The National Health Service (NHS) in England and Wales is attempting to improve the experience of its 1.3 million employees by conducting more regular and localized pulse surveys, using Qualtrics’ XM platform. The move has been triggered by a number of factors, including the effects felt across the health service during the COVID-19 pandemic, as well as a number of organizational changes and political mandates that are making it possible.
COVID-19, undeniably, has had a significant impact on health service workers in countries all over the world - and although the virus is no longer considered a global emergency, its impact is still being felt to this day. Supporting those workers on the frontline, as the NHS seeks to recover from the extreme pressure it has been placed under in recent years, is now a top priority.
Speaking at Qualtrics’ X4 Summit in London this week, Zoe Evans, Head of Staff Engagement at NHS England, said:
We’re not past the pandemic yet, we are still very much dealing with it. And although the World Health Organization has declared COVID-19 no longer a global health emergency, we recognize that it’s going to take a long time for us to come to terms with everything that’s happened
We’ve heard a lot about employee experience and its relationship with the bottom line. And I guess this story is more about one of employee experience and how it’s a humanitarian approach. And an ethical approach. It’s important to consider and be aware of wanting to improve, alongside the impact that it has on patients, the impact that it has on employees that work in that context, and also for every one of us as taxpayers to ensure that we get the best we possibly can.
The NHS - although often referred to holistically - is a very complex, fragmented organization. Political policy is directed by the government, which is then undertaken by the Department of Health and Social Care and directed towards NHS England. NHS England is now made up of a number of organizations that include Health Education England, NHS Improvement, NHSx and NHS Digital.
Beneath that there are 42 integrated care wards across the country, which have seven regional government structures that support them. And then there are 215 NHS Trusts, which make up an array of hospitals and healthcare providers, as well as 1,500 primary care networks. Evans said:
You can start to see a picture that is extremely complex. We have between 1.3 million to 1.4 million employees across the NHS. Up until COVID-19 we had one annual staff survey for which we could get a sense of employee experience across the NHS - for Trusts. It didn’t enter primary care. That is still a cornerstone of the information that we get, it’s done to a gold standard and it’s got academic rigor behind it.
However, despite this annual survey that is still being used for understanding employee sentiment, Evans is seeking to obtain more data and drive more action to improve the employee experience at the NHS.
Evans explained that a new ‘people directive’ was formed within NHS England in April 2020, just as COVID-19 was taking hold of the nation. This was the first time that there was a national structure within NHS England that focused on experience and culture.
A couple of other factors contributed to the NHS thinking more closely about employee experience too - namely that the NHS had published a 10 year plan on how healthcare was going to be delivered over the next decade. And to supplement that was the development of a new ‘people promise’, which was focused on what was needed to support the workforce, and included an 18 month engagement period where NHS colleagues share what would most improve their working experience. These were described by Evans as “massive levers” to enabling more regular listening of employees. She said:
With the ‘people promise’, for the very first time, we had a common language. We had a consistency through which we could measure, understand and ultimately improve employee experience.
In turn, NHS England asked itself the following question:
With the level of complexity within the NHS, and the enormity and impact of COVID-19, how could we implement regular listening in a consistent and standardized way? And how could we use that to understand and support employee experience across the NHS, but at all the different levels? And how could we use this moment in time to activate change for the future direction of employee experience?
Discussions began in April 2020 and a small team quickly delivered its first poll out to the NHS Trusts by July 2020. Since then, NHS England has gone through a more comprehensive development process and moved to the Qualtrics platform in March this year (2023). Evans said:
What have been some of our successes? At this point we get about 127,000 responses every quarter. Through the Pulse platform we get about 40,000 responses. Now through the enhanced capability, we have about 108 organizations talking to us about being able to maximize local flexibility. We can now provide a national perspective, a core question set, but we can also add a flavor to meet the context if we want to deep dive into health and safety, travel to work issues, all of those kinds of issues on a quarterly basis.
Evans said that this is enabling NHS England to dive into issues at a local level, within a national context, and push actions down to a team level too. She added:
We’ve now got 1,400 people that we’ve built as part of our community of practice and the model has very much been about a model of influence of change, creating a community where we can share knowledge, where we can share passion, share a commitment to making a difference.
Being 1,400 strong that’s really made a difference across the NHS - all talking about how we can improve employee experience, sharing case studies, sharing where we have started to see improvement and what they’ve done to make a difference - sharing that more widely and scaling that up.
Not thinking about EX in isolation
Evans said that NHS England is now conducting a quarterly pulse survey, but is also making it available on a month by month basis if organizations want to engage with it in that way. She explained that key to this consistency has been defining what employee engagement is - where the NHS uses a definition that means an individual can behaviorally be themselves at work, psychologically be themselves at work, be motivated, recommend their place of work, and be involved. However, Evans was keen to point out that this has wider positive implications for the health service too. She said:
Organizations that are highly engaged massively relates to other individual patient and organizational outcomes. High employee engagement relates to lower mortality rates, better health outcomes for patients, enhanced patient satisfaction rates, and enhanced patient safety
It also relates to a drop in sickness, absence levels, and lower burnout. Also, importantly, it does relate to CQC financial performance indicators and a reduction in agency spend. So we very much know that employee engagement is a really important thing, and by measuring it in this way, and correlating that with other organizational performance outcomes, you can really start having that conversation to make sure employee experience stays number one on the board.
On its success thus far, Evans said:
The NHS has taken employee listening to the next level and it's working. We are understanding, we are sharing, we are creating the momentum and the movement to change employee experience.