Southside 105 Victoria Street London, SW1E 6QT T: 020 7932 3700

Project title

Employee Engagement Strategy: Prepared for NHS London

Scope

This strategy has been developed by an initial exploration of the existing employee engagement evidence together with a limited number of stakeholder interviews and focus groups to develop: a statement about what employee engagement means for NHS in London a definition; the case for employee engagement and why it is important; themes that highlight the issues, enablers and barriers for the London health economy; and a set of employee engagement standards.

The rationale for NHS London to commission this piece of work

To develop a common definition of employee engagement for NHS staff across London, through understanding the factors important to staff across the capital. This includes what employee engagement means, why it is important, themes that highlight the issues, enablers and barriers, and a set of employee engagement standards. Research evidence across both public and private sectors supports the notion that staff who are engaged deliver higher productivity and organisational performance, increased operating and net profit, improved customer focus, lower levels of absenteeism and higher retention. An important driver of employee engagement is clarity of leadership vision and direction. The strategy examines seven themes that were consistently highlighted by stakeholders as the key enablers and barriers to employee engagement. Leadership, partnership working, communications, management development, bottom up service development, knowledge base and measurement and recommends ways to address the barriers and increase the enablers. This report was commissioned by NHS London from an independent consultant. The report makes a number of recommendations; however NHS London has not necessarily taken all recommendations into account in the drafting of Workforce for London A Strategic Framework.

Recommendations

London Strategic Health Authority Interim Chair: Michael Bell Chief Executive: Ruth Carnall CBE

HQ: Southside, 105 Victoria Street, London, SW1E 6QT

Employee Engagement Strategy

Prepared for NHS London
By Marianne Huggett, Jenny Parkin, Alex Albert and Helen Morling July 2008

Employee Engagement Strategy Prepared for NHS London

1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

Executive Summary Introduction The approach Employee engagement what is it? Employee engagement why is it important? Consistent themes, enablers, barriers and recommendations The employee engagement standard and indicators Conclusion Bibliography Contact details

3 7 9 11 12 15 37 39 40 41

Employee Engagement Strategy Prepared for NHS London

Section 1 Executive Summary NHS London has a clear ten year vision for the delivery of high quality health care and improved health outcomes for Londoners and is currently working on a workforce strategy that will deliver that improvement. This is in line with the intentions of the NHS Next Stage Review which has quality of care at its heart. As part of that thinking, NHS London requires an employee engagement strategy to ensure that it understands what it can do to help support employee engagement at a system level during this period of transformational change, appreciating that the relationship that staff have is with their employing organisation and improving employee engagement is the responsibility of the employer. It also acknowledges that there are other professional, social and demographic changes that continually change how people relate to their organisations. This means that their loyalty, advocacy and pride cannot be taken for granted and constant attention needs to be given to system level barriers and enablers. Employee engagement describes the involvement of people at all levels in positive two-way dialogue and action to deliver the highest quality patient care and create great places to work where people find their work meaningful and are willing to work together for patients, their colleagues and the future success of their organisation. NHS stakeholders in London. Research evidence across both public and private sectors supports the notion that staff who are engaged deliver higher productivity and organisational performance, increased operating and net profit, improved customer focus, lower levels of absenteeism and higher retention. An important driver of employee engagement is clarity of leadership vision and direction. While NHS London has that vision, there is a challenge to engage leaders across the system in this vision so that they in turn can lead the engagement of their managers and staff in the transformational changes. The strategy examines seven themes that were consistently highlighted by stakeholders as the key enablers and barriers to employee engagement. In addition to leadership these themes cover partnership working, communications, management development, bottom up service development, knowledge base and measurement. Each of these themes is considered and recommendations are made which support the development of employee engagement across the London healthcare system as a whole. The recommendations are summarised below. This is the definition that most closely captures the views of a range of

Employee Engagement Strategy Prepared for NHS London Summary of Recommendations Leadership to enhance employee engagement NHS London to support PCT Chief Executives in navigating the leadership/engagement challenge outlined in Figure 2 above by developing pull rather than push implementation strategies which focus on the agreed better future for patients that embraces higher quality and safety. There is a clear link here to the commissioning framework and how the approach taken can have an influence on local levels of employee engagement. As part of system wide talent management activity, NHS London to ring fence CPD funds for leadership development to ensure that at a local level it is given a consistently high priority Work to secure the longer term leadership capability through inclusion of leadership as a core component of professional training and supporting the London Deanery and HEIs to develop an appropriate high quality leadership undergraduate curriculum. Partnership working to enhance employee engagement Complete the review (and take into account the national review findings) to provide commitment and clarity about the role and strategic focus of the regional partnership forum. Without this clarity the partnership forum is unlikely to have a strong positive impact across the system in building employee engagement, indeed it is likely to undermine it. Once this clarity is in place, invest in supporting the partnership capacity to deliver. This might take the form of secretariat or research support for any work that flows from the partnership discussions to ensure momentum that is not entirely reliant on the good will and capacity of individual members. Once this clarity is in place, invest in the development of the partnership relationships so that there is a shared commitment, understanding and trust to fulfil the role. A mature partnership forum will, for example, produce its own business plan, be able to rely on the good intentions of others even when the going gets tough, is clear about its agenda and priorities and follows through on actions. It can then be seen as a model for local partnership working to follow Encourage at local level the active involvement of staff side in the design, prioritisation and communication of employee engagement strategies.

Employee Engagement Strategy Prepared for NHS London Internal communications NHS London to ensure a steady flow of key messages to senior managers across the system to support the development of understanding and debate around the strategic direction and creating a better future for patients together with support materials which make the messages relevant to different staff groups. Line management development To raise the profile and signal the value of great line managers, an option could be to sponsor an award for best line manager as nominated by their team. This could include categories that reflect some of the specific line management challenges for example best line manager of remote workers, best line manager for the development of potential, etc. Bottom up service development In developing the knowledge base and conference and awards (see next section), ensure that learning from bottom up service improvement activity is highlighted and showcased. In the procurement and evaluation of leadership development, consider how improved employee engagement is included as an outcome. Knowledge base Recommendations Establish a connection with the DH/NHS Employers Engagement Working Group to contribute to its work and enhance the knowledge base that is available to Trusts within London. Develop a knowledge base strategy that signposts the national knowledge base and encourages Trusts in London to add to it. Sponsor a conference and awards event that will show case good practice across London, support knowledge sharing and recognise those whose work to build employee engagement is delivering improvements for patients and supporting the changes in ways of working. The awards and conference could be built around the themes of this employee engagement strategy or Next Stage Review themes such as quality or partnership.

Employee Engagement Strategy Prepared for NHS London Measurement and monitoring Examples of good practice in measurement of employee engagement can be included in the knowledge base activity. The employee engagement standard (see next section) can be linked to the commissioning framework so that Trusts can be required to demonstrate how they are meeting the standard to meet commissioning requirements. NHS London to use the NHS Staff Survey data more extensively to inform its own understanding about how employee engagement varies within and between Trusts. This analysis could be used to inform the areas of focus for internal communications, development of the knowledge base activities and as material available to support leadership and management development activity.

Employee Engagement Strategy Prepared for NHS London Section 2 Introduction NHS London has commissioned the development of an employee engagement strategy to support the NHS London workforce strategy document to be launched in September 2008. NHS London is developing a clear ten year vision for the delivery of health care and improved health outcomes for Londoners. This vision includes providing improved access to care in terms of location and extended hours, developing an infrastructure based around chronic illness and ensuring that the service is affordable in the long term. Lord Darzis report Healthcare for London: A Framework for Action1 sets out a clear direction of travel and underpinning principles intended to lead to improved quality and productivity across the healthcare system. It is in line with the intentions of the NHS Next Stage Review, giving patients and the public more information and choice, working in partnership and with quality of care at its heart. The challenge is to deliver this shift of health care out of hospital and into the community through a PCT lead commissioning regime with services delivered through a diverse mix of high performing autonomous provider organisations. There are naturally significant implications for the workforce in terms of potential changes in skill set, ways of working, location and workforce mix which will be explored in the workforce strategy. The cultural experience of work in community based services will be very different and potentially a different psychological relationship with the employer.2 These implications may motivate or demotivate staff, encourage or undermine willingness to go the extra mile for improved patient experience, safety and quality of care. Staff will choose whether to support or resist the process and progress of these changes. The level of employee engagement is unlikely to remain neutral during this period. There are other system level and demographic changes that may be changing the traditional relationship between staff and how engaged they are with their Trust and the NHS. These changes include: Modernising Medical Careers, EU Working Time Directive, the shift towards partnership working to bring expertise from multiple source - including the perspective of patients and carers - to improve outcomes (e.g. Stroke Strategy), the ageing population and workforce and the different expectations of younger workers in Generation X and Generation Y. In addition there are significant variations across the London health economy in the current levels of engagement. The NHS staff survey provides a comparison of how people perceive their working

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Healthcare for London: Framework for action StaffScope report, Loop2, 2008

Employee Engagement Strategy Prepared for NHS London conditions and experience the NHS both across London and against the national picture3. While it is recognized that this is not a perfect tool for understanding staff engagement, it does indicate some Trusts are more successful in providing a positive experience for their staff than others. These Trusts also tend to be the higher performing organisations suggesting a need to ensure that pockets of good employee engagement practice become the standard across London. From the changes signaled from these multiple perspectives - systemic, demographic, social and performance the current relationship between staff and employer will be challenged and changed over the coming few years. Now more than ever it is important to have a clear and consistent view about how to maintain, improve and harness staff goodwill, expertise and pride for the benefit of patients and public, staff themselves and their organisations, as well as to provide the best customer service possible. It is for this reason that NHS London have commissioned a detailed engagement strategy based on the significant body of research evidence and practical examples of best practice to ensure that all appropriate steps are taken to maintain and improve employee engagement over the coming period of change.

Healthcare Commission

Employee Engagement Strategy Prepared for NHS London Section 3 The approach In developing this strategy it was important to give due attention to the following factors: to draw on the existing employee engagement evidence base and best practice as far as possible within the current context of the NHS in London. to ensure the strategy links with other strands of work and activity driven by NHS London to support that work and to avoid unnecessary duplication (e.g. Staffscope4 programme exploring the workforce aspects of out of hospital care, Clinical Leadership5, - Patient Safety and Clinical Quality Strategy6, Productivity programme7). to position this strategy alongside the national policy development, particular What Matters to Staff8 and the Department of Health policy group staff engagement and involvement9. to reflect the set of NHS values recently derived from extensive discussions with staff, patients and the public- respect and dignity, commitment to quality of care, compassion, improving lives, working together for patients and everyone counts. to build on the existing efforts at local level and acknowledge differing local contexts. This strategy has been developed by an initial exploration of the existing employee engagement evidence together with a limited number of stakeholder interviews and focus groups to develop: a statement about what employee engagement means for NHS in London a definition; the case for employee engagement and why it is important; themes that highlight the issues, enablers and barriers for the London health economy; and a set of employee engagement standards. These specific themes were then explored through the identification of case study organisations who have experienced similar issues and through a small number of workshops that tested the definition and reactions to the themes and potential ways that an NHS London employee engagement strategy might have a positive impact on employee engagement. The draft strategy was further tested with senior representatives of NHS London, NHS Employers, Trust management and clinicians and staff side.

Staffscope, Loop 2 NHS London Building Clinical Leadership across London 6 NHS London Patient Safety and Quality Strategy 7 NHS London Productivity programme 8 What Matters to Staff in NHS, Ipsos Mori for Department of Health, May 2008 9 Department of Health policy group on staff engagement and involvement has recently been established by the DH, with representations from NHS Employers, the NHS trade unions the Healthcare Commission and the Institute for Employment Studies
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Employee Engagement Strategy Prepared for NHS London The requirements of this employee engagement strategy are for the provision of: an agreed definition of world class staff engagement, applicable to NHS staff across London; an evidence base and examples to illustrate the benefits that derive from high levels of staff engagement; an understanding of the issues and barriers to engagement within NHS in London; and an action plan for NHS London setting out how to take forward staff engagement at a strategic level.

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Employee Engagement Strategy Prepared for NHS London Section 4 Employee engagement what is it? There is a complex and detailed body of academic literature that explores the development of the concept of employee engagement over the past 10 15 years. This literature suggests it is more than staff satisfaction, builds on organisational citizenship behaviour and commitment to include intellectual, emotional and behaviour elements and describes the employees sense of identification, advocacy and pride and desire for the organisation to succeed10. Employee engagement is about the employees experience of work. It is about the combination of factors that make the individual feel involved and willing to behave in ways that go beyond the day to day minimum and to work towards the longer term objectives of the organisation. The following definition reflects the elements that staff and managers described as important to make it relevant and meaningful: reference to patients, process and outcomes, value and the two-way nature of the dialogue and relationship.

Employee engagement definition for NHS London Employee engagement describes the involvement of people at all levels in positive two-way dialogue and action to deliver the highest quality patient care and create great places to work where people find their work meaningful and are willing to work together for patients, their colleagues and the future success of their organisation.

The purpose of providing a working definition that reflects the understanding of NHS staff in London is to ensure there is a way of describing a complex concept that makes sense across the system and which is useful to those who are accountable for taking steps to improve employee engagement. An alternative definition may emerge over the coming months linked to national work currently being undertaken on employee engagement and this definition will feed through into that national discussion.

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D Robinson, H Hooker, S Hayday (2007) Engagement: The Continuing Story

Macleod & Brady (2008) The Extra Mile: How to Engage Your People to Win Scottish Executive Social Research (2007) Employee Engagement in the Public Sector A review of literature

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Employee Engagement Strategy Prepared for NHS London Section 5 Employee engagement why is it important? During interviews and focus groups there was an immediate acceptance that employee engagement is important for the benefit of employees, patients and organisational performance. Nevertheless it is important to consider the evidence before directing effort and resource to an employee engagement strategy. Why should senior managers and Trust Boards pay attention to employee engagement? High levels of employee engagement have been shown to have a number of positive outcomes: higher productivity and organisational performance increased operating and net profit improved customer focus lower levels of absenteeism and higher levels of staff retention. The research literature and case studies that attempt to quantify the impact of engagement and disengagement present a more or less consistent view that organisations should take this seriously. They also suggest that typical levels of employee engagement provide a significant opportunity for improvement with consequent positive impact on both organisational performance and staff well-being. For NHS in London improving levels of employee engagement offers the potential to support other actions to tackle the productivity gap between NHS in London and the national picture help connect clinician with the organisational as well as the professional agenda and take on leadership roles focus staff on taking a proactive approach to improvements in quality of service support the approach to managing the changes that will be required across the system in the near future.

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Employee Engagement Strategy Prepared for NHS London The box below provides some of the key facts for making the case for employee engagement, based on research by other organisational development specialists: The case for employee engagement 1. A global study of over 50,000 employees found that those employees who are most engaged perform 20% better and they are 87% less likely to leave.
Corporate Leadership Council 2004

2. Along with a survey of 664,000 employees at 50 global companies, Towers Perrin-ISR compared the financial performance of companies with varying levels of employee engagement over a 12 month period. It found that three financial indicators operating income, net income and earnings per share rose when engagement was high and fell when engagement was low.
People Power, ISR/Towers Perrin, 2006

3. Engaged employees indicate a better understanding of how to meet customer needs 70% versus 17% of the non-engaged workers.
Measuring True Employee Engagement, Right Management, 2006

4. A CIPD research report found that engaged employees take less sick leave, perform better and are more likely to recommend the organisation they work for and are less likely to quit.
Working Life: Employee Attitudes and Engagement, CIPD, December 2006

5. Engaged employees take an average of 2.69 sick days per year while the disengaged average 6.19. Gallup 2003

6. Gallup UK study shows only 19% of employees are actively engaged, a similar proportion are actively disengaged (20%) and the vast majority 61% are neutral representing untapped potential. A CIPD survey is slightly more optimistic with 35% of employees indicating active engagement with their work.
Gallup UK quoted in Meere 2005 Employee Attitude and Engagement Survey, CIPD, 2006

7. A 2004 study found that moving employees from strong non-commitment to strong commitment can result in a 57% increase in discretionary effort. They state that moving from low to high effort levels can result in a 20% improvement in employee performance. They coin this the 10:6:2 rule in that a 10% increase in commitment can lead to 6% increase in effort and this results in an improvement in performance by 2%.
Employee Engagement Survey, Corporate Leadership Council 2004

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Employee Engagement Strategy Prepared for NHS London While many of the examples are from the private sector the conclusion of the Scottish Executive Social Research11 literature review on this subject was that there is no discernable difference between the dynamics of engagement with the public sector as opposed to the private sector. The case for engagement focuses on individual organisational characteristics and context rather than the specific sector that the organisation is in. The research also found that in some areas, such as strategic vision and change management, the private sector performs more strongly suggesting that in these aspects of employee engagement at least there is plenty to learn from the private sector. They do however highlight the caution that the authors of many of the studies cited are frequently responsible for the implementation of solutions and cannot be considered strictly independent. Nevertheless, the case for employee engagement as a driver for performance improvement is strong and consistent. Recently published research by Department of Health explores the factors, particularly the emotional factors, which underpin the working relationships that staff have with patients, colleagues, their profession and their organisation12. It has identified ten factors and the associated management actions that will drive the desired outcomes of motivation to provide high quality patient care, staff advocacy of the NHS, patient satisfaction and public satisfaction. This research has built the case that across the NHS it is important to improve how staff respond to: I understand my role and where it fits in Senior managers are involved with our work I have the opportunity to develop my potential To a lesser extent it needs to improve how staff respond to: I help provide high quality patient care It also needs to celebrate and maintain responses to: Ive got a worthwhile job that makes a difference to patients I feel trusted, listened to and valued at work I am able to improve the way we work in my team. These factors can be identified in the themes that emerged as enablers and barriers to employee engagement for staff in NHS in London and are followed through in the development of this strategy.

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Employee Engagement in the Public Sector a review of literature, Scottish Executive Social Research, 2007 What Matters to Staff in the NHS, Department of Health, Ipsos Mori, May 2008

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Employee Engagement Strategy Prepared for NHS London Section 6 Consistent themes, enablers, barriers and recommendations Throughout our initial research, focus groups and interviews, we were able to explore the following themes: the current understanding of employee engagement what is happening at present which is affecting the level of staff engagement both positively and negatively how staff and management know when engagement is being done well the role of NHS London in employee engagement. The data collected during these interviews and focus groups was analysed and synthesised to identify the recurring themes which present the current barriers and enablers to employee engagement. The initial focus of discussions was the local nature of employee engagement activity as the responsibility of local Trusts and the very different contexts in which they operate. For example some Trusts have higher turnover levels, not necessarily as an indicator of poor employee engagement but reflecting the teaching status which attracts people from a wide area for a short period and who then return to work more locally. There was clearly an appreciation that any regionally driven initiative would be unlikely to meet local needs one size wont fit all - and that NHS London must necessarily focus at a system level. There was limited appetite for new checklists, models and tools, which many thought already existed embedded in recent work such as Improving Working Lives, aspects of DH audit tools and the Public Service Forum Drive for Change. The themes that emerged as barriers and enablers to high level employee engagement are highlighted with the understanding that some will be addressed locally while others will benefit from an NHS London system wide response. They also provide a basis for indicators to support a Standard for employee engagement which may be used to ensure that consistent attention is given to employee engagement across the healthcare system (see Section 7). The initial interviews and focus groups also identified specific issues for further exploration through case study examples which would be relevant and pertinent to the current climate of the NHS in London. 6.1. Issues to be explored through case studies

Case studies have been included as part of the evidence base to describe how other organisations have gone about building employee engagement. The organisations that were approached were from 15

Employee Engagement Strategy Prepared for NHS London across the public, private and third sector. They are included both on the basis of good practice but also to explore how they have responded when faced with similar issues. The issues identified were: 1. The role of key groups: senior management, unions, the centre/headquarters: This includes an exploration of who holds accountability for employee engagement and how governance arrangements support it. 2. The role of employee engagement as an enabler of change and continuous improvement: This explores how employee engagement is used to support the formal mechanisms and approach to change. This also considers how different forms of internal communications are used to support employee engagement. 3. Employee Engagement across a diverse workforce and diverse operating environments: This provides evidence for how much variation is used across different groups of employees. 4. World class cities: This explores whether there are any clear lessons to be learnt about applying employee engagement strategies in major cities. 5. The role of standards, measurement and monitoring: This includes the application of available data to prioritise engagement activity and the importance organisations place on different sources of measurement data. The following organisations were approached because they had experienced some of the same issues, enablers or barriers to employee engagement and are therefore able to provide insight into the choices they made even thought the context is unlikely to be identical. We are grateful to these organisations for their prompt co-operation in developing these case studies.

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Employee Engagement Strategy Prepared for NHS London Issue Organisation Royal Bank of Scotland NFU Save the Children Tesco Vodafone 1. Role of key groups 2. Supporting change 3. Diversity 4. World class cities 5. Measurement

6.1.1. Key learning from case studies No one-size-fits-all approach In large organisations working across different environments with a significantly diverse workforce, a central standard employee engagement approach helps all areas of the organisation to prioritise and be creative within a standard process. Save the Children recognised that due to the diverse nature and spread of their organisation, whilst support and guidance for the action planning process to build improved employee engagement could be provided, there was no one size fits all approach that could be imposed on the country programmes. The development of simple engagement wheels enabled Save the Children to focus attention on key factors of engagement and see an overall picture at regional level while giving maximum freedom of action locally. Good internal communications ensure buy-in at all levels Bringing together top down and bottom up approaches to change requires supportive internal communications for staff to become engaged with organisational strategic objectives. One of the major learning points for NFU Mutual Insurance has been the importance of combining a top down and bottom up approach, and not attempting to devolve the implementation of the change strategy too early. Getting the message to more junior staff has been a particular challenge and has taken lots of communication and work with managers helping them to interpret what engagement means in their areas.

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Employee Engagement Strategy Prepared for NHS London Recognition promotes increased levels of staff engagement Innovative recognition structures are one way to promote greater staff engagement in positive and mutually beneficial ways, and not at a great cost to the organisation. At RBS the aim of creating recognition structures was to reward the employee in a memorable way and enhance the relationship. RBS operate a principle that everyone is eligible for recognition, that the rewards of recognition are not to solely the top performer, and that recognition is frequent, immediate, relevant and public. The case studies provide a different perspective on the emerging themes and have been used to enhance the strategy and recommendations. 6.2. Emerging themes, barriers and enablers

Throughout the initial interviews and focus groups there were high levels of agreement that employee engagement is an important topic for Trust management with varying degrees of confidence expressed about understanding it and the strategies to improve it. Seven themes emerged as current barriers and potential enablers. These themes were examined in relation to research evidence, best practice and case study examples and were further tested with a second round of interviews and workshops across a range of stakeholders. These themes are the recommended building blocks of the NHS London employee engagement strategy.

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Employee Engagement Strategy Prepared for NHS London Figure 1: The Building Blocks of Employee Engagement for NHS across London

While not a direct comparison, The Work Foundations model of employee engagement shows a wider range of drivers of employee engagement. A high level analysis of London NHS staff survey data suggests that engagement levels for several of these drivers are currently high (Figure 2). It should be noted that the NHS staff survey data does not map across neatly to all these areas. The areas in gold and green are currently the strengths of employee engagement across the system.

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Employee Engagement Strategy Prepared for NHS London Figure 2: Indicative Employee Engagement Wheel for NHS London

Empowerment 70% Health & Wellbeing 63% Reward & recognition 30% Community 51% Alignment with values

Personal Growth 78%

Fulfilment through Work 60%

Life at work
Life at work Strategic

Corporate Corporate values values

EMPLOYEE ENGAGEMENT

LeaderLeadership ship

Involvement & Voice

Supervision Supervision

Trust & confidence In leadership

Managing performance 51%

Relationship 73%

6.2.1

Leadership

As predicted by the employee engagement research, leadership is a key building block for improving engagement across the NHS workforce. Leadership emerges as a requirement in terms of clarity of vision13, the trust in senior management14, leadership for empowerment15 through the interviews and focus groups. Leaders need to gain agreement for the change and then convert that into practical ways that people can contribute to it and make it happen Employer representative

The challenge is making the vision real and ensuring staff get behind it. Managers and Directors need credibility and need to show they understand the service and operation. It is difficult to personally reengage with staff once trust is lost. Acute Trust HR Director

13 14 15

Melcrum 2006 Towers Perrin 2003 Talent Report People Power, ISR/Towers Perrin, 2006

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Employee Engagement Strategy Prepared for NHS London Senior level roles are expected to change as they are empowered and given more scope to make decisions we are currently a command and control organisation but we dont need to be for all things. HR Director

The leadership challenge with a Trust is split between two roles: NHS Trust leaders need to be visible within their organisations and clearly communicate local information but they also need to be able to communicate Trust changes within the context of the national vision which they may not understand or agree with. NHS London representative

There is clearly a need for clinicians and Trust leaders to advocate changes to all levels of the workforce. For high impact these advocates must have professional credibility. However, it is also clear that NHS London cannot take that advocacy for granted. For example the StaffScope report explores the perceptions of leading clinicians and managers about how the future may unfold with respect to out of hospital care. They conclude there remains a large communication and engagement task to be undertaken to ensure that the full spectrum of Londons clinical and non-clinical workforce understand the Healthcare for London agenda and the part they need to play in its delivery16 We would endorse this conclusion and suggest that front line engagement with the transformational changes will be damaged and potentially unable to progress in any really credible sense unless those who lead them are themselves engaged. Figure 3 below illustrates that without effort given to developing leaders understanding and agreement of the direction of change, their own engagement in leading their managers and front line staff will be compromised. This leaves little opportunity for front line staff to understand and engage with the changes effectively. This is not to suggest that change should be paralysed by discussion and the need to reach complete agreement. It does, however, suggest that pushing forward without it is likely to lead to growing disengagement and finding ways to pull sufficient people towards the future vision is the leadership challenge. At the same time leading the involvement of front line teams in identifying improvements can begin to drive changes too. This mirrors the findings in the recent review of successful change implementation in social and health care services which recommends a focus on three areas for action: leadership that propels change and improvement; employee involvement and participation and stakeholder involvement and participation.17

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StaffScope, Loop2, 2008 (taken for draft not for circulation permission to quote required) SCIE Knowledge Review 16; Improving social and health care services, Fauth and Mahdon, Nov 2007

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Employee Engagement Strategy Prepared for NHS London There is also a leadership challenge in the What Matters to Staff in the NHS18 report with two of the three areas highlighted for action to improve employee engagement directly associated with leadership capability and style: I understand my role and where it fits in Senior managers are involved with our work. In this sense our leadership challenge echoes this, as reflected in figure 3 below:

Figure 3: The leadership/engagement challenge

The need to improve leadership capability at all levels has already been recognised at national, regional and local level. The national workforce strategy that has been published by the Department of Health as part of Next Stage Review, recommends changes to the clinical education curriculum so that leadership is embedded as a core activity for all clinicians at each stage of their career.19 The role of clinicians is clearly described in terms of Practitioner, Partner and Leader.

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What Matters to Staff in NHS, Ipsos Mori for Department of Health, May 2008 NHS Next Stage Review- A High Quality Workforce, 30th June 2008

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Employee Engagement Strategy Prepared for NHS London NHS London has already established a leadership programme aimed at Board and Executive level development as the priority area for NHS London support. While it is understood that leadership is distributed throughout the organisation, currently these wider leadership needs are met through individual PCTs and Trusts. Underpinning all NHS London leadership development thinking are the three principles of raising standards, change and diversity. For example, the procurement of leadership development clearly specifies the desired outcomes and encourages potential suppliers to develop the best combination of approaches to deliver those outcomes. Applications for development clearly signal change and encourage diversity through self nomination and application processes that encourage reflection on potential benefits and future aspiration rather than factual tick boxes. At a local level, leadership capability is enhanced through a variety of mechanisms: master classes with invited external speakers20, buddying with other major employers (outside the health sector)21 and through Board challenges to clinical leaders to present how their teams are the best in the world and if theyre not, explain what they will do to become so22 and not least through the role modelling by senior leaders through visibility, clarity and enthusiasm for corporate objectives and values.23 These examples illustrate local good practice. They are not intended as a comprehensive or exhaustive statement of leadership development activity. The StaffScope study identified the need for enhanced leadership skills across the system and the application of those skills in practice to implement out of hospital working. Change management skills are required for the implementation of changes, and a different level of support is required by staff who may spend a larger proportion of time working alone. There will also be a greater need to lead across organisational boundaries. At a local level there is potential for larger Foundation Trusts to develop their own leadership development programmes with a sizeable cohort of managers and clinical leaders to make the procurement and development of a bespoke programme a possibility. For the smaller Trusts and PCTs it is a bigger challenge to develop leadership skills although again there are clearly pockets of good practice and role models to emulate.

Imperial Health, UCLH UCLH 22 Great Ormond Street Hospital 23 Hillingdon PCT
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Employee Engagement Strategy Prepared for NHS London Leadership to enhance employee engagement - Recommendations The demands on leadership, and through leadership to improve employee engagement, will intensify during the coming few years of change. Building leadership capability throughout the system at all levels is an important role for NHS London and these recommendations are intended to support and extend the current Leadership Programme.

Leadership to enhance employee engagement - Recommendations 1. NHS London to support PCT Chief Executives in navigating the leadership/engagement challenge outlined in Figure 3 above by developing pull rather than push implementation strategies which focus on the agreed better future for patients that embraces higher quality and safety. There is a clear link here to the commissioning framework and how the approach taken can have an influence on local levels of employee engagement. 2. As part of system wide talent management activity, NHS London to ring fence CPD funds for leadership development to ensure that at a local level it is given a consistently high priority 3. Work to secure the longer term leadership capability through inclusion of leadership as a core component of professional training and supporting the London Deanery and HEIs to develop an appropriate high quality leadership undergraduate curriculum.

6.2.2. Partnership Working Employee engagement is sometimes taken to mean the formal mechanisms for dialogue between employers and staff representatives and an effective collective voice for staff is an important element of engagement. Within NHS there is a commitment at national level to the Social Partnership Forum (SPF) with a formal tripartite agreement between Department of Health, NHS Employers and NHS Trade Unions to ensure timely involvement in the development and implementation of workforce implications of policy. There is currently a review of SPF that includes within its scope the effectiveness of the links between national and regional Partnership activity. This review is due to report in August 2008 and may provide helpful input to consideration of the role of partnership working at regional level. At NHS London there has recently been discussion about the role of Partnership and suggested changes to membership and how it links to other meetings, such as the HRD Network, to avoid 24

Employee Engagement Strategy Prepared for NHS London duplication and repetition. An issue it is seeking to address is the low levels of attendance by employers representatives. While it has had support from senior NHS London management, the Partnership Forum does not yet appear to have established a clear or ambitious sense of purpose. The need for an ambitious system wide agenda is recognised by some: There is a real issue here around employment security. If staff felt that their employment in London was protected and secure, they might then have the opportunity to be more engaged. Employer Representative What is needed, and what the national level employee engagement work should aim to do, is to provide a framework for managing change. Employer Representative

If the strategy and workforce implications are agreed between Trusts and the Unions, partnership working would be a good sign of employee engagement. Employee engagement is a way to do things rather than a thing to do. It tends to be an issue that drives partnership working, either locally or nationally. When there is a lull on issues, less people are involved. Staff Representative

There appears to be considerable variation in partnership working at local level and it is seen as one indicator of levels of morale and engagement. There appears to be relatively little connection between regional and local partnership working and at local level the bigger picture is often obscure and limited to the next few months. The expectation is however that the commitment to partnership working should continue through to local level and be visible through the involvement of staff side in the design, prioritisation and communication of employee engagement strategies. We dont always know what is going on or coming up and arent geared up to respond proactively Trust JCC comment Partnership working to enhance employee engagement - Recommendations With a significant change agenda on the immediate horizon, then the Partnership Forum should not lack issues to provide a focus for discussion and action. For example, developing agreed principles and frameworks which can provide an agreed starting point for the local negotiations, proactive discussion and implementation plans. While not wishing to pre-empt the current review, these recommendations indicate what would seem to be necessary steps to ensure that employee engagement is enhanced rather than diminished by the role and performance of the Partnership Forum.

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Employee Engagement Strategy Prepared for NHS London Partnership working to enhance employee engagement Recommendations 1. Complete the review (and take into account the national review findings) to provide commitment and clarity about the role and strategic focus of the regional partnership forum. Without this clarity the partnership forum is unlikely to have a strong positive impact across the system in building employee engagement, indeed it is likely to undermine it. 2. Once this clarity is in place, invest in supporting the partnership capacity to deliver. This might take the form of secretariat or research support for any work that flows from the partnership discussions to ensure momentum that is not entirely reliant on the good will and capacity of individual members. 3. Once this clarity is in place, invest in the development of the partnership relationships so that there is a shared commitment, understanding and trust to fulfil the role. A mature partnership forum will, for example, produce its own business plan, be able to rely on the good intentions of others even when the going gets tough, is clear about its agenda and priorities and follows through on actions. It can then be seen as a model for local partnership working to follow 4. Encourage at local level the active involvement of staff side in the design, prioritisation and communication of employee engagement strategies.

6.2.3. Communications The role of internal communications as an enabler and barrier to employee engagement emerged as a strong and consistent theme during the interviews and focus groups. Proper, regular and useful information gets rid of uncertainty; it enables staff to focus on their role, being aware of how their role fits in. It can assist with knowledge sharing and supports organisations going through change. NHS London Director

The most powerful communications is face to face, getting the CEO of a Trust in front groups of staff, providing them with the opportunity to sell an idea to their staff hugely powerful. Acute Trust HRD

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Employee Engagement Strategy Prepared for NHS London Primary Care and Community services work out in the community so it is more difficult to have team meetings, etc tend to operate with a much greater degree of independence in working with patients. PCT HR Director Staff will report communications as not being done well but team briefing is logistically difficult another line management development area to ensure that the Trust and its managers are putting team brief into context for their teams and encouraging two-way communication on it. Foundation Trust HR Director We are trying to establish team briefing) but this is challenging due to finding shift overlap time. We have a vision of Hill St Blues concept. HR Director

The case for change has been made - but not communicated clearly to staff or public. Board Member We need to stop using business language and develop a new language with staff. Acute Trust HR Director These comments are in line with the challenges faced by many organisations to get internal communication right. Certainly recent research24 underlines the importance that: having a compelling strategic vision is of little use unless it is communicated and debated organisations cannot achieve agility in the face of change without ensuring that employees know what is expected of them and that they have enough up-to-date information to perform well in changing circumstances internal communication processes need to facilitate the flow of good ideas from wherever they originate. There is however a sense in which the comments emphasize top down thinking and processes while the definition of employee engagement stresses the twoway dialogue recognising that people do not just receive, they interpret and sense-make in the light of their own fundamental values and attitudes. It is therefore helpful to think about internal communications in terms of relationship as well as process and is as much to do with staffs relationships with their line managers.25

24 25

IC:UK report, 2007 Towers Perrin 2003

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Employee Engagement Strategy Prepared for NHS London Internal communications to enhance employee engagement - Recommendations Effective internal communications plays an important role in building employee engagement. The role of NHS London is secondary in this respect to local communications through Trust Executives and line managers. Nevertheless it can help by providing key messages, by helping build a vision of the future, sharing examples of how organisations within London are managing communications, particularly within dispersed teams and providing feedback loops to inform a knowledge base. It can acknowledge that the local resource to support managers and internal communications is likely to be highly variable.

Internal communications Recommendations 1. NHS London to ensure a steady flow of key messages to senior managers across the system to support the development of understanding and debate around the strategic direction and creating a better future for patients together with support materials which make the messages relevant to different staff groups.

6.2.4. Line Management Development In addition to leadership skills, the need for the development of line managers was highlighted as a key barrier to staff engagement. Without good line management, high employee engagement is even harder to achieve. Many managers lack management skills in giving and receiving feedback including handling difficult staffing issues early on (before they are formalised into grievances and disciplinary procedures). PCT HR Director There are many HR practices that link to employee engagement. However; the most influential element of engagement is the line manager. When line managers behave in the right way, performance management is improved, absence is reduced etc. a bad line manager can undermine everything else an HR function can do so this is surely where to concentrate efforts. Foundation Trust HR Director In terms of manager development, it isnt just about training, coaching and mentoring is good ongoing development and the point of recruitment needs to be done carefully too lots of managers in the NHS become managers because they are good at their clinical expertise but they are not necessarily good managers. Foundation Trust HR Director

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Employee Engagement Strategy Prepared for NHS London This theme is picked up again in the StaffScope Out of Hospital report not just in terms of development but also in terms of boundaries of the role. Clinicians are not always properly supported to develop the leadership and management skills they need to manage their team. There is not always sufficient clarity about the boundaries of the managers responsibility, particularly with respect to the tasks that line managers are expected to undertake and what will be done by human resource specialists.26 There is also consideration of how to raise people management skills at national level and the possibility of a set of NHS specific national standards and national developments in this area may be helpful. Just as the need to encourage clinicians to understand their role in leadership, the message extends to a higher value being placed on people management skills. Poor line management skills undermines employee engagement and therefore developing capability in this area is key to improving engagement levels. In the context of change, this becomes more important so that managers are confident of their skills in a stable situation and can apply them through a period of change when there are always additional demands on line managers to advocate the way forward and manage the impact of change on the team. This is recognised at local level, with a PCT Chief Executive indicating this as a higher priority than leadership skills. As with leadership development, there are pockets of good practice and activity to build management skills. This tends to be done via networks, master classes and learning set rather than through formalised training programmes. Also there is potential for the larger Foundation Trusts to develop their own management development programmes with a large cohort of business and clinical managers to make the procurement and development of a bespoke programme a possibility. For the smaller Trusts and PCTs it is a bigger challenge to invest effectively in management development activity.

26

StaffScope, Loop2, 2008

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Employee Engagement Strategy Prepared for NHS London Line management development to enhance employee engagement - Recommendations

Line management development Recommendations 1. To raise the profile and signal the value of great line managers, an option could be to sponsor an award for best line manager as nominated by their team. This could include categories that reflect some of the specific line management challenges for example best line manager of remote workers, best line manager for the development of potential, etc.

6.2.5. Bottom up service development Employee engagement is based on the relationship between the individual and their organisation and is heavily influenced by the line manager and immediate team. How levels of employee engagement are developed and improved is therefore a matter for Trust management teams. One of the themes that emerged through stakeholder conversations was the importance of taking a bottom up approach to service development by encouraging staff to identify improvements, to consider some of the team implications of wider organisational challenges and to give ownership of the implementation of ideas to the team. This approach clearly puts into action the elements of the employee engagement definition by involving staff in the issues and solutions, and makes work meaningful by focusing on improvements for patients. It should be endorsed by NHS London. This is in line with the Next Stage Review which emphasizes working in partnership and will empower frontline staff to lead change that improves quality of care for patients. Bottom up service development challenges some current descriptions of what happens at local level and the shift that is required to make it happen. We need to find opportunities where staff can genuinely influence the future development of the service in particular bringing their experience of delivering at the front line to the discussion. PCT HR Director The service only runs through people, it is their organisation so it is about helping them to understand this to gain their commitment. You can do this by involving them in decision-making so that they have more ownership of changes and improvement giving them a say. PCT HR Director

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Employee Engagement Strategy Prepared for NHS London We need to give them more confidence to take the driving seat rather than expecting them to follow rules made up by others. NHS London

The StaffScope study participants highlighted what they are looking for from their employers. One element includes bottom up service development good employment practice, where staff feel valued, supported in developing their skill and both empowered to and supported in improving healthcare27 As well as local examples of bottom up service development in practice there are also wider health sector examples within the NHS to draw on, for example the writings of Atul Gawande28 exploring the idea of positive deviance . Beyond endorsement of this approach, this is not an area for direct NHS London activity. The SHA occupies a system-wide improvement role and clearly cannot enforce new strategies on the Foundation Trusts. Employer Representative

Nevertheless the importance of encouraging bottom up service development and involvement in implement change is clear. A JCC representative summed it up as follows: We know there will be work coming up to look at the sustainability of the eighteen week target. They will probably bring in an external consultant to do the work because we dont have time. If we came up with the answers then at least we would have some incentive to put them into practice. Staff side representative It follows that there may be some limited scope to encourage Trusts to shift resource from using external resource in this way to providing additional time-limited temporary support to free up team members to develop service improvements themselves. Bottom up service development to enhance employee engagement - Recommendations There is limited scope for NHS London to take direct action on supporting bottom up service development directly. It does need to ensure that it is endorsed through other elements of this strategy.

27 28

StaffScope, Loop 2, 2008 Atul Gawande (2007) Better: A Surgeons Notes on Performance

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Employee Engagement Strategy Prepared for NHS London Bottom up service development Recommendations 1. In developing the knowledge base and conference and awards (see next section), ensure that learning from bottom up service improvement activity is highlighted and showcased. 2. In the procurement and evaluation of leadership development, consider how improved employee engagement is included as an outcome.

6.2.6. Knowledge base The diverse nature of the organisations working within the system and units which work in isolation makes the identification and sharing of best practice difficult. There is a tension that best practice can be seen as a one size fits all response which will be rejected as not appropriate to the local context. There is a risk that each organisation will reinvent the wheel so that they own the solution. Nevertheless the potential for NHS London to play a role in capturing and dissemination ideas and good practice emerged as a theme. There is a huge amount of good work going on and best practice to be shared so information needs to be shared that will save time and money. For those who lack confidence, we can point them to those that do it well. NHS London NHS London

It is very difficult to copy best practice, to emulate it. Instead we tend to chop success off at the legs, even try to undermine it. We can share good practice but perhaps as a menu of things that organisations might like to try. NHS London

There was also concern that insufficient attention was given to celebrating and communicating achievements. We are very bad at communicating e.g. Connecting for Health has worked very well, ESR hasnt really cost the country much at all for the value it adds, and we should be celebrating these achievements. NHS London

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Employee Engagement Strategy Prepared for NHS London The idea of a conference to share information across the system and celebrate success was expressed on a number of occasions. There are examples of this happening successfully at a local level. Great Ormond Street hospital holds staff recognition awards which are motivating for staff. Staff and patients can nominate, and we are running a series of articles in our newsletter setting out why they were nominated. I think things like this make us feel more like a team as we share in the success and sense of community. Foundation Trust HR Director

We could do with an annual NHS London conference for everyone to get together; this would be celebratory and motivational. NHS London

There is currently a national working group focussing on understanding and collecting examples of good practice in employee engagement29. Connecting to this work would avoid duplication of effort and would mean Trusts could draw on a wider established knowledge base already signposted on NHS Employers website. Recognition schemes have long been used as a means of highlighting strong performance, celebrating good practice and reinforcing desired behaviours. RBS are currently reinvigorating their approach to recognition by making it personalised and the initial impact has been highly favourable. Knowledge base to enhance employee engagement - Recommendations

Knowledge base Recommendations 1. Establish a connection with the DH/NHS Employers Engagement Working Group to contribute to its work and enhance the knowledge base that is available to Trusts within London. Develop a knowledge base strategy that signposts the national knowledge base and encourages Trusts in London to add to it. 2. Sponsor a conference and awards event that will show case good practice across London, support knowledge sharing and recognise those whose work to build employee engagement is delivering improvements for patients and supporting the changes in ways of working. The awards and conference could be built around the themes of this employee engagement strategy or Next Stage Review themes such as quality or partnership.
29

See NHS Employers website for details: http://www.nhsemployers.org/

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Employee Engagement Strategy Prepared for NHS London 6.2.7. Measurement and monitoring The Healthcare Commission run an annual survey of NHS Staff. There seem to be extreme views about the usefulness of this data as a source understanding staff attitudes and levels of engagement. The annual staff survey is very poor, less than 50% buy into it and we never know why people complete it (positive or negative reasons?). As a means of judging engagement its a bad science. NHS London The long time lag between completion and results being available makes it very hard for Trusts to appropriately action plan, and also can result in Trusts or the NHS in general receiving bad press on certain issues which may well not be issues anymore. NHS Trust HR Director

The staff survey measures relative negativity. For example they ask staff if they plan to leave they dont ask why they stay or what they value about working in the NHS or most enjoy about their work. PCT HR Director

Staff survey results are a good indicator it goes to all staff in our area with a 63% return rate. PCT HR Director There now exists around five years worth of trend data which would be useful in terms of highlighting the drivers for change. Commissioners should start to use that data to raise the alarm bells on the quality of the services being commissioned. This is a potential way to raise levels of accountability in engagement and make the provider more accountable for the services they provide. Employer Representative Were commissioning a separate piece of work with Mori to go into more detail on the staff survey results so that we get some qualitative data that we can actually take action on, rather than just a temperature check that the staff survey provides. Foundation Trust HR Director

In terms of measuring success, we will look at performance, sickness, turnover and survey results. HR Director We do a thorough analysis, communicate it to managers and staff in a number of ways, develop action plans and use the data to support business planning and decision making. Foundation Trust HR Director

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Employee Engagement Strategy Prepared for NHS London There are clearly very different views on the usefulness of the current NHS staff survey. The most negative appear to make assumptions that the staff survey cannot be made into something useful, while the most positive address any shortcomings for example by adding some questions specific to their needs. There was an indication that interest in staff survey results is growing at Trust Board level as they become aware of the link between performance and employee engagement. At a national level some of the challenges about the survey content have been addressed and some changes made to reflect the What Matters to Staff in NHS findings. This has been done in a way that allows continuity so that the ability to track trends is maintained. A Department of Health sponsored working group is currently addressing some of the process concerns. The case studies indicate how other organisations are using their staff surveys to understand the varying levels of engagement of different staff groups by function, age, grade, length of service, location, etc. so that they might develop a deep insight into the patterns of engagement and can prioritise appropriate responses. They also use other HR metrics (usually staff turnover, sickness absence) in a systematic way to understand and respond to changing levels of employee engagement. Furthermore, the literature on employee engagement reinforces the fact that there is no substitute for properly gauging the temperature of staff attitudes in terms of engagement. While clearly there are pockets of good practice in the use of measurement of staff engagement within the London healthcare system, the impression over all is that this is patchy. This is particularly true in terms of connecting the softer staff survey data with harder HR metrics. There was a mixed response to the suggestion that the NHS Staff Survey is a key data source for NHS London to understand employee engagement partly based on the lack of confidence in survey itself and partly based on the new relationship between NHS London, PCTs as commissioners and Trusts, particularly Foundation Trusts. There was a reminder that NHS London cannot mandate actions of this type. The staff survey already forms part of the Healthcare Commission Annual Health Check and through this route can begin to raise questions in the mind of Commissioners about the quality and sustainability of delivery. It could be added to the Commissioning standards framework or form part of the evidence to meet the employee engagement standard (see Section 7). Measurement and monitoring to enhance employee engagement - Recommendations There is scope to encourage a more consistent use of the NHS Staff Survey. This can be supported by national work which will produce a business case to illustrate positive outcomes within NHS and external organisations by Autumn 2008.

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Employee Engagement Strategy Prepared for NHS London Measurement and monitoring Recommendations 1. Examples of good practice in measurement of employee engagement can be included in the knowledge base activity. 2. The employee engagement standard (see next section) can be linked to the commissioning framework so that Trusts can be required to demonstrate how they are meeting the standard to meet commissioning requirements. 3. NHS London to use the NHS Staff Survey data more extensively to inform its own understanding about how employee engagement varies within and between Trusts. This analysis could be used to inform the areas of focus for internal communications, development of the knowledge base activities and as material available to support leadership and management development activity.

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Employee Engagement Strategy Prepared for NHS London Section 7 The employee engagement standard and indicators NHS London is committed to improving employee engagement throughout the London healthcare system and ensure staff are led and managed consistently well at a local level in line with the national NHS values and What matters to staff in the NHS. This standard and indicators describe the elements we believe will deliver great places to work, that are productive and encourage staff to work together and support changes that are in the best interests of patients. NHS London Employee Engagement Standard

All leaders and managers are able to describe what they are doing to maintain and improve employee engagement within the context of their organisation

Indicators of the standard being met: Leadership Vision and strategic direction leaders have articulated a powerful vision for their organisation in the context of Healthcare for London Staff understand and are able to articulate organisational and departmental objectives and can see how their work and changes contributes to the bigger picture Staff have trust and confidence in senior leaders and believe in the good intention of the senior team to consider the best interests of patients and staff when making decisions. Partnership Employee representatives and managers have constructive relationships even when the going gets tough Members of JCCs and Partnership Forums are clear about their shared priorities and follow through on actions. Communications Managers across the system are consistently and confidently delivering key messages All internal communication process emphasise the two way nature of the channel so that staff feel listened to and senior managers understand how their messages are heard and are brought closer to the front line. People Management Employees know whats expected of them, are set clear standards of performance, and know that they are to be held accountable by their manager

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Employee Engagement Strategy Prepared for NHS London Managers support and develop staff and are effectively recognising and valuing employees contribution HR policies and practices continue to focus on improving working lives principles. Bottom up Service development Staff are willing to put forward ideas to improve patient care and services, in the expectation that they will be heard and given the opportunity to follow them through Staff have the data to understand and compare team performance with the best and identify areas for improvement Staff have scope to respond to patient need within agreed quality and safety guidelines. Knowledge base Examples of excellence are shared, recognised and celebrated. Measurement and monitoring Quantitative and qualitative data is collected to understand What Matters to Staff within their organisation Staff survey results and action plans are on the Board agenda Senior management have a deep understanding of differing levels of engagement and the implications for their strategic priorities.

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Employee Engagement Strategy Prepared for NHS London Section 8 Conclusion The research evidence from across the public and private sector points to improvements in employee engagement leading to higher productivity and transformational change. While this is the prize, there are considerable barriers that will require capable and engaged leadership and this cannot be taken for granted. The role of NHS London in promoting employee engagement has to be one of enabler and others in the system are looking for signals of top down control rather than two way dialogue and involvement. This employee engagement strategy is intended to help you navigate this fine line of needing to drive significant changes in a way that encourages and supports local Trusts and teams to step forward and take on the challenges.

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Employee Engagement Strategy Prepared for NHS London Section 9 Bibliography Atul Gawande (2007) Better: A Surgeons Notes on Performance Chartered Institute of Personnel Development (Dec. 2006)Working Life: Employee Attitudes and Engagement Chartered Institute of Personnel Development (2007) Employee Engagement Available online at: http://www.cipd.co.uk/subjects/empreltns/general/empengmt.htm?IsSrchRes=1 Corporate Leadership Council (2004), Employee Engagement Survey, 2004 Corporate Executive Board. Corporate Leadership Council (2004a), Driving Performance And Retention Through Employee Engagement, 2004 Corporate Executive Board. Department of Health and Ipsos Mori (May 2008) What Matters to Staff in the NHS Fauth, R, and Mahdon, M. (2007) Improving Social and Health Care Services Healthcare for London: A Framework for Action (July 2007) Sarah Harvey and Laurie McMahon (July 2007) Healthcare for London Staffscope: understanding the future needs for Londons health and social care workforce ISR/Towers Perrin (2006) People Power Macleod, D. & Brady, C. (2008) The Extra Mile: How to Engage Your People to Win Pearson Publishing Right Management (2006) Measuring True Employee Engagement Robinson, D. Perryman, S. Hayday, S. (2004) The Drivers of Engagement Institute for Employment Studies Robinson, D. Perryman, S. Hayday, S. (2007) Engagement: The Continuing Story Institute for Employment Studies Scottish Executive Social Research (2007) Employee Engagement in the Public Sector: A review of literature Scottish Executive Tamkin, P. (2005) The Contribution of Skills to Business Performance. Institute for Employment Studies Towers Perrin Global Workforce Study (2007-2008) Closing the Engagement Gap: A Road Map for Driving Superior Business Performance Towers Perrin (2003) Talent Report West M.A.; Borrill C. et al. (2002) The link between the management of employees and patient mortality in acute hospitals 40

Employee Engagement Strategy Prepared for NHS London Section 10 Contact details Prepared for: Julie Screaton/Anne Rainsberry/Partnership Forum NHS London Southside Victoria Street London SW1 Tel: 020 7932 3700

Prepared by: Marianne Huggett, Jennifer Parkin, Alexandra Albert and Helen Morling The Work Foundation 21 Palmer Street London SW1H 0AD Incorporated under Royal Charter, Registered Charity Number 290003 www.theworkfoundation.com Tel: 020 7976 3542 mhuggett@theworkfoundation.com

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NHS London Employee Engagement standards

What is employee engagement? Employee engagement describes the involvement of people at all levels in positive two-way dialogue and action to deliver the highest quality patient care and create great places to work where people find their work meaningful and are willing to collaborate for patients, their colleagues and the future success of their organisation.

NHS London is committed to improving employee engagement throughout the London healthcare system and ensure staff are led and managed consistently well at a local level in line with the national NHS values and What matters to staff in the NHS. These standards describe the elements we believe will deliver great places to work, that are productive and encourage staff to work together and support changes that are in the best interests of patients.

Employee engagement standard

All leaders and managers are able to describe what they are doing to maintain and improve employee engagement within the context of their organisation

Indicators of the standard being met Leadership Vision and strategic direction leaders have articulated a powerful vision for their organisation in the context of Healthcare for London Staff understand and are able to articulate organisational and departmental objectives and can see how their work and changes contributes to the bigger picture Staff have trust and confidence in senior leaders and believe in the good intention of the senior team to consider the best interests of patients and staff when making decisions. Partnership Local Partnership Forums play an active role in developing, prioritising and communicating employee engagement strategies Employee representatives and managers have constructive relationships even when the going gets tough Members of JCCs and Partnership Forums are clear about their shared priorities and follow through on actions. Communications Managers across the system are consistently and confidently delivering key messages All internal communication process emphasise the two way nature of the channel so that staff feel listened to and senior managers understand how their messages are heard and are brought closer to the front line. People Management Employees know whats expected of them, are set clear standards of performance, and know that they are to be held accountable by their manager Managers support and develop staff and are effectively recognising and valuing employees contribution HR policies and practices continue to focus on improving working lives principles. Bottom up Service development Staff are willing to put forward ideas to improve patient care and services, in the expectation that they will be heard and given the opportunity to follow them through Staff have the data to understand and compare team performance with the best and identify areas for improvement Staff have scope to respond to patient need within agreed quality and safety guidelines. Knowledge base Examples of excellence are shared, recognised and celebrated.

Measurement and monitoring Quantitative and qualitative data is collected to understand What Matters to Staff within their organisation Staff survey results and action plans are on the Board agenda Senior management have a deep understanding of differing levels of engagement and the implications for their strategic priorities.