Engage to make a difference

East Lancashire Hospitals NHS Trust (ELHT) is a healthcare provider treating over half a million patients a year in the North West. Back in 2013, they were investigated as part of the Keogh Review and as a result were categorised as an organisation in “special measures”. Morale amongst the staff consequently hit rock bottom, against a backdrop of negative media articles.

Staff engagement was identified as a fundamental driver to improve staff and patient experience. However, it was appreciated that the cultural change required would take time to achieve.

To gain regular feedback from their staff, they used the Staff Friends and Family Test (Staff FFT, now known as National Quarterly Pulse Survey NQPS), to which they added several local questions. Based on this feedback and information from the NHS Staff Survey, they set about rebuilding ELHT with the clear intention to create a culture where staff felt they belonged.


  • A communication gap between board and ward, negatively impacting staff morale.
  • Staff engagement was below the acute average of 3.74 based on the NHS Staff Survey.
  • Feedback highlighted the challenges facing frontline staff weren’t understood.
  • ELHT needed to create freedom for all staff to speak up.


ELHT invested in a dedicated staff engagement team, including a full-time Staff Guardian. This team developed a programme called “Engage to Make a Difference”.

The project aimed to promote staff engagement and participation. Several mechanisms were used to reach out to staff:

  • surveys
  • a dedicated email address to raise confidential concerns
  • a rumour buster email address
  • big ideas button
  • confidential 1:1s with the Staff Guardian
  • “Share to care” meetings
  • senior leader visits to wards/departments, and
  • listening events such as “Big conversations”.

From this, they were able to identify ten key enablers along with other key principles/concepts that would be important in encouraging staff participation.

These enablers were built into the first employee engagement strategy. Along with the strategy, an annual employee engagement action plan was monitored by the sponsor group, chaired by the Chief Executive.

Picker workshops were run following each release of the NHS Staff Survey and provided staff with the space to understand, discuss and reflect on the latest results, before putting plans in place. These plans formed the basis of the “Big Conversations” events.

Based on staff feedback, numerous interventions have been introduced, including:

  • employee of the month
  • engaging managers programme
  • staff mediation service
  • mental health first aid training
  • staff app created and utilised by over half the employees
  • back to the floor programme where the directors walk in the shoes of the staff, and
  • staff engagement zones on each site, promoting information and feedback.


Since the implementation of the “Engage to make a difference” project, ELHT’s overall engagement score, a key metric of staff motivation, has gone from 3.73 in 2013 to 3.85 in 2017, to 7.3 in 2019 (on the new ten-point scale).

In the NHS Staff Survey 2019, satisfaction responses were better than average for eight out of ten key themes; thirteen questions demonstrated significant improvements and year on year their staff experience, and staff satisfaction had improved. ELHT also scored significantly better on 73 questions when compared to the Picker average.

Other improvements include:

  • Quarterly Staff FFT (2019/20 Q4) scores consistently demonstrate high levels of advocacy with 83% of staff recommending the organisation for care and treatment (Picker average 82%), and 77% recommending as a place to work (Picker average 67%).
  • In February 2019, they achieved a ‘good’ CQC rating.
  • Winner of the “Creating a supportive staff culture” award at the Health Service Journal Awards in 2018

Going forward

“Engage to make a difference” continues to improve the experiences of staff and patients at ELHT. They hope that with the actions they are putting in place, they will soon progress to a CQC rating of outstanding.

With Picker’s guidance, we were able to use the insights from the Staff FFT and the NHS Staff Survey to continually develop our programme and create the sense of belonging we want for our staff.

Lee Barnes, Associate Director Staff Wellbeing Engagement, East Lancashire Hospitals NHS Trust.

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