Developing feedback loops to sustain staff engagement
The North East Ambulance Service (NEAS) employs more than 3,000 people, responding to 390,000 emergency and urgent incidents each year across the North East of England. It has faced historical challenges and has had relatively low NHS Staff Survey scores. Since 2022 it has adopted a new approach to improving staff experience which has improved it scores and helped it to improve service quality.
Key outcomes and benefits
NEAS has seen sustained improvement across its NHS Staff Survey scores since 2023 and in particular in scores for compassionate leadership, which improved from 6.59 to 6.74; staff engagement, going from 5.83 to 6.00; and health and wellbeing, increasing from 5.11 to 5.31.
There have also been improvements in the NEAS scores for flexible working and on the ability to raise concerns.
The trust has improved its overall culture according to Care Quality Commission (CQC) inspection reports, and there has been a positive impact on staff morale with reduced staff turnover and lower staff absence levels. Alongside this, service outcomes and targets have improved.
NEAS was one of the ten most improved trusts in the country on staff engagement in 2023 and sustained this in 2024. It has moved over the last four years from being a below-average scoring ambulance trust.
The organisation continues to develop and implement an innovative approach to staff experience and is currently focussing on issues around speaking up, calling out lower-level behaviours and developing health and wellbeing support.
What the organisation faced
NEAS has historically faced similar issues to other ambulance services: staff working in challenging situations and a disparate workforce who can be hard to contact. This is alongside high levels of violence.
A key catalyst for change was a critical CQC report in 2023 (downgrading the trust from Good to Requires Improvement), which led to a new approach.
A new senior leadership team worked with staff to develop and implement a new workforce strategy focussed on improving staff experience and retention. The trust has sought to shift organisational culture and develop a more compassionate leadership approach. Most recently it has also played a leading role in identifying and addressing issues around sexual misconduct in ambulance services.
What the organisation did
The organisation has implemented change across a range of staff experiences. This has included:
- developing an overall workforce strategy
- ensuring accountability for action on workforce issues via a people and development subcommittee reporting to the board
- using data from the NHS Staff Survey and other feedback, and analysing and triangulating it to inform directorate leaders for action - this is then communicated to staff via an 'acting on your feedback' framework.
- (since 2023) an annual staff experience improvement plan has been developed each year, with actions that are aligned to the NHS People Promise and trust objectives
- the CEO and other senior leadership members engaging in regular open communication with frontline colleagues
- staff being encouraged to come forward with ideas for improvement and to work with the transformation and improvement team
- the creation of a leadership development programme, to supporting line managers with their development across a range of competencies.
Health and wellbeing support
The trust launched the Mental Maintenance campaign to tackle stigma and staff concerns about unclear, inconsistent mental health resources.
Designed to shift the focus from a crisis response to regular, proactive mental health care, the initiative offers tailored toolkits for managers and staff, training, and peer support. The campaign has reduced stigma and empowered staff to take charge of their mental wellbeing.
Due to its success, the Association of Ambulance Chief Executives has requested its expansion across all UK ambulance services. Read more about the Mental Maintenance campaign.
Freedom to Speak up
Most recently, the organisation has been focussing on improvements to its procedures for raising concerns with a dedicated Freedom to Speak Up Guardian appointed in 2023, and a FTSU champion team launched in May 2024.
Results and benefits
There has been a sustained improvement in NEAS' NHS Staff Survey scores. In particular, the trust has seen better results across eight of the nine NHS People Promises, and the overall staff engagement and morale theme has improved significantly.
There have been improvements in range of workforce metrics. These include:
- the overall score on compassionate leadership went from 6.59 to 6.74
- the trust's health and wellbeing moved from 5.11 to 5.31
- on staff engagement the organisation increased from 5.83 to 6.00.
Overcoming obstacles
As in most NHS organisations resources have been an issue. The trust was able to make use of staff who were redeployed from frontline duties during the COVID-19 pandemic into corporate HR teams to support colleagues.
This has allowed the delivery of the staff experience agenda over the last 18 months.
The operational challenges of an ambulance environment have continued to be an obstacle.
Take away tips
- Culture and leadership are central to improved staff experience - supporting leaders to lead differently is an essential element.
- Sharing and acting on feedback should be a year-round process, not an one off event.
- Staff involvement should be central to quality improvement and this approach can help to provide better services.
- Improved health and wellbeing provision tailored to local challenges supports improved staff experience and retention.
Contact
For more information please contact: Victoria Wright, head of staff experience and OD, via victoria.wright@neas.nhs.uk.
