Staff engagement in the NHS: leading the field or lagging behind?

Steven Weeks

Steven Weeks, policy manager at NHS Employers, has written this blog looking at how organisations across different sectors have worked to improve staff engagement, and how the NHS can learn lessons.

As we start a new year and wait to see the results from the annual NHS Staff Survey, it’s a good time to reflect and think about on how the NHS compares with other organisations in terms of its levels of staff engagement

The NHS is often compared unfavourably with the private sector in terms of HR practice. On staff engagement in particular there have been unfavourable comparisons with organisations such as John Lewis. This has led the NHS to sometimes be overly defensive and feel that because it is different and has demonstrably high levels of staff commitment, it has little to learn from other employers. The reality is a little more complex.

There is no standardised, economy-wide, people-management survey equivalent to the NHS Staff Survey. However, there have been largescale surveys of UK employees and many large businesses do publish staff engagement data derived from surveys. This data shows that the overall level of staff engagement in the NHS is above average for the UK economy, but there are though some sectors of the economy that have higher levels of engagement and there are small number of UK companies are world-leading in this area.

The NHS measures staff engagement using three primary metrics - job related motivation, levels of involvement, and willingness to recommend the employer. The NHS scores very highly on job related motivation with scores well above average for most UK employers. This level of commitment is demonstrated regularly in times of severe pressure on the NHS. However, NHS scores on levels of involvement are much more mixed while NHS levels of involvement are good for ward level, but less so at organisational level. The willingness of NHS staff to recommend their employer is variable and only just in line with the UK average.

A number of private sector organisations have implemented approaches to which the NHS may find useful to adopt or adapt. These tend to be concentrated in a small number of sectors.

  • Involvement mechanisms to assist quality improvement. This is concentrated in UK export manufacturing firms such as BAE systems and the car industry. Many NHS organisations have implemented quality improvement programmes which do seek to involve front line staff in developing ideas. There is though scope to improve and extend these approaches.
  • Approaches to utilising staff feedback. Most large UK companies have some form of staff opinion survey. A number of organisations in sectors such as retail and energy have moved beyond this to have more flexible and targeted methods to seek out and act on staff feedback. Companies in sectors such as IT and transport have used online technology as a means of getting real time feedback and enabling staff to put forward suggestions.
  • Organisations which operate in a sales, retail or customer service field have developed a range of approaches to recognising staff contribution. Not all of these would be appropriate for the NHS but there are examples which the NHS could adapt, for example how to encourage team building and how to reward staff for implementation of values.

In terms of the overall levels of staff engagement, mutual and employee-owned enterprises have been particularly successful as have a small number of family-owned businesses.

The NHS Employers website has a range of case studies looking at experience of staff engagement within the NHS. For examples outside the NHS, the best resource continues to be the Engage for Success website. Engage for Success is now part of the CIPD which also produces materials on staff engagement across the economy.

The NHS can be proud of its record on staff engagement but there is clearly also plenty of room for improvement and learning from successful approaches in other sectors is part of that.

NHS Employers will take learning from other sectors in our 2019 work programme. If you are aware of examples that it would be useful to share, please get in touch via

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