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Employee engagement in a
high-pressure environment

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Imperial College Healthcare NHS Trust
Nathaniel Johnston
ENGAGEMENT AND TALENT LEAD // TWITTER: @n8_tweets

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Who we are

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In a health context…

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“There is a clear relationship between the
wellbeing of staff and patients’ wellbeing”
- The Kings Fund, 2012
Engagement = better healthcare

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Additional evidence shows that healthcare organisations with higher levels of staff engagement have:
FEWER HOSPITAL
ACQUIRED
INFECTIONS
SIGNIFICANTLY
FEWER MISTAKES
BETTER OUTCOMES LOWER
MORTALITY
RATES
A BETTER
PATIENT
EXPERIENCE
Engagement = better healthcare

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• Bottom 20% of NHS organisation for our engagement score
• Lowest scoring hospital Trust in London
• Low response rates
• Fatigue at frequency of surveys
• Lack of input from staff on survey design and sharing results
• No “you said, we did” output from surveys
Where were we?

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OUR TRUST
OUR VOICE
6
What did we do?

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This is our overall outcome measure. Going forwards, it will enable us
to track engagement levels over time. It is calculated from a
combination of three factors:
• Advocacy: How likely people are to recommend Imperial
Healthcare NHS Trust to friends and family as a place to work
• Motivation: How motivated people self-report feeling motivated to
give their best effort at work
• Satisfaction: Overall how satisfied people say they are with their
job
Overall
engagement
OUR TRUST
OUR VOICE

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Creating more good days for staff…
1. Staffing
2. Leadership
3. Culture
5. Teamwork
6. Efficiency
8. Pay and CPD
4. Working
conditions
7. Capacity
0 20 40 60 80 100 120 140 160 180 200 220 240 260 280 300 400 500
Support & understanding Line-management
Organisational
management
Senior leadership Direction
10. Change
9. Well-being
MORE STAFF! Adequate staffing levels
Recognition, appreciation & praise Value staff
Respectful and
friendly culture
Positive
attitudes
No
bullies
Improved environment Improved facilitates
(fix the lifts)
Provision of food
and drink for staff
Not 3
sites
Control
aircon
Teamwork & teambuilding Communication across & within teams
Accountable
and
responsible
A good IT system Efficient processes Pro-active planning
Admin
support
Less
paper
work
Resources & equipment Decreased workload / more time
Reduce waiting.
Manage bed / room
capacity.
Training & development Higher, fairer pay
Career
progression
Shift flexibility Improve staff morale.
Social / well-being activities
Time for breaks /
finish on time
Empower staff Listen
Staff
voice
Research &
innovation
Address
issues
TOP 10 over-
arching themes
OUR TRUST
OUR VOICE

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OUR VOICE
Top reasons for high overall job satisfaction

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1. Staffing
2. Demands
3. Efficiency
5. Support
6. Culture
8. Invest in staff
4. Teamwork
7. Management
0 20 40 60 80 100 120 140 160 180 200 220 240 400
Resources & equipment Manageable workload
Less patients /
not overbooking
Admin time or
support
Patient
flow
Less
pressur
e
10. Empowerment
9. Work conditions
Address staff shortages – enough staff to work with
A better IT system Less inefficiencies
& time wasting
Less paperwork
& bureaucracy
More planning,
less chaos
Easier
processes
Communication (less emails) Teamwork & team building
Can do
attitudes
Support & understanding Good management
Safety
/
speak
up
Strong
leaders
Recognised & valued Respectful attitudes
Address
bullying
Positive
attitudes
Less
blame
Shift flexibility
Performance
management
Fairness &
equality
Role clarity
& direction
Provide
feedback
Focus
on
care
Training & development Work-life balance Fair pay Care
about staff
Better environment Improve facilities
Temperature
control
Food &
drink
Less
travel
Consulted & listened to
Empowered, not
micro-managed
Change &
innovation
More
transparent
TOP 10 over-
arching themes
OUR TRUST
OUR VOICE
Creating fewer bad days for staff…

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OUR VOICE
Top reasons for low overall job satisfaction

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Recognition
& Value
Contribution
& Control
Safety &
Wellbeing
Connection
& Support
Direction
& Purpose
OUR TRUST
OUR VOICE
Our Engagement drivers...

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Our
Engagement
drivers Engagement increases when people feel respected for who
they are, and that their efforts are noticed and valued.
Recognition & value
The Harvard Business Review says successful teams receive five times as much
appreciation as criticism.
Focus on ensuring:
• Recognition and appreciation
• How we want to recognise good work or efforts
• Specifically, what would people like to notice and appreciate in the team?
OUR TRUST
OUR VOICE

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Our
Engagement
drivers Engagement increases when people are able to develop their
skills, strengths and ideas and put them to good use.
Contribution & control
Gallup research shows people whose managers focus on their strengths are twice as
likely to be engaged as people whose managers focus on their weaknesses
Focus on ensuring:
• People know what each other’s strengths are in the team
• Managers know what skills or areas people want to develop
• People know how to help each other to do their best work
• We nurture more ideas
OUR TRUST
OUR VOICE

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Our
Engagement
drivers Engagement increases when people feel safe from poor
behaviours, and that their work contributes to their wellbeing.
Safety & Wellbeing
A BMJ article showed rude or bullying behaviours make patient safety errors much
more likely to happen.
Focus on ensuring:
• We reduce bullying at work.
• Identifying behaviours teams want less of and reducing them
• Identifying how teams can support each other when things are really busy
• How we make it safer to ‘speak up’
OUR TRUST
OUR VOICE

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Our
Engagement
drivers Engagement increases when people feel a good sense of
teamwork and support in their team, with other teams and from
leaders.
Connection & support
In an NHS study, a 5% increase in team-working scores in staff surveys correlated with
a 3.3% fall in mortality rates
Focus on ensuring:
• People know what a ‘real team’ looks like and what support they want from each other
• Teams know what other teams want from them and how they could change how they work
• Teams get what they need from other teams and are clear what they need from them
OUR TRUST
OUR VOICE

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Our
Engagement
drivers Engagement increases when people find meaning in their
work, understand what’s expected of them, and see that in
others too.
Direction & purpose
Studies have shown that managers can increase engagement by setting challenging
SMART goals. 1
Focus on ensuring:
• People are clear about what’s expected of them – individually and as a team
• Individual objectives help to meet the team’s objective
• People are clear about their expectations of each other
• People are positive about what we are doing?
Refresh of the Trusts corporate objectives that are cascaded during the
appraisal process so all staff have a “line of sight” to how their role delivers the
organisation’s mission
OUR TRUST
OUR VOICE

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How did we take this further?

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“I have worked in the Trust
for 15 years and after this
session, I feel like I’ve been
really listened
to and heard”
- Advanced Nurse Practitioner
Photo: HIV/Sexual Health team meeting, Nov 2016
In the shoes of our people

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You said, we did

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• Gone from “worst 20%” and jumped two levels to “average”
• 9% response rate increase
• Highest engagement score since 2012
• Action plans received from all directorates (first time ever!)
• Over 700 staff participated in an “In our Shoes” workshop
• Renewed energy and motivation around engagement
“Following changes to the work environment, we have seen improvements in our
patient “friends and family experience tracker”- so that is a real pat on the back for
the MRI Scanning Team”
Where are we now?

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• Gearing up for the second year of the Our Voice, Our Trust survey
• New development programme educating managers on their role in employee
engagement currently in design
• Toolkit resource on engagement and retention activities for managers
• Continued roll out of the In Our Shoes listening exercises
• Moving forward on our journey towards being a great place to work, for all
Future…

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Thank you
@n8_tweets