a disconnect between responsibility and control, and to patients who have good reasons not to assume staff always put them first.

So it is vitally important that staff involvement is designed to strengthen team work in transparently accountable ways that enable responsibility to be shared but not fudged.

That kind of culture takes time and learning to develop, and the process can be uncomfortable at times.

But if there is one public service that should understand that making things better can sometimes hurt a bit it is surely the NHS!

  • Brendan Martin is managing director of Public World. For more information about how we can help you, please contact him at
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