ISSN 1475-4398

Volume 9 Number 2 2010

. Strategic HR Review

Improving employee engagement andwellbeing in an NHS trust

--=-Gordon Tinline and Kim Crawe

Gordon Tinline is Director ofRobertson Cooper Limited,Manchester, UK. KimCrowe is an ExecutiveDirector of ServiceDevelopment and Delivery,Merseycare NHS Trust,Parkbourn, UK.

DOl 10.1108/14754391011022226

Abstract

Purpose - The purpose of this paper is to present how Mersey Care NHS Trust introduced a uniqueintegrated leadership development and employee wellbeing programme from UK businesspsychologists, Robertson Cooper, to help it prepare for Foundation Trust equivalent (FTe) status.A priority for the Trust was to ensure that staff felt involved and supported throughout the restructure andfelt good about coming to work and engaged by their roles.

Design/methodology/approach - Robertson Cooper designed a programme to integratemanagement and leadership development with work to assess and improve levels of employeeengagement and wellbeing. It used its employee survey ASSET to measure the levels of psychologicalwellbeing, engagement and productivity of employees in Mersey Care NHS Trust and assess the impactof the change.

Findings - Using the results, individual employee action plans were designed to improve wellbeing andengagement, and inform managers about how to address staff priorities and become more effectiveleaders. Of the senior managers and clinicians who completed the evaluation, 83 percent agreed thatthe content of the development centres met their expectations.

Originality/value - The paper describes a concrete example of how Mersey Care NHS Trust isimproving employee engagement by focusing on wellbeing.

Keywords Employee involvement, Leadership, National Health Service, Change managementPaper type Case study

IT]mproving employee engagement is a challenge that many organizations nowI recognize as critical to their performance and reputation. Its importance has beenacknowledged on a number of fronts, including the major report on employee

engagement recently commissioned by the UK government's Department of BusinessInnovation and Skills (BIS) from David MacLeod (MacLeod and Clarke, 2009). This articledescribes a concrete example of how one organization, Mersey Care NHS Trust - a UKpublic sector provider of health services that is part of the National Health Service (NHS) - isimproving employee engagement by focusing on wellbeing.

Definitions of employee engagement vary but at the core of the concept is the idea thatemployees are connected to the organization in such a way that their discretionary effort iswillingly released and they are prepared to "go the extra mile" for their organization. A coreargument here is that this can only be achieved and sustained when employee wellbeing,particularly psychological wellbeing, is positive. The relationship between wellbeing andengagement is explored in Robertson Cooper's 2008 wellbeing report and associatedresearch (Robertson Cooper, 2008), as discussed below.

The relationship between employee engagement and wellbeing

Robertson Cooper has collected more than 80,000 cases of data using ASSET, its measureof psychological employee engagement and wellbeing. ASSET also measures the enablers

VOL. 9 NO. 2 2010, pp. 19-24, © Emerald Group Publishing Limited, ISSN 1475-43981 STRATEGIC HR REVIEW 1 PAGE 19

and blockers of wellbeing and engagement, plus health outcomes and related factors likemotivation and self-reported productivity levels. Because of the interest in both engagementand psychological wellbeing, the 2008 analysis focused on the factors that underpinemployee engagement and productivity. The goal of the analysis was to explore the linksbetween engagement, psychological wellbeing and productivity - concentrating the ASSETscales that measure psychological health, engagement and (self-reported) productivity.

In summary, the findings of the analysis show that engagement is linked strongly toproductivity, as one would expect. But when the combined role of engagement andpsychological wellbeing was explored, it was found that the correlation with productivity rosedramatically - suggesting that the combination of engagement with psychologicalwellbeing (PWB) is more powerful than engagement alone. As the diagram in Figure 1shows, two aspects of PWB - sense of purpose and psychological health - increased theoverall correlation with productivity.

It was also found that engagement itself is linked with psychological wellbeing (ie sense ofpurpose and psychological health scores). The suggestion is that underlying levels ofpsychological wellbeing are important conditions for achieving high levels of engagement.This enables conclusions to be drawn about the real drivers of employee engagement andtherefore which "levers" to pull if you want to start to improve it.

Within the context of the NHS, the emphasis on employee wellbeing has recently beenreinforced by the Boorman (2009) review. This argues that NHS organizations need to getbetter at looking after the wellbeing of their employees if they are to successfully support thehealth of the nation. It highlights a number of needs, as prerequisites for employee wellbeinglinked to better service delivery, which are relevant to this case study:

• The need for broad commitment, top management leadership and staff engagement at alllevels.

• Embedding staff health and wellbeing in the core business of the organization.

• Proper resourcing for staff health and wellbeing services.

• Agreed and consistent measures of the effectiveness of staff health and wellbeingprograms.

Change challenges at Mersey Care NHS Trust

Mersey Care NHS Trust provides specialist mental health and learning disability services forthe people of Liverpool, Sefton and Kirkby. It is one of three UK mental health trusts with ahigh secure unit. The trust was facing a number of significant strategic change challenges

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PAGE 20 I STRATEGIC HR REVIEW I VOL. 9 NO. 2 2010

sychological wellbeing are importantadltiev'i:ng high levels of engagement. "

" ... underlyi gconditions fa

--= .....sSET assessment provided Mersey Care wi a O)I'"''''C e '" si e and detailed profile of...._= carriers and enablers of wellbeing across the .... s: - ferences highlighted byocanon, role and length of service, among other c --8 ia, •.E.SO provided the organization

data to feed into the leadership development process •• ch applied a developmenter model, to ensure leaders were challenged 0 i aDOUi - e impact they were having

_ ,where relevant, the changes they needed to ma. e - 8 ance staff wellbeing.

eadership development centres

The development center model is an established adapt 0 assessment center methods.Participants work through a number of observed and assessed structured exercises (e.g.group discussions, role plays, in-tray exercises, e.c.). agans agreed criteria, and receivedevelopmental feedback on their performance.

The criteria for the DCs were based on the NHS Lea ~ snip Qualities Framework (LQF) butthis was reduced to four core dimensions. The LQF is an established leadershipcompetency framework widely used in the NHS. Ho .•e er. like many such frameworks, it hastoo many dimensions (N = 16) to be applied e 'eco

- ely in a limited development context.Therefore, a content analysis of the framework as applied to cluster the competencies intofour core areas:

1. self-development (internal focus);

2. drive and motivation (external focus);

3. leading through people; and

4. strategic capacity.

This reduced model was easier to apply in a one-day DC and was well received, not just byMersey Care, but also by HR professionals from other trusts who acted as observers on theevents.

DCs are usually very focused on the individual's development needs in relative isolation fromthe organizational context. We were keen to encompass the change context here byincluding a focus on developing leadership that was directly targeted at improvingemployee engagement and wellbeing. The design also incorporated opportunities forreflection and peer mentoring that enabled participants to carefully consider the relevanceof the DC experience to their career progression at a time of substantial organizationalchange and restructuring. In order to meet these objectives a second Robertson Cooperassessment tool, Leadership Impact, was used as part of the DC process.

Targeted leadership assessment

The Leadership Impact tool is a personality assessment based on the "Big 5" model ofpersonality, which is the most widely recognized and used personality model. It starts withthe assumption that there are five stable elements to our personalities and that people havedifferent natural preferences for each. The five elements are openness, conscientiousness,extraversion, agreeableness and neuroticism. Leadership impact does not report explicitlyon these areas, but uses the leaders' scores to provide feedback around their impact on theengagement and wellbeing of their workgroups .

• - - ~m:GIC HR REVIEWIvd. 9 10.22010

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All senior managers and clinicians attending the DCs completed the questionnaire. Thebenefit of using this tool was the ability to provide feedback to individuals on their naturalleadership style and how it impacts the key areas that determine employee engagement andwellbeing (the same areas measured by ASSET). The participants were encouraged toconsider their Leadership Impact profiles in relation to the wellbeing and engagement levelsof the actual workgroups that they led - as revealed by the relevant ASSET survey results.This process, developed by Robertson Cooper, is known as Vector Analysis - see Box 1.

The DCs were one-day events held off-site in the period October 2008 to February 2009 andwere open to all senior managers and clinicians likely to play a leadership role in the newCBUs. Generally, the DC approach was well received - for example, 75 percent ofparticipants agreed that they found the DCs useful for their personal development and 83percent agreed that the content of the DCs met their expectations. This data was gatheredthrough a post-DC evaluation survey. One longer term planned indicator of success is arepeat all staff ASSET survey (see below).

Moving forward

Looking to the future, the challenge is to build on this approach and the positive reactionsthat the first phase has inspired. Now that the CB Us are embedded there are a number ofplanned activities, including the following:

• Revisit the Leadership Impact data at a CBU senior leadership team level. The focus willbe on considering the collective leadership impact on engagement and wellbeing at thebusiness unit senior leadership team level. Facilitated workshops will be offered tosupport leadership teams through this process.

Box 1. Vector analysis: Connecting leadership approach directly to staff engagement andwellbeing

Vector Analysis is a process that brings together an assessment of the natural leadership style of amanager with an assessment of the wellbeing and engagement levels of the staff they lead. Itprovides a simultaneous focus on leadership development and employee engagement andwellbeing. Two assessment tools are used as the basis for the Vector Analysis process, LeadershipImpact and ASSET.

Leadership Impact is a personality-based assessment of the leader, which shows his/her likelyimpact on the workgroup. It reports on the leader's natural style in terms of the balance he/she islikely to strike between challenging people and supporting them. It focuses on leadership strengthsand highlights the risks of overusing strengths without flexing his/her approach. The report isstructured around six key areas that leaders must impact positively to ensure that their people feelmotivated, energized, engaged, resilient and, above all, deliver high performance. These are theextent to which staff will feel informed and equipped; feel in control; have a balanced workload;experience well-managed change; have collaborative relationships; and have a strong sense ofpurpose.

ASSET is a short questionnaire that the leader's workgroup completes (e.g. direct reports). Itmeasures the workgroup's perception of the workplace in terms of what is blocking and enablingproductivity and performance. It provides a real "view from the floor" based on an establishedmodel of the factors that impact performance at work. It asks about what the workplace feels like -NOT how the leader or manager behaves.

By bringing together the results from Leadership Impact with those from ASSET, the Vector processprovides a common framework for reporting on the leader's likely impact and the key situationalfactors that drive performance and wellbeing. Vector Analysis provides insight for leaders thatopens up a process of personal development that can deliver benefits for the leader and theworkgroup alike. The combined results from the two assessments provides a powerful process fordeveloping leaders and workgroups to bring about measurable performance improvements inboth, with a strong focus on the areas that are critical to wellbeing and engagement (e.g.collaborative relationships, well-managed change, balanced workload and sense of purpose).

VOL. 9 NO. 2 2010 I STRATEGIC HR REVIEW I PAGE 23

• The whole workforce ASSET survey is likely to be repeated in 2010. This will be a keyevaluation metric in establishing how far Mersey Care has come in improving staffengagement and wellbeing. One challenge will be improving on the 33 percent responserate in the last survey, as this in itself can be a strong indicator of staff engagement. It ishoped that the active use of the results of the last survey, particularly through leadershipdevelopment, will encourage more staff to respond on the basis that they consider thesurvey to be a meaningful and useful staff consultation exercise.

The process has given Mersey Care a strong basis for ensuring that leadership developmentis focused on employee engagement and wellbeing. However, there is still substantial workto do to ensure this becomes the norm within the trust and there are a number of barriers toachieving this goal. One of these barriers is the wide range of leadership developmentapproaches and models the NHS is exposed to and, to some degree, generates. The factorsthat underpin employee engagement and wellbeing - such as strong relationships,ensuring a sense of purpose and managing workloads and change effectively - tend to beconstants in complex organizations. Mersey Care, like other NHS trusts, has to rise to theChallenge of ensuring it keeps these factors firmly at the heart of leadership developmentand practice, while being able to take account of new thinking that comes along over thenext few years.

References

Boorman, S. (2009), NHS Health and Well-being Review - Interim Report, Department of Health,London.

Cartwright, S., Tytherleigh, M. and Robertson, S. (2007), "Are mergers always stressful? Some evidencefrom the higher education sector", European Journal of Work and Organizational Psychology, Vol. 16No. 4, pp. 456-78.

Donald, I., Taylor, P., Johnson, S., Cooper, C., Cartwright, S. and Robertson, S. (2005), "Workenvironments, stress, and productivity: an examination using ASSET", International Journal of StressManagement, Vol. 12 No. 4, pp. 409-23.

Johnson, S., Cooper, C., Cartwright, S., Donald, I., Taylor, P. and Millet, C. (2005), "The experience ofwork-related stress across occupations", Journal of Managerial Psychology, Vol. 20 No. 2, pp. 178-87.

MacLeod, D. and Clarke, N. (2009), Engaging for Success: Enhancing Performance through EmployeeEngagement, London, available at: available at: www.berr.gov.uk/files/file52215.pdf

Robertson Cooper (2008), Well-being at Work: The New View The Business Well-being Network AnnualReport, Robertson Cooper, Manchester.

About the authorsGordon Tinline is a director at Robertson Cooper Ltd. A chartered occupationalpsychologist, he joined Robertson Cooper at its formation in October 1999 and is adirector of the business. He has led a large number of Robertson Cooper's projects and hasprovided leadership development for senior management teams. He designs and runsboard level development in several NHS Trusts. Prior to joining Robertson Cooper, he was aprincipal consultant with PA Consulting Group. He has an MSc in Organizational Psychologyfrom UMIST and an MBA from Warwick Business School. Gordon Tinline is thecorresponding author and can be contacted at: gordon.tinline@robertsoncooper.com

Kim Crowe is executive director of service development and delivery at Mersey Care NHSTrust. FOllowing a politics degree, she commenced her career in the NHS as a managementtrainee and since then has held a range of positions in HR management. She was appointedexecutive director of HR with North Mersey Community Trust in 1997 and executive directorof OD with the newly created Mersey Care NHS Trust in 2001. She is also a non-executivedirector for an award-winning social enterprise called the Furniture Resource Centre.

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