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Trust introduces a programme to amplify employee voice via multiple channels of speaking up mechanisms, resulting in high staff satisfaction responses and effective team working


    • The Keogh Review identified a communication gap between board/ward, creating immense impact on workforce and leading to low staff morale
    • Staff engagement was below the acute average of 3.74
    • Struggled to be recognised by the Care Quality Commission
    • Create freedom for staff to speak up and be identified as a value addition in society


    • Implemented Engage to Make A Difference- a project to promote staff engagement and participation
    • Provided speaking-up mechanisms like surveys, a rumour buster email address, share to care meetings etc.
    • Held listening events such as Big Conversations
    • Identified 10 key enablers along with other key principles/concepts, encouraging staff participation
    • Monitored an annual corporate/divisional employee engagement action


    • Resulted in highest staff satisfaction responses (20%) in 16 key findings
    • Improved staff engagement score to 3.86 in 2017
    • Improved effective team working, resulting in greater staff engagement/experience
    • 81% of staff recommended the organisation for care/treatment and 74% recommended it as an ideal place to work
    • Achieved a ‘good’ CQC rating


East Lancashire Hospitals NHS Trust (ELHT) is situated in the north-west of England and is a healthcare provider treating over half a million patients a year. The lifeblood of ELHT is our workforce of 8175 staff. As a consequence of The Keogh Review (2013) ELHT was investigated, the outcome was ELHT categorised as an organisation in “special measures”.

The impact on the workforce was immense, morale was at rock bottom. The local population had lost faith in ELHT due to negative national/local media articles naming ELHT as a “failing hospital”. Creating freedom for all staff to speak up was identified as a fundamental driver to enhance the climate at ELHT understanding that cultural change takes many years to achieve. Based on feedback from staff we set about rebuilding ELHT with the clear intention that we wanted to create a culture whereby staff felt that they belong at ELHT.

That staff believed in what ELHT was trying to achieve and that staff felt valued for what they contributed and that their contribution was important and purposeful. Likewise we intended to create an organisation that was worthy of the community it served and was widely recognised for providing safe personal and effective care.


Staff engagement was below the Acute average (3.74) with an ELHT overall engagement score in 2012 of 3.72 and 3.73 in 2013 based on the national staff surveys.

Feedback raised in the Keogh review highlighted a communication gap between board/ward which resulted in the Trust-board not being sighted on challenges facing front-line staff. A significant focus on improving staff voice was key.

ELHT invested in a dedicated staff engagement team including a full-time Staff Guardian. The team devised a project: Engage to Make A Difference. The projects aim was to amplify employee voice via multiple channels of speaking up mechanisms across ELHT:

- 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.

- Back to the floor.

-SPEC visits to wards/departments.

-Employee Engagement sponsor group chaired by the Chief Executive

Listening events known as Big Conversations across the whole organisation where lead by the Chief Executive. The Conversations asked questions around what staff where proud of, what barriers got in the way of providing safe, personal and effective care and what solutions staff had to overcome these barriers.


Since the implementation of the Engage to Make a Difference project ELHTs overall engagement score has gone from 3.73 in 2013 which was below average for Acute Trusts to 3.86 in 2017 which is above average for Acute Trusts and indicates that staff satisfaction has significantly improved at ELHT evidencing a change of climate and potentially culture at ELHT. Staff satisfaction responses were in the highest 20% (best) in 16 key findings. This equates to 50% in the highest (best) 20%.

Examples of a selection of Key findings in the highest (best) 20% compared to other Acute Trusts are:

Staff satisfaction with the quality of work and care they are able to deliver.

Percentage able to contribute towards improvements at work.

Effective team working.

Percentage appraised in last 12 months.

Staff satisfaction with resourcing and support.

Organisation and management interest in and action on health and wellbeing.

Percentage reporting most recent experience of violence.

Percentage reporting most recent experience of harassment, bullying or abuse.

Percentage reporting errors, near misses or incidents witnessed in last month.

Fairness and effectiveness of procedures for reporting errors, near misses and incidents.

Staff confidence and security in reporting unsafe clinical practice.


Feedback provided by staff through the various engagement mechanisms consistently identified 10 key enablers by staff to be important to them to create a culture in which staff felt they would flourish. These enablers were built into the first employee engagement strategy 2014-2019 along with other key principles/concepts to ensure the strategy was devised via a participative approach by, for and with staff.

Along with the strategy an annual corporate/divisional employee engagement action plan is monitored by the employee engagement sponsor group chaired by the Chief executive originally formed in 2014.

Big Conversations have been an annual event since 2014 and form part of the divisional staff engagement activities, following immediately after the publication of the national staff survey results. Numerous mechanisms continue to promote speaking up and employee voice is well embedded across the Trust.

Examples of embedded interventions based on staff speaking up:

- Employee of the month

-STAR awards

- Engaging Managers programme

-Staff App created, downloaded and utilised by 3000 staff

-Staff Mediation Service

-Mental Health First Aid training for staff

-Review of our approach to HR formal processes

-Resolution champions reporting to the Staff Guardian.

- Staff Engagement zones on each site.

Our approach has also been presented with the NHS Improvement culture community of practice to share practice


Placing a supportive culture at the centre of ELHTs work has improved value for staff by creating greater staff satisfaction, engagement and staff experience already highlighted by our staff survey scores.

Also our quarterly staff friends and family scores have consistently demonstrated high levels of advocacy with 81% of staff recommending the organisation for care and treatment and 74% recommending as a place to work.

Both feedback mechanisms highlighting our climate and culture have significantly improved based on feedback from our staff. Likewise ELHTs overall performance has significantly improved since setting out on this journey with all our key performance indicators except our 4 hour target being met, i.e: cancer, referral to treatment, infection prevention and control, stroke, harm free care and our financial duties.

The number of complaints from service users is at an all time low and our staff have won numerous national awards and accolades. Also our CQC rating has progressed to good and we fully aim to progress to outstanding in the coming years.

All of which highlight that our investment in creating a supportive culture has had the desired effect of progressing our vision to be widely recognised for providing safe personal and effective care.


Our stakeholders were all staff at ELHT. We engaged with staff via numerous engagement mechanisms to try to appeal to all audiences of the amplify employee voice. Staffs contribution was the key to ensuring we had a strategy that impacted beyond words on a page, and ensured that simple meaningful actions created a paradigm shift which has taken the organisation on a journey from burning platform to burning ambition and has enabled ELHT to be widely recognised for providing safe personal and effective care. 


Key individuals

Lee Barnes