Case Study

University Hospitals Birmingham - listening to retain

Learn how University Hospitals Birmingham improved staff retention through a shift in culture, feedback-driven strategies and effective use of data.

20 February 2024

This case study shares learning from the approach to retention at University Hospitals Birmingham. In particular it highlights how the trust adopted a new approach to organisational culture and staff engagement which has had a positive impact on staff retention. Effective use of data is a key element and has played a key role in making progress. The trust still faces challenges but has improved retention and is moving in right direction.


University Hospitals Birmingham (UHB) identified the need to enhance its’ organisational culture and employee experience. After a prolonged period marked by substantial transformation and change, and the effects of the Covid-19 pandemic, the trust developed a multifaceted approach to improving retention, with a particular focus on employee engagement. 

The new approach was developed based on feedback from staff and now includes more intensive support in early career, use of stay interviews and enhanced development opportunities. Underpinning this work is the strategic use of data and analysis.

Key benefits and outcomes

Since the project started, the trust has observed:

  • a reduction in turnover and vacancies
  • enhanced levels of employee engagement
  • a reduction in sickness absence rates.

What the organisation faced

In 2018, UHB underwent a merger with Heart of England NHS Trust, forming one of the largest NHS foundation trusts in the country. The consolidation of these two trusts required rapid and extensive changes, to bring four hospitals under one single organisation. However, much of this work was put on hold at the start of the pandemic.

During the pandemic, many staff had a change to their working locations and those who could work from home were asked to do so. These changes resulted in uncertainty and significant upheaval for staff, impacting team dynamics and a sense of belonging to their teams and the wider organisation. 

In the post-covid period, staff turnover increased and the response from staff surveys identified high levels of burnout, disengagement, and poor employee experience. Feedback identified that due to the significant changes that had occurred, and the pace in which they had been delivered, staff were left with feelings of change fatigue, and many lacked a sense of belonging to the trust. 

UHB aimed to explore how to reduce turnover while identifying strategies to enhance both the experience of staff and culture within the trust. 

What the organisation did

A strategic retention and engagement group was established to better understand the reasons for turnover, and to agree a strategy for improvement. The group centred its efforts on three key areas: 

  • Enhancing attraction and engagement.
  •  Improving development opportunities for staff.
  • Creating a positive organisational culture. 

In its first year, the group focused on improving the methods of gaining insightful feedback from staff. This included the following initiatives.

  1. A new exit and leaver process: Leaver forms are completed via a QR code, and the trust now has central access to responses. From this, patterns and themes can be identified and be used to inform trust-wide improvement. The questions were also improved, to encourage staff to provide ideas for future improvements, which has provided UHB with rich data about employee experience in different settings. 
  2. The introduction of a 100-day engagement programme: A monthly engagement event with staff takes place throughout the first 100 days of their employment, providing feedback about the induction and onboarding process. This programme was informed by detailed data analysis, which showed a disproportionate number of staff leaving the trust within their first year of employment, to enable improvements to the induction and onboarding process. 
  3. The introduction of stay interviews: Stay interviews have been introduced to provide further information about why staff were staying at UHB, and why they were considering leaving. UHB aims to roll this out trust-wide in 2024, to proactively address issues concerning staff to further improve retention. 
  4. Engagement in both high and low-turnover departments: Engagement sessions with staff in high-turnover areas took place to understand views of local departments as well as the wider trust. Extensive engagement work took place in ‘hotspot’ areas, identified through staff experience indicators, including sickness, staff survey results and turnover, leading to bespoke support interventions. The team was also mindful to approach areas with low turnover to understand more about what is working well and how this leaning can be shared. Staff were also asked what they wanted to see from the trust’s reward and recognition offer, and what was important to them. This has contributed to a proposal for flexible bank holidays and extended salary sacrifice schemes. 
  5. Roll out of trust talent management framework: A talent management framework, comprising of a talent assessment toolkit and succession planning toolkit has been developed. Key to this was empowering managers to have regular talent conversations with their staff, enabling a person-centred approach to talent and development. Managers have been provided with the tools to engage with staff appropriately depending on their individual goals and ambitions. This engagement with staff has enabled local departments to better understand what their staff need to encourage them to stay and grow their careers at UHB. 

Results and benefits

As a result of the engagement, the trust has seen more staff completing the staff survey, leaver questionnaires and exit interviews and attending the weekly CEO update, showing a definite increase in staff engagement. There was a clear message of support from the trust chief executive, which has also inspired staff to come forward and share their experiences. In the past year, the trust has seen an improvement in turnover, from 12.85 per cent in November 2022, to 11.46 per cent in November 2023. 

Collaborating with teams locally to comprehend their concerns and desired workplace improvements has also yielded significant benefits. Teams have been able to feed in their ideas to make the working environment more positive on a day-to-day basis. It has also contributed to the development of people management resources and training programmes. 

There is still a significant journey ahead as UHB embarks on a cultural transformation journey after a recent culture review. However, the programmes of work that have commenced are anticipated to continue to have a positive impact. Examples of future projects the trust will be taking forward based on the feedback received from staff are team-based rostering, legacy mentoring and a talent development programme targeted at BAME staff, those with a disability and who are neurodiverse.

Overcoming obstacles

The project group regularly engaged with staff who felt they had previously provided their feedback to the trust, and nothing had changed. Therefore, critical to the success of the project was engagement with line managers and staff about what was being done and why. This helped to reduce scepticism and improvement engagement in the roll out and delivery of the work. 

Communicating key messages about how the trust was acting on the feedback that had been gathered showed staff they were being listened to and that UHB was doing something about the information received. 

Take away tips

  1. Collaborate: Cross-team working has enabled engagement with a wider remit of staff. Having the expert opinion and buy-in of different staff groups, enabled engagement with staff who may normally find it difficult to engage with the trust.
  2. Small wins add up: A significant amount of the activity that has taken place to date are   local interventions in hot spot areas rather than trust-wide strategic initiatives. While trust-wide work is essential, working with local teams can still make a significant difference. 
  3. ESR won’t tell you everything: Workforce metrics and KPIs are incredibly useful but they don’t tell the whole story on their own. Proactively speaking to staff about their experiences provided UHB with a deeper level of insight and inspiration for future programmes of work. 
  4. Be proactive in reaching out: Don’t wait for people to come to you to share their experiences. Going to them in their place of work will enhance the depth of knowledge and understanding you will gain from their feedback and will ensure the feedback is balanced and representative of different staff groups. 

Contact details

For more information about the work in this case study, please contact Lily Anstey, deputy chief people officer at UHB: