Seven suggestions for sustaining engagement in tough times

We've captured top tips from some of the best performing organisations in the 2021 NHS Staff Survey.

10 August 2022

Since the publication of the NHS Staff Survey for 2021, NHS Employers has been in discussion with organisations that maintained or increased their staff engagement scores. These organisations have shared some lessons from their experience, which have been incorporated into the seven suggestions below. Two of these organisations, Solent NHS Trust and the Royal Orthopaedic Hospital NHS Foundation Trust, have provided us with further information about their journeys in audio clips.


There was an overall decline in staff engagement levels in the NHS Staff Survey 2021 and this was clearly linked to the workload pressures on the service, COVID-19, and the wider cumulative impact of the pandemic. These suggestions concentrate on what trusts can do locally to sustain engagement. Further action will also be needed at national level, including ongoing investment in staffing.

Suggestion one: keep going


The organisations that saw improvements in or maintained their staff engagement scores shared a long-standing focus on staff experience and staff engagement. During the pandemic, these organisations ensured they kept this focus despite the additional pressures. They also had supportive senior leadership and endorsement from the board.



Suggestion two: build on the basics


The foundation for sustaining staff engagement is overall staff experience. Tackling issues such as workload, maintaining support for health and wellbeing, and ensuring that staff have good line management will all help to sustain staff engagement. Organisations that continued to focus on health and wellbeing support and were able to invest in staff saw a positive impact on their engagement levels. In these organisations, work on staff engagement was part of a wider programme of activity to sustain good staff experience.

Listen to Sharon Mahli at the Royal Orthopaedic Hospital NHS Foundation Trust on engaging staff and ensuring morale has remained high throughout the pandemic.

Suggestion three: listen and act


Successful organisations sought out staff feedback in a range of ways and made clear how it was used. Data collection is a continuous process rather than an annual exercise; on top of the NHS Staff Survey, these organisations deploy local surveys/People Pulse, National Quarterly Pulse Surveys, and use a mix of online and face-to-face feedback routes. Online channels are well established in most of these trusts with widespread use of virtual meetings and some specific tools such as staff chat spaces and mood barometers. There had been a limited move back to face-to-face forums at the time the NHS Staff Survey was being completed, for example, regular in-person meetings with senior leaders, though this has increased since. These organisations acted on the issues raised and communicated how data was used. Results from the NHS Staff Survey were shared with staff and managers, and senior leaders were held accountable for responding on issues raised.  Furthermore, these organisations have good partnership working with local staff side representatives to ensure a collective voice for staff and this had been deepened during the pandemic.

Suggestion four: staff involvement


Ensuring that that staff continue to feel involved and able to put forward and implement ideas was a common theme among these organisations. Most have a staff-led model for quality improvement and some had use specific tools for this, such as online crowdsourcing or face-to-face collaborative conversations. Some employ models for seeking out ideas from staff and identifying those that can be taken forward. Others have a facilitation model supporting local teams to develop ideas for improvement in their own areas.

Listen to Andrea Hewitt of Solent NHS Trust on the organisation's staff experience journey over the past seven years through development of a trust-wide strategy and values, as well as the growth of staff networks.

Suggestion five: ensuring everyone has a voice


Ensuring that all staff are able to raise issues was common among these organisations. They sought out views from all staff groups through working with full range of staff networks. Many had specific discussions with staff networks during 2021 and acted on issues raised, such as race equality in the workplace. A majority also increased the number of staff networks within their organisations to cover all groups of staff and wider range of issues, such as neurodiversity. Some had also strengthened their arrangements for Freedom to Speak Up to ensure all staff felt able to raise any concerns.

Suggestion six: appreciate and value staff


The best performing organisations increased the ways they recognised staff contributions as valued and appreciated. The measures they had taken included visible statements such as thank you letters from senior leaders, as well as encouraging an overall culture of appreciation and supportive line management. Many have overhauled their local recognition schemes with new categories and retained awards ceremonies during the pandemic, although in most cases these had been run as virtual events. At a number of these organisations, some additional provision has also been offered to show how staff contribution is valued, for example, by offering extra annual leave or vouchers.

Suggestion seven: innovate and adapt


Leading organisations in the NHS Staff Survey 2021 maintained their overall focus on staff experience, but adapted their methods to changing circumstances by making use of online tools. They now make use of their NHS Staff Survey and other data, such as from the National Quarterly Pulse Survey, and the NHS People Pulse to adapt and develop their approaches. The People Promise provides the overall framework for their work on staff experience. Their local context shapes the tools they use.