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Employee Engagement within the NHS

23-May-2014 0:00
in General
by Chris Marshall

 The NHS is paying close attention to employee engagement, recognising it as a vital force for productivity improvement, better patient outcomes and cost savings. The NHS Employers website contains a vast resource of tips and tools to help managers at all levels in the NHS get to grips with the latest thinking on how to better engage employees.


A recent article in the Guardian (Employee engagement must be a priority for NHS Trusts, 19 March 2014) cites research showing that ‘only 14% of nurses surveyed are happy in their current role, with 57% considering a new role and 21% actively seeking a change. Healthcare organisations with low levels of employee satisfaction are likely to suffer the most from resignations and sluggish recruitment, while those with good reputations will attract and retain the best staff.’ Clearly there is still a long way to go.


Engagement in the NHS currently covers a wide spectrum of activities including staff health, fitness and safety. Everything to do with making staff feel valued is part of what employee engagement means in the NHS.


Although there is general agreement about the benefits of better engagement, it is not so clear what levers make the biggest difference. However, a feature common to all engagement efforts is their top-down flavour. A bottom-up approach is needed to supplement and reinforce an exclusively top-down style.


Most employee engagement efforts highlight the need for managers to be better at listening to employees. This is a big step but what about encouraging employees to take more initiative themselves? A twin-track approach may work best, with equal emphasis on top-down and bottom-up engagement.


If we ask why managers are more engaged than other employees, the answer must be the stronger sense of ownership that managers experience, the feeling of driving things rather than being driven by others. Ownership in turn means feeling that it is in your power to initiate real change rather than just respond to direction or a job description.


If we focus on the core of employee engagement, involvement in decision-making and felt ownership, then we can clarify the key differences between top-down and bottom-up engagement.


Top Down Engagement

Managers can foster greater employee ownership in two ways:


  1. Asking them for input, not just to solving staff work issues but also in thinking about the department as a whole, everything that is the responsibility of particular managers.
  2. Delegating higher-level responsibilities, aspects of the manager’s job that managers might normally reserve for their own attention.
  3. Empowering employees to show leadership independently by taking the initiative to promote improvements of their own.

The third way of fostering engagement is actually a broad cultural change aimed at encouraging managers to be more open to bottom-up initiatives and feedback. This means empowering employees to do more than make their own work related decisions to also take leadership initiatives to improve organisational functioning.


Bottom Up Engagement

We feel a greater sense of ownership for activities we initiate ourselves than for anything that someone else asks us to do or for which we are paid. Bottom up engagement is really self-engagement, initiatives that employees take in their own jobs to improve any aspect of organisational functioning that they can influence.


Employees who engage themselves show leadership bottom-up by promoting process improvements or by taking independent action in a way that shows leadership by example to their colleagues and managers.


Employees who engage themselves are continually searching for leadership opportunities, any aspect of their work that is an opportunity for improvement. When they convince their boss or team members to approach a task in a better way, they have shown leadership either by example or by being an advocate for change.


Conclusion: A New Culture

An exclusively top-down approach to engagement can make employees feel more valued whilst still feeling powerless and dependent. A more engaging culture requires managers to be more proactive in supporting bottom-up initiatives. Some managers may see this as a threat to their authority whilst many employees are reluctant to challenge their boss.


The risk of not making such a large-scale culture change is that employee engagement efforts could be limited to peripheral improvements.

To find out how engaging you are as a manager you can conduct an engaging manager 180, and to find out how engaged your employees are an engagement survey this in turn can help you decide how best to make changes to your organisation and self in order to have a more engaged workforce.

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