Engaging your board and building your business case

staff in a meeting

17 / 6 / 2016 Midnight

The role of a health and wellbeing lead in any NHS organisation should be seen as fundamental to driving the health and wellbeing agenda for staff. Securing support at the highest level within the organisation is a key element of this role. This section provides you with the tools to engage your board and obtain that support.

Why is it important to engage the board?

The board is a key influential group that makes strategic decisions about resources and priorities. Without board engagement it can be difficult to achieve wider organisational support. The board is interested in the successful operation of the organisation in terms of achieving high-quality patient care while ensuring financial sustainability. 

You should highlight the impact that improved employee health and wellbeing can have on core organisational outcomes. This will make sure that health and wellbeing is seen as central to the core business of the organisation rather than an optional add on which is nice to have but not essential.

Evidence from organisations that have successfully implemented health and wellbeing, and achieved positive results across the whole organisation, indicates they did this with the full engagement and support of the board.

The importance of a board and clinical lead

Showing the impact of health and wellbeing

Create a business case

Obtaining the data

Presenting key data

How other trusts have achieved board level support

Engaging key board members

The importance of a board and clinical lead

A health and wellbeing champion on the board should ensure that employee health and wellbeing is:

  • reported on and discussed at board meetings on a regular basis
  • considered in all organisational decisions
  • embedded in the wider operation of the organisation through policies and procedures.

The question about who is going to be the champion for this area of work should be put when engaging with the board so that they have a chance to discuss it and for a volunteer to come forward or for one to be appointed.

It is important that the champion is involved in setting the strategy and driving the work forward, supported by the health and wellbeing lead and representatives from staff across the organisation.

Health and wellbeing depends on the culture of an organisation and any change in culture needs to be driven through strong board or equivalent level leadership. As part of the NHS England healthy workforce programme, we are working with senior leaders in eleven NHS organisations to identify any change that is needed to ensure that staff are supported and well at work. Two new role descriptors have been developed to help NHS organisations identify skilled leaders, to drive and champion staff wellbeing across the organisation. 

The job roles covered in the descriptors are for a senior/board lead and a clinical lead. These resources form part of the NHS England healthy workforce programme, where the health and wellbeing team is working together with board and clinical leads to establish what senior leaders need to do to ensure that their staff are looked after. Download the role descriptors from our case studies and resources page.

Show the impact of improving health and wellbeing

Start by providing information on the current organisational impact of sickness absence.  To gain support for change you will also need to show the impact expected from implementing health and wellbeing interventions. You can use our presentation to help you persuade the board of the importance of wellbeing and its impact on staff. The presentation is editable to suit your local needs. 

Calculations that show what could be saved by the organisation for a percentage reduction in sickness absence can highlight the importance of the issue to the board. Look at our interactive web based sickness absence savings calculatorThe Healthy staff, better care for patients report provides a list of the sort of data that could be used to measure employee health and wellbeing.

It is important to show how sickness absence and other data impacts on organisational performance measures such as infection control rates, mortality rates and agency staffing costs. Presenting such evidence begins to show in an analytical way the impact that employee health and wellbeing can have on business performance and in many cases patient experience and satisfaction.

Previously, NHS Yorkshire and Humber developed a tool to benchmark staff survey results against patient survey results.

The key features of the tool are:

  • an easy to use clickable interface to enable interrogation of staff survey data
  • a key findings feature which identifies highest and lowest scores for each of the key findings in the staff survey grouped under the headings of the staff pledges. This provides trust with other organisations they can contact for ideas on best practice as well as being able to compare overall performance in terms of the NHS Constitution
  • it produces graphs which allow comparison of trends in performance in key findings
  • a new form of visual presentation known as a "spider diagram" which enables organisations to see the distribution of their results
  • data enabling you to see the links between data on staff and patient experience to identify correlation.

The tool can be downloaded here.

Create a business case

Creating a business case is a great way to engage your board and persuade them of the benefits of health and wellbeing. Think about the financial costs and benefits to having healthy and engaged staff and the impact this will have on patient outcomes. Below are a few things to consider when writing your business case: 

1. Costs - think about the human costs associated with a business case. What are the repercussions of not doing anything? You could include sickness absence return to work savings, cost of any specific resources, identify savings from this investment, return on investment, hard versus soft costs and staff turnover figures. Other advice and things to consider:

  • concentrate on financial savings within the fiscal period
  • link to past successes
  • recruitment/succession planning.

2. Benefits - look for the organisational wins and the implications of the board accepting and rejecting the case, as well as continuing to raise the profile of health and wellbeing in your trust. You could include increased staff engagement/morale, patient audit results, social networks, productivity resilience, reduction in sickness absence rates/reasons, agency spend and stress factors. Others advice and things to consider:

  • Key Performance Indicators (KPIs)
  • friends and family tests
  • Keogh/Francis/Berwick.

3. Timescales - identifying your sponsor early will give your business case the boost it needs to be driven forward. You can clarify the reporting arrangements and diarise when these will be needed. Your project plan should be included in this section focussing on short, medium and long term planning. When will the programme start, how long will this run for and at what points will you evaluate.

4. Project Team - who sits on your project group will be dependant on the type of initiative the business case is focussed on, but may include:

  • users
  • OH/HR
  • board
  • staff side
  • governors
  • estates
  • communications
  • infection control
  • health and safety
  • health and wellbeing champions
  • lead for key areas.
5. Key risks - establishing what the barriers to the business case success is crucial to avoiding any additional questioning by the board. Some possibilities are:

  • low attendance
  • staff being released from day jobs
  • lack of engagement
  • culture
  • sustainability
  • patient risks
  • impact on the trust targets/objectives.

Listen to Jeff Buggle, Director of Finance & Performance Management at East Kent Hospitals University NHS Foundation Trust talking about how to build a robust business case for investment in staff health and wellbeing in our podcast. 

Obtaining the data

All of the data suggested should be available to you from within the organisation with the exception of the national figures.  Organisational data on sickness absence rates and causes for absence should be available to you from human resources and payroll colleagues.  Healthy staff, better care for patients shows the source of each piece of employee health and wellbeing data.

You may wish to enlist the help of someone with statistical experience to help you develop the figures in support of your business case.

National data will either be available from human resources colleagues who will know the target rate for the organisation and have access to figures published nationally or from the HSCIC website.  

Presenting the data

It is essential when engaging with board members or making a presentation that you present up to date data that will grab the attention of your audience and relate to the wider policy and operational issues with which they are dealing. It is important that you are aware of the health and wellbeing data which is required for external monitoring purposes.

One of the first pieces of data that you will need to present is the organisation’s sickness absence rate and a comparison to the national or regional average figures. It is also helpful to put these figures in the context of performance over a number of years, especially if they have fluctuated.

Presenting the data in a number of different ways also engages the board in the real meaning of the figures. You might consider showing absence as:

  • Total number of hours lost
  • Total number of days lost (assuming an average day)
  • Total number of weeks lost
  • Equivalent number of FTEs that have not been providing patient care.

Data from HR and payroll should enable you to identify the main causes of sickness absence and number of days lost.

How have other trusts achieved board level support?

Evidence on the importance of having a board that is engaged with the implementation of the health and wellbeing agenda can be found in a number of good practice examples hosted on the NHS Employers website. 

One such example is The Walton Centre NHS Foundation Trust where the Chief Executive, HRD and the trusts joint leads for health and wellbeing, deputy directory of HR and staff side lead have led by example and all got involved in the agenda. They focus on their own health and wellbeing and encourage others to do the same.

York Teaching Hospitals NHS Trust successfully presented a case to their board for greater investment in the HR function to support managers in dealing with sickness absence. They made the case with their board with a robust business case projecting that investment would bring a greater financial and organisational benefit.

Engaging key board members

This section provides you with advice, guidance and tailored information to support you in engaging directly with individual board members. Each member of your board will have a slightly different perspective on what is important and this section will help you tailor our health and wellbeing message to gain greater impact. 

Use the resources in this section if you are engaging directly with an individual board member or when preparing presentations or data for the board.

This section focuses on the following members of the board:

  • Nursing directors.  This section covers the areas that employee health and wellbeing impacts on patient experience and outcomes and as the biggest section of the NHS workforce and why it is vital that nurses are healthy and able to provide high quality care
  • Finance directors. The information provided will enable you to build a strong business case and engage with your finance director.

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