Leadership skills for engaging staff in quality improvement

Research shows that staff engagement is directly linked to patient and quality benefits, with good leadership rightly recognised as being absolutely necessary to achieving transformation in healthcare. 

In its report, the NHS Leadership Model, The NHS Academy sets out nine key attributes which are designed to help those who work in healthcare become better leaders. Five of the nine attributes are leadership skills for engaging staff: inspiring shared purpose, leading with care, connecting our service, sharing the vision, and engaging the team.

In this article we are going to look in more detail at leadership skills for engagement, both in a broader context and also linked to success in Quality Improvement (QI).

The role of managers in staff engagement and QI

Managers can play a pivotal role in successful staff engagement – although their efforts may not always be recognised. The NHS Employers’ Staff Engagement Toolkit highlights that while developing an approach to staff engagement may feel like an overwhelming challenge: ‘Improving staff engagement is a key part of meeting these challenges as it is linked to better financial performance, increased staff health and wellbeing and improved services for patient.’

This all leads to the inevitable conclusion that staff engagement is vital to success in QI and managers need to have the key leadership skills for engaging staff to achieve transformational change in their organisations.

In the report ‘Beyond clinical engagement: a pragmatic model for quality improvement interventions, aligning clinical and managerial priorities’ the authors discuss whether a focus on clinicians, at the expense of managerial staff, has proven counterproductive in QI. The authors state that ‘Clinical engagement is not a universal challenge; moreover, there is evidence that managers—particularly middle managers—also have a role to play in quality improvement.’ While this relates to QI specifically, it is also relevant to staff engagement in any initiative.

The report by the Health Foundation: ‘What’s Leadership Got to do with it’ seeks to understand the links between leadership and quality improvement in the NHS. The document supports the idea that effective QI is attainable with the right leadership and culture. Managers can play a role in breaking through barriers in healthcare by putting hierarchy aside. Staff prefer non-hierarchical approaches and ‘clinicians often perceive managerial interactions as authoritarian and lacking patient centredness and see QI as inclusive, bottom-up engagement’ (BMJ: Why healthcare leadership should embrace quality improvement, 2020).

One thing is clear: managers and leaders who invest in and actively want to achieve staff engagement can greatly influence the culture of an organisation. If we want QI to become widespread and the norm in healthcare, management and leadership need to be willing to change. If you have good leaders in place, as well as buy in from the board, you can really make strides with your QI.

The authors of the article ‘Beyond clinical engagement’ say: ‘We suggest that neither clinicians nor managers can make meaningful QI progress in isolation: their collaboration is fundamental to sustainably embedding practice innovations'... which leads to us to ask, what are the necessary leadership skills for engaging staff?

Leadership skills for engaging staff

We can define staff engagement as the way that people behave, act and think. Influencing these behaviours in a positive way will increase the level of engagement that staff have at work. However, to engage staff, you need to possess and use a broad range of skills. We are going to highlight some of the necessary leadership skills for engaging staff:

Being a team player – firstly, you need to be prepared to be a team player and to delegate if you want to engage staff. You cannot achieve transformational success in splendid isolation!

Even handedness and maintaining a consistent attitude - consistency is cited as being vital for embedding quality within healthcare organisations.  

Good communication – communication is key to successful staff engagement - and having a vision that you can share with your teams that is both realistic and achievable.

Listening and acknowledging – you need to be able to support your team’s personal development, listen to your staff, and make sure they know that ‘every role counts’. Enabling involvement in decision making is another key skill.

Motivating and encouraging – By sharing your experience, you can motivate and encourage people around you.  

Mentoring and supporting – being able to lead by example and share your experience and mentor your team can lead to genuine staff engagement. 

If you want to find out more about training leaders, both for QI and staff engagement, take a look at our article: ‘Training the quality leaders of the future’. 

Develop a clear vision and mission for engaging staff in QI

In its report ‘The Improvement Journey’ The Health Foundation talks about the importance in QI of creating an ‘overarching improvement vision that is understood and supported at every level of the organisation.’ It goes on to consolidate this sentiment by setting out the six stages of the improvement journey, the third being: ‘securing wider organisational buy-in and creating a vision is vital for achieving good QI.’

Setting out clear goals from the outset is important if you want staff to be accountable for their actions and to buy in to the overall QI vision. The Health Foundation suggests creating and sharing a ‘theory of change’ from the outset of your QI journey, so there is a clear link between activities and the outcome you want to achieve.

A great example of developing a clear QI vision and mission can be seen in the work of the East London NHS Foundation Trust (EFLT). In 2014, the team launched their QI programme with a mission to 'Improve the quality of life of all the people we serve'. The mission and vision were clear and concise – and the team knew that by improving access to evidence-based care this would make their services more effective, give more power to staff and improve patient experience and outcomes.

This clear mission and strong priorities have enabled the team to engage with staff and, consequently to do some great patient safety work in a collaborative way. The fact that they were able to communicate their vision, mission and goals has led to them becoming leading experts in Quality Improvement in healthcare.

Establish a culture based on integrity and trust

'A dip in staff morale is the first sign of a dip in quality.' So said Sir David Nicholson in 2011. Establishing a culture based on integrity and trust can avoid any such pitfalls and lead toward better staff engagement and, as a result, better quality improvement.

Let’s look at what Donald M. Berwick, President Emeritus and Senior Fellow, Institute for Healthcare Improvement (IHI) recommends: ‘So what can we do about it? Move from inspection to improvement. Move from surveillance and contingency and reward and punishment, remove from asking people to try harder to asking people how we can help them to learn.’ Similarly, Don Berwick’s approach advocates moving away from an untrusting culture and moving towards openness, transparency, motivation and engagement.

It might sound like a difficult change to make – so, how do you transform your organisation from one extreme to the other? However, by implementing the necessary skills for staff engagement, you are half-way there.

In the ‘Improvement Leaders’ Guide’ by the NHS Institute for Innovation and Improvement, a senior leader of Improvement explains: ‘Leading improvement - basically it’s all about the leader having a mindset change from one of firefighting to one of continuous improvement.'

To conclude – there are many leadership skills for engaging staff – but by using the right tools, this does not have to be an insurmountable challenge. Developing a culture of trust is of paramount importance, while staff engagement brings so many benefits.  To finish with the words of Don Berwick: ‘I prefer a leadership system which has a different theory of motivation, that says: you did a great thing, and I might too.’