At 2am, a care worker on a night shift makes a quiet but consequential decision. Something feels slightly off with a resident. She could escalate immediately, contacting a manager or nurse leader, or she could watch, reassess, and use her own judgement. What she chooses (and how confident she feels making that call) is not a product of her employment contract or her induction handbook.
It is a product of culture.
I have worked in health and social care for nearly thirty years. I began as a practitioner, became a registered manager, and then a director. Alongside this, I now run Lumina Leadership & Wellbeing, a consultancy that supports care organisations to build the leadership cultures that make genuine engagement possible. And in all that time, one thing has remained true: the most important determinants of how a care worker shows up – whether they go the extra mile, whether they speak up, whether they stay – are not visible on any organisational chart.
They happen in corridors, in handover conversations, in the way a manager responds when something goes wrong. They happen in the presence or absence of a leader who knows your name and lives the values and expectations. The culture remains long after the manager has gone home.
The Deskless Reality
Most of the conversation about employee engagement was built around office environments. The open-plan workspace. The all-hands meeting. The manager who drops by your desk. These are not inherently bad ideas, but they do assume a shared physical space — a common territory where culture can be observed, modelled, and reinforced.
Social care does not have that luxury.
A residential care home operates around the clock, across multiple shifts, often with a registered manager who is simultaneously managing compliance visits, staffing gaps, family liaison, and regulatory documentation. A domiciliary care provider might have a workforce spread across an entire county, each worker moving alone between the homes of vulnerable people, with little to no contact with one another throughout a working day.
The question, then, is not how to replicate office-based engagement in care – it is what genuine engagement actually looks like in this environment
I have sat with enough care leaders to know that many of them feel this acutely. People work in care, because they care deeply and this includes care for their teams. But the mechanisms available to them (the team meeting, the supervision session, the away day) are squeezed by operational pressure, and the informal culture that fills the gaps is rarely one they have designed intentionally.
Visible Leadership in an Invisible Environment
When I was building the team that would go on to achieve a CQC Outstanding rating, I had to think very carefully about what visibility actually meant in our context. It was not about being present 24/7, rather, it was about creating an environment where people felt trusted, supported, and clear on what was expected of them.
Visible leadership in a deskless environment means that when a care worker on a night shift makes that 2am call, they do so knowing, not just believing, but knowing, that their judgement is trusted, that escalation will be welcomed rather than criticised, and that if they get it wrong they will be supported rather than blamed.
That kind of psychological safety does not emerge from a policy document. It is built, slowly, through consistent leadership behaviour. It is built when a manager responds to difficult news with curiosity rather than defensiveness. When a concern is raised and something actually changes. When values are not just displayed on a wall but referenced in real conversations, in real moments, by real people – when leaders live daily to the same expectations.
The research on psychological safety consistently shows that it is team-level behaviour, not individual disposition, that determines whether people speak up. And in care, speaking up can be the difference between a safeguarding incident caught early and one that is not.
What AI Changes – and What It Does Not
There is a genuine and growing conversation in the sector about artificial intelligence. Some of it nonsense, some of it fear-mongering but some of it is genuinely worth paying attention to.
The workforce shortages facing health and social care in the UK are not a new problem, but with recent changes to sponsorship and the introduction of the Employee Rights Act, they have reached a point where they can no longer be absorbed by goodwill and overtime alone. Turnover in the sector consistently runs at rates that would be considered catastrophic in most other industries. The cost – financial, operational, human – is enormous.
AI-assisted tools are beginning to appear that can genuinely reduce the administrative burden on frontline managers: scheduling tools that account for preferences and continuity of care, communication platforms that bridge the shift divide, systems that surface early warning signals around team wellbeing or performance. These are not trivial gains. Time returned to a care manager is time that can be redirected towards the thing that engagement research tells us matters most – human connection.
Whilst technology can give leaders more time to lead, it cannot do the leading for them. Those relationships will always sustain and care is wholly relational.
The care worker who stays in a role does not typically stay because of the rostering software. She stays because of how she is treated on a Wednesday afternoon when everything goes wrong. She stays because her manager noticed she seemed quiet last week and asked if she was alright. She stays because she feels, in a sector that the wider world persistently undervalues, that the work she does is seen and matters immensely.
AI can help surface those moments – can flag when someone’s hours have changed unusually, can prompt a check-in, can reduce the friction that stops a manager from having a conversation they know they should have. But the conversation itself has to be real. And that requires a leader who knows what they are doing and why.
The Culture Question Underneath the Engagement Question
I want to say something that I think is often missing from engagement conversations in the care sector specifically: most care leaders are not struggling to care. They are struggling to lead intentionally in conditions that make intentional leadership very hard.
Engagement surveys tend to measure the output of culture. What I find more useful is to look at culture itself – how information flows through an organisation, how people talk to one another when things go wrong, whether values are signposted on a wall or genuinely embedded in everyday behaviour. These are not soft questions. They are strategic ones.
The organisations I work with that have the strongest engagement outcomes are almost never the ones that have run the most engagement initiatives. They are the ones where the senior leader has done the harder, quieter work: getting clear on what they actually stand for, making their expectations explicit, and then holding themselves to the same standard they hold everyone else to.
In a 24/7, deskless, emotionally intensive environment, that kind of leadership does not just improve engagement scores. It shapes the quality of care that vulnerable people receive. It determines whether a good care worker stays or leaves. It is, in the end, not a nice-to-have.
It is the work.
Author: Claire Callaghan – Founder & Strategic Culture Advisor, Lumina Leadership
Photo credit: StockCake
