Employee engagement in a high-pressure environment

See how Imperial College NHS Trust responded to being near the bottom of the NHS staff engagement league tables with an employee engagement program that’s already delivering results in its first year.

Engagement and Talent Lead at the Trust, Nathaniel Johnson talks through the set up of the program and gives his tips for success in staff engagement.

1. # Qualtrics Converge Employee engagement in a high-pressure environment

2. Imperial College Healthcare NHS Trust Nathaniel Johnston ENGAGEMENT AND TALENT LEAD // TWITTER: @n8_tweets

3. Who we are

4. In a health context…

5. “ There is a clear relationship between the wellbeing of staff and patients’ wellbeing ” - The Kings Fund, 2012 Engagement = better healthcare

6. Additional evidence shows that healthcare organisations with higher levels of staff engagement have: FEWER HOSPITAL ACQUIRED INFECTIONS SIGNIFICANTLY FEWER MISTAKES BETTER OUTCOMES LOWER MORTALITY RATES A BETTER PATIENT EXPERIENCE Engagement = better healthcare

7. Bottom 20% of NHS organisation for our engagement score Lowest scoring hospital T rust in London Low response rates Fatigue at frequency of surveys Lack of input from staff on survey design and sharing results No “you said, we did” output from surveys Where were we?

8. Timeline + Ongoing anecdotal feedback DATE DATE DATE

9. What did we do?

10. This is our overall outcome measure. Going forwards, it will enable us to track engagement levels over time. It is calculated from a combination of three factors: Advocacy : How likely people are to recommend Imperial Healthcare NHS Trust to friends and family as a place to work Motivation : How motivated people self-report feeling motivated to give their best effort at work Satisfaction : Overall how satisfied people say they are with their job Overall engagement

11. Creating more good days for staff … 1. Staffing 2. Leadership 3. Culture 5. Teamwork 6. Efficiency 8. Pay and CPD 4. Working conditions 7. Capacity 20 40 60 80 100 120 140 160 180 200 220 240 260 280 300 400 500 Support & understanding Line-management Organisational management Senior leadership Direction 10. Change 9. Well-being MORE STAFF! Adequate staffing levels Recognition, appreciation & praise Value staff Respectful and friendly culture Positive attitudes No bullies Improved environment Improved facilitates (fix the lifts) Provision of food and drink for staff Not 3 sites Control a ir con Teamwork & teambuilding Communication across & within teams Accountable and responsible A good IT system Efficient processes Pro-active planning Admin support Less paper work Resources & equipment Decrease d workload / more time Reduce waiting. Manage bed / room capacity. Training & development Higher, fairer pay Career progression Shift flexibility Improve staff morale. S ocial / well-being activities Time for breaks / finish on time Empower staff Listen Staff voice Research & innovation Address issues TOP 10 over-arching themes

12. Top reasons for high overall job satisfaction

13. 1. Staffing 2. Demands 3. E fficiency 5. Support 6. Culture 8. Invest in staff 4. Teamwork 7. Management 20 40 60 80 100 120 140 160 180 200 220 240 400 Resources & equipment Manageable w orkload Less patients / n ot overbooking Admin time or support Patient flow Less pressure 10. Empowerment 9. Work conditions Address staff shortages – enough staff to work with A better IT system Less inefficiencies & time wasting Less p aperwork & bureaucracy More planning, less chaos Easier processes Communication (less emails) Teamwork & team building Can do attitudes Support & understanding Good m anagement Safety / speak up Strong leaders Recognised & valued Respectful attitudes Address bullying Positive attitudes Less blame Shift flexibility Performance management Fairness & equality Role clarity & direction Provide f eedback Focus on care Trainin g & development Work-life balance Fair pay Care about staff Better e nvironment Improve facilities Temperature control Food & drink Less travel Consulted & listened to Empowered, not micro-managed Change & innovation More transparent TOP 10 over-arching themes Creating fewer bad days for staff …

14. Top reasons for low overall job satisfaction

15. Add title + descriptor to each logo (see next slide) Recognition & Value Contribution & Control Safety & Wellbeing Connection & Support Direction & Purpose Our Engagement drivers...

16. Our Engagement drivers Engagement increases when people feel respected for who they are, and that their efforts are noticed and valued. Recognition & value The Harvard Business Review says successful teams receive five times as much appreciation as criticism. Focus on ensuring: Recognition and appreciation How we want to recognise good work or efforts Specifically, what would people like to notice and appreciate in the team?

17. Our Engagement drivers Engagement increases when people are able to develop their skills, strengths and ideas and put them to good use. Contribution & control Gallup research shows people whose managers focus on their strengths are twice as likely to be engaged as people whose managers focus on their weaknesses Focus on ensuring: People know what each other’s strengths are in the team Managers know what skills or areas people want to develop People know how to help each other to do their best work We nurture more ideas

18. Our Engagement drivers Engagement increases when people feel safe from poor behaviours, and that their work contributes to their wellbeing. Safety & Wellbeing A BMJ article showed rude or bullying behaviours make patient safety errors much more likely to happen. Focus on ensuring: We reduce bullying at work. Identifying behaviours teams want less of and reducing them Identifying how teams can support each other when things are really busy How we make it safer to ‘speak up’

19. Our Engagement drivers Engagement increases when people feel a good sense of teamwork and support in their team, w ith other teams and from leaders. Connection & support In an NHS study, a 5% increase in team-working scores in staff surveys correlated with a 3.3% fall in mortality rates Focus on ensuring: People know what a ‘real team’ looks like and what support they want from each other Teams know what other teams want from them and how they could change how they work Teams get what they need from other teams and are clear what they need from them

20. Our Engagement drivers Engagement increases when people find meaning in their work, understand what’s expected of them, and see that in others too. Direction & purpose Studies have shown that managers can increase engagement by setting challenging SMART goals. 1 Focus on ensuring: P eople are clear about what’s expected of them – individually and as a team I ndividual objectives help to meet the team’s objective People are clear about their expectations of each other People are positive about what we are doing? Refresh of the Trusts corporate objectives that are cascaded during the appraisal process so all staff have a “line of sight” to how their role delivers the organisation’s mission

21. How did we take this further ?

22. “I have worked in the Trust for 15 years and after this session, I feel like I’ve been really listened to and heard” - Advanced Nurse Practitioner Photo: HIV/Sexual Health team meeting, Nov 2016 In the shoes of our people

23. You said, we did

24. Gone from “worst 20%” and jumped two levels to “average” 9% response rate increase Highest engagement score since 2012 Action plans received from all directorates (first time ever!) Over 700 staff participated in an “In our Shoes” workshop Renewed energy and motivation around engagement “Following changes to the work environment, we have seen improvements in our patient “friends and family experience tracker”- so that is a real pat on the back for the MRI Scanning Team” Where are we now?

25. Gearing up for the second year of the Our Voice, Our Trust survey New development programme educating managers on their role in employee engagement currently in design Toolkit resource on engagement and retention activities for managers Continued roll out of the In Our Shoes listening exercises Moving forward on our journey towards being a great place to work, for all Future…

26. # Qualtrics Converge Thank you @n8_tweets