Why engagement matters

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'Evidence-based common sense' was how Peter Lees described the Fund's new report on leadership in the NHS at our summit on 23 May.

The report draws on evidence demonstrating the relationship between staff engagement and organisational performance to make the case for a new style of leadership. If the NHS is to address the financial challenges that lie ahead, while improving patient care, leaders will need to balance the pace-setting style that predominates among top leaders by valuing and encouraging the contribution of others.

In a human service organisation like the NHS, the experience of patients is directly affected by the skills, attitudes and behaviours of staff. The evidence shows that staff who have clear objectives, control over their work, and well-structured appraisals are more likely to report that they are engaged in the work of their organisations than those who do not. Engaged staff are those who are well led, with the leaders of frontline teams having a particularly important role in creating a climate in which staff feel empowered.

In his contribution, David Nicholson paid tribute to NHS leaders for performing so effectively at a time of major change. As he put it, managers have been 'condemned, abolished and abused', and yet despite this have kept control of performance while dealing with the biggest reorganisation in the history of the NHS. The establishment of the NHS Leadership Academy is a strategic intervention intended to develop the talent of the future generation of leaders while also supporting existing leaders to adapt to the new environment.

David also reflected on his own leadership style and the steps he is taking to marry pace-setting with other approaches. As he acknowledged, pace-setting has helped to deliver real improvements in patient care in the past decade but it will not be sufficient for the challenges that lie ahead. If integrated care is to become a reality, leaders will need to work across organisations and services, using influence as much as authority and developing a repertoire of styles depending on the context in which they find themselves.

The Francis Inquiry into Mid Staffordshire NHS Foundation Trust, which is expected to report in October, loomed large over the Summit. It is likely that Francis will comment on the quality of leaders and will make recommendations on what needs to be done to avoid repetition of the failures of the kind that occurred at Mid Staffordshire. Speakers argued that more attention should be given to ‘professionalising leadership’, which suggests that the regulation of managers will receive active consideration, as well as their training and development.

The most important reminder of why engagement matters was provided by Maureen Bisognano of the Institute of Healthcare Improvement in Boston, Massachusetts in her international keynote address. Maureen gave some powerful examples of the value of patient engagement, including an initiative in Jonkoping County Council in Sweden where patients undergoing dialysis now control their own care with the support of nurses instead of vice versa. In the new model of care, patients have become co-producers and there have been improvements in outcomes and reductions in costs.

Malcolm Grant, the new Chair of the shadow NHS Commissioning Board, reflected that the Summit could not have come at a more apposite time, as the NHS embarks on an immensely complex process of change. Malcolm drew on his own experience of leadership in a university setting and drew parallels with the NHS, emphasising the importance of an enabling rather than top-down approach, where people have the space to excel and innovate. He emphasised the role of the NHS Commissioning Board in supporting clinical commissioning groups, and the importance of local collaboration to address local challenges. Malcolm described the new NHS architecture as one of shared leadership and reflected that collaboration and co-operation, and working through consensus, have never been more crucial to NHS leadership.

The summit provided further compelling insight and argument for the 'evidence-based common sense' that stronger engagement between staff, clinicians and patients is crucial to improving patient outcomes, delivering integrated care, and tackling the unprecedented financial and organisational challenges facing the NHS.


Bee Mottley

Comment date
15 March 2020

I hear continually about making improvement between staff, clinicians and service users but this has always been the case and therefore nothing new. I feel there are often unobtainable targets to reach causing pressure on everyone and I think at times it is difficult to say how it really is.


Comment date
04 December 2012
Attended an interesting session about this last night. Is there a difference between engaging and connecting? I think there is in clinical care and I wonder if the difference also involves it being more difficult to measure connecting.


Comment date
09 November 2012
It is the leadership that dictates what kind of cake you end up with.....

Mike Stone

Comment date
21 June 2012
'Common Sense' isn't identical across different groups of people (for example, nurses and paramedics will have differing 'group norms' for common sense) but the main problem, it seems to me, is that large organisations have problems reconciling 'train people well, tell them to use their brains, and let them get on with it' and 'who gets blamed when something goes very wrong' ?

Ian Alford

Comment date
31 May 2012
Interesting discussion ...and your final comments Nosap are food for thought (no pun intended!), and I agree with the concept but from a practical perspective I'm not sure it's that simple. I see evidence and hear comments that show that individuals are not always that good at doing the things patients need and therefore leadership is vital in making it happen - and yes it has to be in the 'work context'. I was at the conference and I guess the main thing that heartened me was a shift towards a leadership style that embraced a tad more humanity and emotional intelligence that is not incompatible with 'having teeth' when required!

Nosap Ience

Comment date
25 May 2012
Jerry you are bang on! The 'new' report is a bit passed the sell by date. Leadership and engagement are huge problems for the NHS but not in the way KF thinks.

The existence of 'leadership' as anything useful is the problem. Theoretical alignment of some behavioural characteristics of some influential individuals does not a system create.

Similarly engagement, recognised for many years in the literature, is only one rather unsophisticated step on the road to sustainable improvement and far less profound than for example, 'participation'. Knowing the Jonkoping work well, that is all about participation. And this is not semantics it is a quantum shift in thinking that takes you to a very different place. Engagement is to participation as a slap is to a handshake. Technically the description is very similar, but the outcome and response very different.

If you just get really good at doing the thing your patient wants, leadership and engagement are unnecessary. I do see that developing people is good, but let's develop them in the context of their work. Leadership if anything is a sweet glaze, on a cherry, on a decoration, on a centre piece, on the icing on the cake.

Steve O'Neill

Comms/OD consultant,
Comment date
25 May 2012
Maybe it isn't that common Jerry ? Not new insights, I know, but often falling in the 'knowing-doing' gap. Perhaps it is the speed of moving from knowing to doing that can be make culture change in the NHS feel glacial ...

Jerry Marsden

Comment date
25 May 2012
This doesn't seem to me to be saying anything particularly new or insightful - indeed it is "common sense". I'm interested to know why it took a year to work this out, and what evidence you plan to collect to show that implementing your ideas will benefit the NHS?

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