This research has explored the role of employee engagement in the NHS. The intention was to provide a review of what employee engagement means in the sector, its importance in enhancing performance and NHS outcomes such as patient care and quality, and to understand whether the case for better employee engagement has effectively been made or further improvements are needed. To that end, the research aims to improve the steps taken to ensure healthcare workers are valued, supported and engaged in their work.

Employee engagement is a term that has emerged as a topic of significance among organisational psychologists, businesses and HR consultants over the last decade, as a result of the claim that employee engagement can drive bottomline results and improve productivity. It was the ‘Engage for Success’ initiative1 that brought the topic to centre stage, citing clear examples where improving employee engagement was associated with better performance, and the scale of potential benefits were reported to be large and significant. For instance, some studies suggested that improving widespread engagement within the UK to match the levels seen in the top tier of high performing countries could add £25.8bn to the economy. This has sought to inspire the development of a wider movement through the sharing of good practice around what works to create a more committed, happier and engaged workforce. Wider recent initiatives, such as those associated with the business-led community interest company, be the business, are also drawing attention to the importance of a more engaged and empowered workforce2. However, there are continuing debates about its definition, and theoretical basis, which may have hampered how effectively it has been achieved in practice across different parts of the economy, giving rise to what some have called an engagement deficit. The consequences of disengagement can be severe and undoubtedly shed some light on the persistent productivity problems seen across the UK. In the NHS the effects can be particularly profound, with some studies demonstrating that employee disengagement can literally be a case of life and death.

Significant steps to advance employee engagement in the NHS have been taken since 2008 and, there has been a growing interest in supporting improvements in practices over the last decade with a basis to measure, monitor and benchmark engagement levels across the sector, having been in place since 2009. Positively, engagement outcomes have been rising overall since 2012, according to the NHS Staff Survey. However, a closer examination points to variation in engagement levels, between and within Trusts, suggesting that in reality there may be a more complex employee engagement story. This implies further work still needs to be done to understand what employee engagement means in practice within different parts of the NHS, and what barriers and challenges are getting in the way of securing better engagement outcomes and a happy and more empowered workforce. Two high profile reports within the NHS (the Francis Inquiry3 and the Keogh Report4) have drawn attention to the vital role that employee engagement can have for better staff morale and in turn NHS performance. In addition, although there is now a stronger research base highlighting the link between employee engagement and NHS outcomes (informed by for example the work of West and Dawson5), questions remain about whether the business case has been sufficiently made, especially at a Trust level. As staff wrestle with a number of ongoing day to day challenges at the coalface, which tighten resources and introduce service pressures, this continues to threaten the conditions that will enable more consistent levels of staff engagement across the sector to be achieved. In the absence of any strong strategic approach, this also risks substantial fragmentation locally in what engagement practices are pursued. There has therefore been a growing interest in what interventions can drive a more integrated approach that ensures engagement permeates right through the organisation.

The study was designed to explore staff engagement in more depth in the NHS, looking at a range of evidence to see how this may be linked to patient outcomes and organisational results. The high level research question set was: ‘Based on published evidence from performance data, qualitative research and case studies, what is the business case for investing time, money and other resources in engagement exercises?’

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