Establish a culture based on integrity and trust

Research shows that staff are more engaged in their work and committed to their organisations if they believe that their leaders act with integrity and if they have confidence in the fairness of their organisation and its procedures. Staff are also more engaged if they feel valued by leaders and operate within a supportive community (Maslach et al 2001).

Conversely, we know that NHS staff are more likely to want to leave organisations that tolerate high levels of bullying or discrimination (Review of Staff Engagement and Empowerment in the NHS 2014).

The message is that values are important. NHS leaders need to attend to creating organisational cultures that help to maintain high levels of engagement and underpin safe, highquality patient care. At Frimley Park Hospital Foundation Trust, for example, there has been a conscious effort to define the trust’s core values and the behaviours that should underpin them, including honesty, fairness and compassion.

Statements on culture can play a useful role. But it is critically important that leaders are seen to act authentically and that organisations live by the values they espouse. Staff are likely to become cynical and detached if they detect a gap between what leaders say and what they do, what leaders claim is important and where they really focus their energies, or between the stated values and the behaviours that are encouraged or tolerated in practice.

As well as defining their values, successful trusts such as Frimley Park Hospital Foundation Trust and Guy’s and St Thomas’ NHS Foundation Trust are identifying ways of embedding them within their systems and processes, such as their recruitment procedures, appraisals and reward systems. A small number of trusts, such as Wrightington, Wigan and Leigh NHS Foundation Trust and Northumbria Healthcare NHS Foundation Trust, are developing more effective procedures to address behaviours that are inconsistent with their values, such as incivility, aggression, bullying and harassment, whether in relation to patients or other staff.

Board members should ask the following questions

  • Do we have a clear sense of the values and behaviours that we want to promote in the organisation?
  • What are we doing to promote those values and to address behaviour that is inconsistent with them?
  • What actions have we taken recently to tackle bullying and harassment in the organisation?

Next: place staff engagement firmly on the board agenda