Report: Feeling seen, being heard, taking action

Recommendations from our latest report with agiLab on how we better support agile working needs of those in low-income households.

14 March 2023

A recent report published in December 2022, suggests that employees in lower-income households may have less access to agile working opportunities and may lack the resources required to fully benefit from agile work.

‘Feeling seen, being heard, taking action,’ is an academic piece of research commissioned by NHS Employers in partnership with agiLab. The report explores the concept of 'appreciation' in helping to address the agile working needs of workers from lower-income households.

agiLab is a collaboration between University of Sussex and the NHS to develop research-led best practices for effective agile working.

The act of appreciation

We found that appreciation is symbolic of the value and worth that lower-income workers are seeking and represents whether resources are available to engage in agile work effectively.

"I just felt valued, even though I was brand new, they were like well no, we'll give you the nearest station, we'll give you a part-time line and you can manage it around your children...I just felt like a totally valued person..they're just a lot more open minded and they're really inclusive as well....It was just really refreshing for me to actually be in an organisation like that."

Sandra, NHS employee

To understand what appreciation means for this group of employees, four themes emerged:


Theme 1 related to the positive experiences and difficulties that lower-income agile workers face.


Theme 2 outlined five different forms of appreciation that lower-income agile workers strive for.


Theme 3 identified ways to foster facilitation and incorporation of appreciation in agile work.


Theme 4 identified the barriers in facilitating and incorporating appreciation.



The report shows that workers in this group associate feeling seen and being heard with being valued and appreciated. They also value feeling supported through significant personnel taking action to help them meet their agile working needs. Feeling valued was indicative of them feeling a sense of worth and feeling that they can be the best they can be in the workplace.

Common values

The common themes from the research found that employees from lower-income households valued:

  • good health
  • time
  • a loving family
  • supervisor support
  • financial security
  • autonomy
  • job-control
  • self-esteem. 

Recommendation to facilitate best practices in agile work for lower-income household workers

As a result of the findings, the research recommends embedding appreciation in the NHS workforce with particular attention being paid to this group of workers. Employers in the NHS should encourage line managers to foster a culture of appreciation in the agile workforce, and leaders need to ensure that the needs of the workforce can be implemented in a tailored and appropriate fashion.

"I suppose it's about not assuming that they're all set up to go, you do have to check on an individual level …So it's that kind of information, you need to check and just not make an assumption."

Amelia, employer.

THANK framework

The ‘THANK’ framework has been created to help employers embed appreciation in their organisations.

Methodology and participants

  • The participants in this report were classified based on objective and subjective criteria.

    The objective criteria were:

    1. income of £25,000 (full-time equivalent) per annum or below
    2. educational status
    3. occupational status
    4. the subjective criteria were if two or more of the following factors were met.

    Workers were asked if they:

    1. feel financial strain
    2. have difficulty covering bills, travel costs and other outgoings
    3. are a single parent of dependent children
    4. have caring responsibilities for another person over 18
    5. live in cramped/difficult housing conditions.
  • This research was undertaken between March 2022 and November 2022.

    Interviews were held with 16 lower-income workers from a range of different occupations within and beyond the NHS.

    We also interviewed five employers and five stakeholders who work with lower-income workers in various capacities. The data was analysed using reflexive thematic analysis and revealed that ‘appreciation’ was a key factor that influenced the experiences of lower-income workers engaged in agile work.

    A qualitative research design was developed to address this question and we had three key aims:

    1. how has the move to agile working impacted lower-income workers
    2. what is needed for lower-income workers to undertake agile work effectively
    3. what recommendations could be implemented to facilitate best practices in agile work for lower-income workers?

    The study was approved by the University of Sussex Ethics Committee (ER/ER336/5).