Strengthening improvement culture and workforce retention at scale: Clinical Governance NHS

An evidence led perspective for NHS Foundation Trust leadership

NHS Foundation Trusts are operating in a period of sustained workforce pressure, increasing scrutiny and rising expectations around culture, quality and assurance. Alongside delivering safe and effective care, Trust leaders are expected to demonstrate how staff experience is understood, how learning is embedded, and how improvement can be evidenced for Boards, regulators and external review.
 

Download the white paper

Delivering our promise to our staff - engage, empower and retain


A practical framework for improvement culture, workforce engagement and assurance

Delivering our promise to our staff - engage, empower and retain is a white paper developed to support this challenge. Drawing on national workforce data, published research and real NHS experience, it explores why retention has become such a critical issue and what organisational leaders can do, now, to address it in practical and sustainable ways.
 
Within this context, effective clinical governance NHS is inseparable from workforce experience. Listening to staff, acting on what is heard and evidencing learning are not optional cultural activities, they are core to safety, quality and long term resilience.

What the white paper covers

The white paper focuses on the underlying drivers of staff morale, satisfaction and retention across large, complex NHS organisations. It moves beyond headline initiatives to examine the organisational and cultural conditions that shape everyday experience at work.
 
It brings together evidence and analysis to support Trust leaders to:
  • Understand the scale and nature of the NHS retention challenge
  • Explore why people leave, and why they stay
  • Identify the organisational levers that influence job satisfaction and morale
  • Strengthen listening, engagement and empowerment at scale
  • Align improvement culture with governance and assurance expectations

Central to the paper is a clear framework for workforce retention, identifying eight interrelated drivers that organisations can influence locally. This provides a practical foundation for a coherent NHS staff retention strategy, grounded in evidence rather than assumptions. It also aligns improvement activity with a wider NHS quality improvement framework, ensuring consistency across services while allowing local adaptation.

Supporting reflection through a practical checklist

Alongside the white paper, a short online checklist is available to support reflection and leadership discussion.
 
Can you evidence improvement culture in your Trust? has been designed to support honest, constructive reflection rather than inspection or scoring. It helps Trust leaders consider whether current approaches to listening, learning and improvement can be clearly evidenced for internal assurance, Board oversight and regulatory review.
 
The questions focus on everyday practice rather than formal policy. They explore how frontline insight is captured, how action is taken, how feedback loops are closed and how learning is demonstrated over time. Used alongside the white paper, the checklist supports leadership teams to translate insight into action in a way that complements the NHS model for improvement.
 
There are no right or wrong answers. Honest reflection is more valuable than a high score.

Why this matters now

National workforce data and independent analysis continue to highlight the scale of the retention challenge facing the NHS. Vacancy rates, sickness absence and intentions to leave remain high across many staff groups, with clear implications for patient care, safety and financial sustainability.
 
In response, Trusts are increasingly expected to demonstrate not just that workforce strategies exist, but that they are working in practice. A credible NHS staff retention strategy is shaped by whether staff feel heard, valued and able to influence improvement in their area of work.
 
In this environment, strengthening improvement culture is not separate from assurance. It is central to clinical governance NHS, enabling organisations to evidence learning, responsiveness and leadership grip. Aligning this work with the NHS model for improvement helps ensure that change is systematic, shared and sustained rather than fragmented or short lived.

A proportionate, evidence led approach

The white paper and checklist deliberately avoid alarmist language or simplistic solutions. They do not suggest there is a single fix for retention or improvement culture.
 
Instead, they focus on the practical steps leaders can take to strengthen listening, learning and empowerment over time, building cultures where staff experience informs action and improvement can be demonstrated with confidence.

Start with the evidence

Download Delivering our promise to our staff - engage, empower and retain to explore an evidence led perspective on workforce retention, improvement culture and assurance across NHS Foundation Trusts.