Evidence Case Study: NHS 

This content is part of the Vision for the Public Sector Zone 


The following case study was provided as part of the evidence for the effectiveness of employee engagement strategies in improving performance, productivity and, in the private sector profitability.  It has been used cumulatively with other submissions compiled by many leading companies and organisations to leave little room for doubt about the statistical importance of engaging employees.

This particular case study is an additional support to The Evidence Paper


The NHS is the largest UK public sector employer, employing 1.4 million individuals across the UK. The NHS, however, is not simply one employer.  The employers are the individual NHS hospitals, trusts and other organisations.


There are compelling links between employee engagement and customer outcomes in the NHS, where the customer in this instance is the patient. NHS sector research completed by Aston University in 2009 demonstrated a high degree of correlation between good employee engagement scores and a range of desirable outcomes for patients.

The research showed that patient satisfaction is significantly higher in trusts with higher levels of employee engagement, as well as revealing some of the key drivers of this relationship. The percentage of staff receiving job-relevant or health and safety training, the prevalence of well-structured appraisal meetings and reports of good support from immediate line managers, were all linked to improvements in levels of patient satisfaction.  

The research also showed that NHS trusts with high engagement had lower standardised patient mortality rates, even when controlling for prior patient mortality, and these effects were of meaningful size. Patient mortality rates were approximately 2.5% lower in those trusts with high engagement levels than in those with medium engagement levels.

The research also showed that engagement was a critical factor in explaining absenteeism.  NHS employees were absent 10.7 million days in 2009. This equates to a loss of 10.3 million days annually at a cost of circa £1.75 billion. This is equivalent to the loss of 45,000 FTE each year. Clearly, any factors that are linked with absenteeism should be of great interest to NHS managers as they could provide the key to increasing both efficiency and quality.

Research from Aston University demonstrates that an increase of one standard deviation in engagement is associated with reductions in absence sufficient to generate savings equivalent to around £150,000 in salary costs alone for an average acute trust. Given the 164 acute trusts in the UK this represents a potential saving of £24.6 million each year, not including non-salary costs or the prospect of similar savings in other NHS trusts.

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