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The NHS staff survey is one of the biggest workforce surveys carried out in the world. Conducted every year since 2003, the survey captures the national position in detail, as well as offering local, organisation-level intelligence in relation to staff engagement and morale. It paints a picture of how staff at every level of the NHS are experiencing their working lives on a day-to-day basis. And we know that this experience is vital when it comes to the provision of quality care to patients and the retention of highly-skilled and valued staff.

In 2021, the decision was taken to redesign the survey so that the questions aligned with the NHS People Promise, a set of affirmations which outline the NHS’ ambitions to achieve a positive, compassionate and inclusive culture. It is a set of specific principles which form the roadmap to where the NHS aspires to be in terms of its performance in the sphere of people and culture by 2024.

Here at ImproveWell, we believe that giving everyone a voice is key to improving quality and patient care. Our solution helps organisations to build a culture of continuous listening and improvement, to ensure that all staff feel heard and valued and that their input at work makes a difference. So we have taken a great interest in the latest set of NHS staff survey results and analysed what they tell us about what’s going well in the arena of staff engagement and the areas where some trusts seem to be struggling.

What’s Going Well

North Staffordshire Combined Healthcare NHS Trust, (Combined Healthcare) a provider of mental health, social care, learning disability and substance misuse services in the West Midlands, scored some of the best results across the whole NHS in relation to the People Promise. This included the highest scores in their cohort for staff engagement and morale.

So, what are they getting right, and what can other Trusts learn from them? A key principle for the organisation is one of “active listening”.  The 2018-2020 Communication and Engagement Strategy describes this as:

“A continual awareness that we don’t just listen and communicate for the sake of it or as an end in itself, but in order to deliver – and be seen to deliver – concrete outcomes and improvements in our strategies and the recovery-focussed services we seek to deliver for local people, incorporating their views, insights and preferences.”

Initiatives that have supported the active listening strategy include the Listening and Engagement Active Partnerships (LEAP) initiative, whereby staff and wider stakeholders can submit comments or suggestions, and each item is analysed to identify whether or not something specific is being suggested or requested and – if so – adoption or rejection of each suggestion is logged, tracked and fed back to the original proposer upon completion or rejection.

In the same vein, the latest strategic plan for 2023-2028 included a consultation with some 300 staff, partners and people with lived experience of the Trust through a series of workshops and focus groups. Questions were asked covering issues such as what the Trust’s priorities should be and how the Trust should innovate. Stakeholder responses are represented in this visual taken from the Strategic Plan:

Combined Healthcare has also taken steps to create greater emphasis on promoting and celebrating team and directorate level activities and achievements. One example of this is the adoption of the Leading with Compassion initiative.

Another key priority has been an approach of “we come to you”, whereby content, social media and subscription services are created that deliver content direct into people’s hands. This has seen the introduction of monitors across the Trust to reinforce key messages, values and key initiatives, the launch of the multimedia channel Combined TV, as well as tools to send centrally managed messages and information direct to staff desktops and devices.

Combined TV is a rolling four-hour show that is updated with fresh content weekly. Here staff can learn the latest news across the organisation, access information about different policies and strategies, read staff and service user stories and find out about service innovations. This means that staff feel fully informed and engaged in what’s going on across the Trust. It also improves visibility of senior leaders.

Combined Healthcare was the winner of the HSJ Trust of the Year award in 2022, partly due to its detailed plans for improving care following the pandemic, which helped it to achieve the much-coveted Outstanding CQC rating. The Trust is one of only two specialist mental health Trusts in England to have achieved this rating, so Combined Healthcare is a great example of excellent staff engagement and high-quality patient outcomes going hand in hand.

Areas for Improvement

Even the strongest Trusts still experience challenges with staff engagement and morale. This is perhaps unsurprising, given the pressure on NHS services in recent years. Research by The King’s Fund has suggested that 50% of all staff in the NHS are likely to experience chronic stress, a known contributor to burnout. This can impact on the quality of care provided to patients and also on staff retention, creating a vicious cycle which can put patients at risk and cost Trusts time and money as they struggle to fill vacancies and provide a safe service.

Culture at work is also still a major issue. The staff survey national picture remains worrying in this area, with nearly one in five staff reporting being bullied by colleagues and nearly one in ten saying that they have experienced discrimination. It seems unlikely that the NHS will be able to address its operational challenges without tackling these deep-seated cultural problems that hinder organisational success.

Creating a Positive Working Culture

The NHS People Promise outlines an ambition to be compassionate and inclusive and to provide a working environment free from bullying and discrimination, a place where everyone feels included and welcome. This is not easy to achieve when resources are stretched and services are under pressure, but it is possible, and we have worked with some trusts who have made great strides in this area.  

East London NHS Foundation Trust (ELFT), a community and mental health provider, worked with ImproveWell to develop a quality improvement approach to explore what hinders people from finding joy in their work on a day-to-day basis. This has formed part of ELFT’s Enjoying Work programme. The main objective of this work is to bridge the gap between problems and solutions, to ensure that staff feel that their voices are being heard and they can see tangible action being taken in response to their concerns. The work has been carried out across teams working in many different types of environments, including district nursing, community mental health, inpatient staff and corporate teams.

The project looks in detail at the things which contribute to people having a great day at work, and the things that get in the way. A key focus here is on empowering staff to make changes to things that matter to them and really make a difference to people’s lived experience of their working lives.

The ImproveWell solution has been a vital tool in this work, and provides a portable, accessible platform where staff can complete bespoke surveys to take a snapshot of morale and wellbeing at any given time, and also make improvement suggestions. The platform then enables the organisation to process and aggregate their data in ways which work for them and support their values and aspirations, and to monitor progress against improvement goals.

ELFT continues to make great progress in the field of staff engagement, working hard throughout the pandemic and beyond to implement a package of staff wellbeing support programmes and to foster a positive, problem-solving culture across the organisation. This work has resulted in the People and Culture team winning the prestigious HR Team of the Year award in December 2022, presented by the Healthcare People Management Association.

ELFT’s work shows what can be achieved when dynamic technological solutions are partnered with a real desire to improve working conditions for staff on the ground, and when these ambitions are championed by leaders at all levels throughout the organisation.

The collaborative work with ELFT has enabled ImproveWell to further develop our digital solution, so that it can be used as a digital tool to support the IHI Framework for Joy in Work. The solution has subsequently been adopted by the National Collaborating Centre for Mental Health (NCCMH) at the Royal College of Psychiatrists, as part of a national Enjoying Work collaborative to achieve improved workforce wellbeing. The programme aims to enable healthcare teams across the whole country to use these quality improvement techniques to help staff to find ways to connect with what brings them joy in their work, thus enhancing staff wellbeing and morale.

The Institute for Healthcare Improvement launched its Joy in Work collaborative in 2021 and has made the ImproveWell solution available to all participating organisations, including some international partners. This is a great example of the scalability and adaptability of the ImproveWell platform, offering a digital quality improvement tool to diverse organisations across the world. The ability to gather staff feedback 24/7 and to collate it in a bespoke way enables teams and organisations to drive sustainable change, and dramatically improve both the quality of care provided to service users and the experience of work for staff every day.

Helping Trusts to Move Forward

Here at ImproveWell, our experienced team understand the challenges that NHS organisations are experiencing. We have worked with Trusts at every stage of the improvement journey, and we have something to offer everyone, wherever they find themselves in the staff survey league tables.

If you think we could help you and your team to improve staff experience and achieve quality improvements in your organisation, don’t hesitate to reach out for an initial discussion about our services.

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