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The case for staff engagement in healthcare is clear; high-engagement organisations show an 18% increase in productivity, a 23% increase in profitability, a 58% decrease in patient incidents and an 81% decrease in absenteeism.

So why are so many healthcare organisations still seeing staff engagement beyond the annual survey as a ‘nice to have’? Or, even more worryingly, why are they waiting until niggly problems become major issues or reputation-damaging CQC reports before listening to staff in a meaningful way?

Our Chief Medical Officer, Dr Na’eem Ahmed, speaks of his experience on the NHS frontline, saying: “Frontline workers are like smoke detectors. When you truly listen to them, in a systematic, real-time way, you will hear voices that are often drowned out by busy schedules or hierarchy in the NHS. These voices will usually tell you about small issues, which in healthcare are still important. Crucially, trends in these small problems usually add up to paint a bigger picture of a future major issue – like burnout on a mass scale, staff leaving in their droves or safety issues.”

Employees who feel heard are the driving force behind quality care, patient safety, and organisational success. A 2017 study by Salesforce reiterates this, showing that employees who feel their voices matter are nearly five times more likely to be empowered to deliver their best work.

Our CEO Lara Mott, said: “Frontline workers often have the best solutions to problems. Healthcare is an ever-changing environment, so the most successful solutions are usually from the people with current experience of day-to-day life in health and care settings.”

But what happens when communication lines between leadership and frontline staff are broken?

Ultimately, the cost is patient safety. Gallup reported the most engaged NHS teams experienced a staggering 58% decrease in safety incidents (mortality and falls) compared to the least engaged teams and a 64% decrease in safety incidents (accidents).

The endpoint of compromised patient safety results from three main factors, all driven by not listening to frontline staff.

1. Increased staff turnover
When health and care organisations lose experienced staff, this headcount is often replaced with a less experienced professional, but their lack of experience is not accounted for. This means slower decision-making and a higher potential for clinical mistakes, not only affecting patients but increasing the burden on staff who have chosen to stay.

This, in turn, creates a ‘spiralling effect’ that leads to more people opting to leave. As workload pressures intensify, staff experience greater levels of stress and burnout which adversely impacts their physical and mental health, leading to more sick days. Sick days can also be an indicator of people wanting to leave. One study found that a nurse or midwife who missed three days of work for mental health reasons was 27% more likely to leave three months later than a peer with no absences. Gallup’s report also showed a huge reduction in absenteeism of 81% in the most engaged teams.

This is clearly a vicious cycle that is growing in significance – Nuffield Trust research shows in the last decade, the numbers of healthcare professionals pointing to work-life balance, promotion, and health as reasons to leave have all roughly quadrupled. It is a cycle that will spiral quickly if not spotted early through listening to and engaging staff and making improvements suggested by them. It often leads to a domino effect of people leaving from feeling disengaged, to then feeling overworked due to vacancies and inexperienced replacements. Add to these the financial and logistical costs of recruitment, training and plugging the gap with locums, which is a notoriously expensive solution.

2. Low staff engagement and morale
Whilst morale clearly impacts retention and staff turnover, research has also shown a strong link between patient safety and engagement levels. A 2020 study by Zallman, FInigan et al showed that perceptions of patient safety increased between 4% and 11% for every 17% increase in staff engagement. A 2022 meta-review by Scott, Hogden, Taylor and Mauldon on the topic concluded that evidence to support employee engagement’s positive impact on patient safety might be useful in managing the fallout from the COVID-19 pandemic. And a review of NHS Surveys showed higher workforce engagement predicts lower mortality, which in turn predicts engagement – a clear indication of the cost of not engaging for improvement.

3. Missed opportunities for improvement
Improving quality without involving frontline staff is like ignoring a beeping smoke detector. Quality improvement isn’t a solo endeavour; it requires the collective wisdom and expertise of those who intimately understand the NHS. Staff involvement in quality improvement not only leads to more accurate system diagnoses but also generates the most effective change ideas. By not engaging frontline staff, the NHS will miss out on opportunities for meaningful improvement.

The cost of not engaging the healthcare workforce isn’t just measured in pounds lost; it’s also counted in opportunities missed and trust eroded. As health and care organisations face more complex challenges around backlogs, budgets, and an ageing population, it’s more important than ever to listen to those on the frontline. It’s time for healthcare leaders to recognise that meaningful, inspired improvement comes not from leadership or management teams but from those with hands-on experience of the frontline.

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