Staff engagement is absolutely vital to the success of Quality Improvement (QI) projects and has an enormous impact on the quality of care.
As Batalden and Davidoff identified : ‘Everyone in healthcare really has two jobs when they come to work every day: to do their work and to improve it.’
Staff and patient satisfaction surveys demonstrate time and again that healthcare settings that use QI well and have a good improvement culture deliver better patient outcomes, with more engaged and patient-focused staff.
Staff engagement in QI enables teams to try out small changes in the way they work, which can make a great difference and, consequently, can lead to organisational change. In this article, we are going to look at the impact of staff engagement in QI and how patient care can be enhanced by engaging healthcare staff in improvement.
What is staff engagement?
Staff engagement can be described as an employee’s positive motivational state, characterised by ‘vigour, dedication and absorption’. The NHS Employers’ Staff Engagement Toolkit describes staff engagement in healthcare as ‘a measure of employees’ emotional attachment to their job, colleagues and organisation which profoundly influences their experiences at work and their willingness to learn and perform.‘
In other words, when teams are motivated by their everyday work and have an allegiance or loyalty for the organisation in which they work - this where you can find true staff engagement. Staff engagement in healthcare is something that organisations should be striving for – as it has a strong link to good patient outcomes and a range of other measurable benefits.
Why is staff engagement important for quality improvement?
…and why is it so important to engage staff in improvement?
Engaged, motivated and empowered staff create better outcomes – not only better outcomes for patients - but also other benefits that can be felt across the healthcare continuum. These are highlighted in the NHS Employers’ Staff engagement toolkit, when they state that ‘Employee engagement has a strong link to key measures of employee effectiveness such as improved attendance, higher productivity and greater “discretionary effort.”’
Staff engagement is shown to help support the implementation of QI across an organisation, so one of the key steps towards QI success is sharing visions and getting buy in from staff members.
The East London NHS Foundation Trust (ELFT), for example, have embraced QI and been very successful in their approach, which has a key focus on the importance of staff engagement. They say: ‘QI presents a real opportunity to rediscover the fun and enjoyment in work. QI enables us to connect in multiprofessional teams, rediscovering what motivates us and taking ownership of how we respond to the changing NHS and the subsequent challenges we face in delivering best and safe practice.’
The Chief Inspector of Hospitals, Professor Ted Baker recognises the importance of staff engagement when visiting hospital sites where improvement is well embedded, saying: ‘Staff are engaged, they are focused on the quality of patient care, and they are confident in their ability to improve.’
The benefits of staff engagement
Better staff engagement means better patient outcomes, and researchers have established a clear link between levels of staff engagement and patient experience. In other words, where staff engagement scores are high, patient satisfaction scores are higher and hospital mortality rates are lower.
Engaged employees have a strong link to effectiveness and higher productivity. With the high rate of attrition in some areas of the healthcare workforce - engaged employees are less likely to leave the organisation, especially in the early stage of their career. Engaged employees also have higher levels of trust in management and a greater understanding of their role within the organisation.
So, by engaging with people across your organisation you can get closer to achieving your QI goals. In the Health Foundation report: ‘The improvement journey: Why organisation-wide improvement in health care matters, and how to get started,’ the report recommends an: ‘integrated, organisation-wide approach to improvement, through which local activities are aligned, coordinated and appropriately resourced.’
Experiences in East London NHS Foundation Trust have shown that this works, as they have developed priorities, a mission and vision for its quality improvement work, which is growing significantly.
Staff engagement – in relation to QI, but also in more general terms - can be transformative to your organisation and can really support organisational change. If you are able to engage staff in improvement plans and enable staff and patients to help shape the care experience for the better, your organisation is more likely to achieve overall improvement.
Positive impact of staff engagement in the quality of care
Staff engagement clearly has a positive impact on the quality of care. As Professor Ted Baker, the Chief Inspector of Hospitals has said, ‘QI has been shown to deliver better patient outcomes, and improved operational, organisational and financial performance.’ He goes on to say that when they visit sites where staff are engaged, it ‘gives us confidence about the long-term sustainability of the quality of care.’
There are a wide range of ways you can encourage staff engagement, from staff recognition schemes to excellent communications strategies, and we will explore these in further articles.
To finish with an uplifting quote, in the article 'Training healthcare professionals in quality improvement' the writers state that when asked the question ‘how can we do something better?’ they suggest: “through harnessing the talents of multi-professional teams – with meaningful patient involvement – to rediscover the joy and optimism in our work and what truly motivates us and to see this translated into improved sustainable outcomes for our patients and our working days.” Wise words indeed!
 Batalden PB, Davidoff F. What is “quality improvement” and how can it transform healthcare? Qual Saf Health Care 2007;16:2–3.