Employee engagement in the NHS

Background

Staff health and wellbeing is an important area for employers. Leading a healthy life, both physically and mentally, helps the individual health of employees, but also benefits employers through boosting productivity in the workplace.

The Five Year Forward View strategy, published by NHS England in 2014, underscores the importance of staff health and wellbeing as a crucial factor in improving the performance of the NHS and chief executive Simon Stevens announced a number of new initiatives and policy developments aimed at improving health and wellbeing within the workforce in 2015.

Staff engagement is seen as being vital for health and wellbeing, with higher levels of engagement associated with lower levels of presenteeism – employees being present at work but working at a sub-optimal level – and absenteeism – employees being absent from work. Both factors have a direct impact on the productivity of the workforce and employers.

Goals

RAND Europe conducted an independent study to examine the factors associated with engagement among NHS employees. The report was created as part of a project with the Health Foundation, a charity committed to bringing about better health and healthcare in the UK. Other partners involved in the project are the Work Foundation and the Point of Care Foundation. The study looked at the potential link between organisational, personal and health-related factors and employee engagement, and how engagement is linked with the outcomes at the individual or organisational level. The views expressed in the report are the authors’ own and do not necessarily represent the views of the Health Foundation.

Methodology

RAND Europe analysed data from the NHS Healthy Workforce Survey, which was conducted in 2016 across 35 UK NHS organisations, and 7,246 employees. In addition, this data was complemented with employer and employee-level information from VitalityHealth’s Britain’s Healthiest Workplace (BHW) survey in 2016, which involved RAND Europe’s analysis of the survey results.

Findings

Staff engagement

• Comparing the NHS to other sectors in the UK, the findings suggest that employee engagement in the NHS is lower than in some UK sectors, such as media and telecommunications and professional services, but better than in others, such as financial services and logistics.
• The findings suggest that staff engagement in the NHS is similar to other large employers with a similar demographic composition among their workforce.
• When examining factors associated with employee engagement in the NHS, the report suggests that a number of demographic factors are associated with levels of engagement, including gender and age. For instance, female employees tend to report higher levels of engagement, whereas engagement tends to decrease with age before levelling in the mid-50s and then increasing again in the years before retirement.
• Employees working in different NHS occupations report different levels of engagement. For instance, among employees in social care, admin and general management levels of engagement tend to be lower on average. In contrast, employees in medical and dental occupations, and nursing and healthcare assistants tend to report higher levels of engagement.
• Staff engagement tends to be highest in the first two years of an NHS employee’s career, before steadily declining until about 12 years of tenure and then rising again.
• The work environment clearly impacts staff engagement. NHS employees who have flexible hours and can work from home once in a while report higher levels of engagement. This may help staff to manage their work-life balance, deal with working anti-social hours and, in some cases, manage caring responsibilities.
• NHS employees who report high levels of workplace stress, a lack of control, and are not clear about their role, have lower levels of engagement. Moreover, NHS employees who report being bullied or have a lack of peer support in the workplace tend to be less engaged on average.
• Being able to offer certain health and wellbeing interventions and making employees aware of these interventions are associated with higher levels of engagement. However, a relatively small percentage of staff seems to be aware of active interventions, with these levels being between 20 and 35 per cent of staff, according to the NHS Healthy Workforce survey. An even fewer percentage of employees participate in these interventions, with this varying between one and ten per cent for the ten most common programmes/interventions.
• NHS organisations with a relatively high level of engagement among their workforce tend to report a better financial situation and have better ratings among patient quality surveys.

Staff health and wellbeing

• The data from the NHS Healthy Workforce survey shows that the prevalence of obesity, mental health problems, and high blood pressure varies between staff groups within the NHS, with these tending to be high in nursing, general management and ambulance workers. Similarly, lifestyle factors such as physical activity levels differ substantially between age groups, with older groups tending to be less physically active.
• The proportion of NHS staff that reported being bullied at work ‘at least some times’ is 12 per cent compared to 6.5 per cent on average across employees in the Britain’s Healthiest Workplace survey.
• Around 20 per cent of NHS employees are at risk of mental ill-health, with ambulance staff (24 per cent) and nursing and healthcare assistants (22 per cent) being most at risk.

Recommendations

• A ‘one size fits all’ approach to NHS staff engagement is unlikely to be the answer. Staff engagement differs among the groups that make up the NHS population. Therefore, approaches aimed at improving staff engagement will need to be targeted at specific groups.
• It is important to keep making the business case for improved staff engagement to key policy makers and decision-makers in the service starting possibly with finance directors and chief executives. The Five Year Forward View has offered a window to make further progress on staff engagement and the wider health and wellbeing of staff.

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Read the full study

Additional Project Team Member

Martin Stepanek