Evidence based approaches to workforce wellbeing

Although there is no one-size-fits-all approach to improving the wellbeing of your workforce, the evidence base on the most effective interventions and approaches is constantly evolving and can provide a useful basis for reviewing your approach and making decisions. 

The evidence base can be useful across your health and wellbeing strategy, including to:

• build your business case and gain buy-in for change 
• inform decision making and help focus your approach, including funding decisions 
• guide your approach to evaluation and reviewing your strategy

Find out more about the evidence base relating to each of the following topics:

• Summary of evidence relating to health and wellbeing interventions
• Why workforce health and wellbeing matters
• Outline of health and wellbeing issues in the NHS workforce
• Interventions and approaches

The workplace health and wellbeing evidence base is constantly growing and evolving – do you know about a key study we haven’t included here? Let us know by emailing us.

Overview of health and wellbeing interventions evidence base

NHS Employers commissioned the Institute of Employment Studies to undertake a rapid evidence review of the evidence base of health and wellbeing interventions used in healthcare and their implications for wellbeing outcomes. The key learning generated by this review is summarised below, and you can find out more in the full Health and Wellbeing Interventions Rapid Evidence Review, published in October 2020.

• There is no single one-size-fits-all solution for workforce wellbeing. Interventions with good take-up and which led to positive wellbeing outcomes were those where healthcare staff had options as to which interventions they could engage with and suited their wellbeing needs.
• The quality and extent of the evidence base is variable and needs more attention. Organisations often use a broad range of interventions, focusing on both mental and physical wellbeing, treatment-based and prevention focused interventions. The extent to which these interventions are robustly evaluated is variable. Organisations should pay great attention to evaluating their approaches, including both wellbeing outcomes and process evaluation, and may find it useful to partner with research organisations to do this robustly. 
• A whole-system approach to wellbeing should be considered alongside interventions. This includes a focus on the whole employment experience, including element such as workload, autonomy, employee voice and management processes.

The below documents and reports have been influential in shaping thinking and approaches in health and wellbeing across the NHS. These may help you to develop and review your health and wellbeing approach.

Why workforce wellbeing matters

The evidence base for why workforce wellbeing matters is well established. You might want to refer to the learning from these reports, studies and evidence to build your case for making changes in your organisation: 

• Better workforce wellbeing is related to improved patient safety and quality of care
• The Francis Inquiry into Mid Staffordshire NHS Foundation Trust revealed the fatal impact of disconnected and detached staff with poor mental wellbeing and a lack of empathy and  emotion.
• There is well-established evidence base demonstrating that poor wellbeing is correlated with poorer patient outcomes, summarised in a systematic review by Hall et al, 2016
• Better staff experience overall is linked to better wellbeing, lower turnover and lower sickness absence, as outlined by The Kings Fund, 2018.
• Poor mental health in the NHS equates to £1,794- £2,174 per employee per year, according to HEE’s Staff and Learners’ Mental Wellbeing Report, 2019

Outline of health and wellbeing in the NHS workforce

There has been a plethora of research, studies and reports outlining the state of health and wellbeing for the NHS workforce, and making recommendations for change and improvement. Here are three seminal reports exploring wellbeing in the NHS:

• NHS Health Education England NHS staff and learners' mental wellbeing report, February 2019 - This report, led by Commission Chair, Sir Kenneth Pearson, reinforces the importance of promoting and supporting the wellbeing of NHS staff and those learning in NHS settings. The report examines at what the NHS are doing currently, where there is excellence and where the NHS can aspire to excellence. Take a look at our dedicated web page which can help support you to implement some of the recommendations from this report. 
• The Boorman Review, November 2009 - The final report of the independent NHS Health & Well-being Review was published on 23 November 2009. The report reiterates the case for change, and provides a comprehensive set of recommendations for improvement in provision of health and wellbeing across the NHS.
• Thriving at work - The Stevenson/Farmer review of mental health of employers,  October 2017 Following the request from the Prime Minister at the beginning of 2017, Paul Farmer and Dennis Stevenson undertook an independent review into how employers can better support the mental health of all people currently in employment including those with mental health problems or poor wellbeing to remain in and thrive through work. This extensive report includes recommendations employers can adopt regardless of their workplace type or size. Our dedicated web page can help support you to implement some of the recommendations from the report. 

Interventions

There are a broad range of preventative and treatment-based physical and mental health interventions, although there is no single best approach. 
Read section four of the IES report Health and Wellbeing Interventions in Healthcare: A rapid evidence to find evidence specifically relating to interventions from the NHS. 
Below we’ve also curated a set of research studies around common health and wellbeing themes to inform and guide your approach.

Mental health

Mental Health First Aid

The evidence base on the effectiveness of Mental Health First Aid in organisations is mixed and conflicting. 

• HSE research outlines that there is little evidence for the impact of MHFA on users of the service, but does have an impact on those trained as mental health first aiders. 
• IES point out the mixed evidence and caution against using MHFA as a solo approach, and that many other training and awareness raising approaches are effective in workplaces.
• The Institute for Occupational Safety and Health examined international examples of MHFA in contrast to other mental health awareness or intervention approaches. The research outlines the potential benefits and pitfalls of implementing MHFA in workplaces, and makes practical recommendations for organisations. As an output of this study, IOSH have developed practical tools for organisations to improve the implementation of MHFA alongside other approaches, including:
• Mental Health First Aiders: Workplace Considerations
• Mental health in the workplace: benchmarking questions 

Counselling

Research by the Institute for Employment Studies in 2020 evidenced the benefits of workplace counselling, including: reduced sickness absence, reduced presenteeism and improving retention. Read the study in full to find out more, including how workplace counselling can be evaluated and adapted for even greater impact. 

Schwartz Rounds

A realist informed mixed-methods evaluation of Schwartz Center Rounds® in England, 2018 - this report highlights that Schwartz Rounds offer a safe, reflective space for staff to share stories with their peers about their work and its impact on them. Interestingly, the report shows that there was no change in staff engagement scores of participants, but poor psychological wellbeing reduced significantly. Take a look at the report in more detail for the full findings.

Healthy lifestyles and physical wellbeing

The Work Foundation carried out a systematic literature review examining the breadth of evidence on workplace-based lifestyle interventions, including weight-loss, physical activity, smoking and alcohol. 

Systematic approaches to wellbeing

Organisational culture

Evidence from the What Works Centre for Wellbeing highlights the importance of organisational culture in achieving improved wellbeing outcomes. Read the report What works for health and wellbeing in the workplace? to find out more.

Job design and job quality

The What Works Centre for Wellbeing have summarised the range and quality of evidence demonstrating a link between high quality roles and better workforce wellbeing. Read the full report to find out more about the evidence relating to each of these elements of job design:

• job security
• social connections
• training and development
• role clarity
• employee voice and workplace culture.