NHS

BACKGROUND:
Recent studies have suggested engagement is linked with beneficial outcomes for individuals and organisations. Despite growing demand for resources and advice on engagement within the NHS, there has been no systematic evaluation of how engagement strategies can be developed and operationalised within the NHS.
OBJECTIVES AND RESEARCH QUESTIONS:
To evaluate evidence and theories of employee engagement within the NHS and the general workforce to inform policy and practice. Four research questions focused on definitions and models of engagement; the evidence of links between engagement and staff morale and performance; approaches and interventions that have the greatest potential to create and embed high levels of engagement within the NHS; and the most useful tools and resources for NHS managers in order to improve engagement.
REVIEW METHODS:
Evidence was evaluated using a narrative synthesis approach involving a structured search of relevant academic databases and grey literature. The search yielded a final data set of 217 items, comprising 172 empirical papers, 38 theoretical articles, four meta-analyses and three books. From the grey literature, only 14 items were used in the analysis.
MAIN FINDINGS:
There is no one agreed definition or measure of engagement. Existing approaches were grouped under three headings: a psychological state; a composite attitudinal and behavioural construct; and employment relations practice. Most fell under the first category, with the Utrecht Work Engagement Scale being the most prevalent. Most theorising around engagement used the job demands–resources framework. Thirty-five studies considered engagement and morale, and the most consistent finding was a positive link between engagement and life satisfaction, and a negative link between engagement and burnout. Some studies suggested that engagement was positively associated with organisational commitment and job satisfaction and negatively linked to turnover intentions. Of 42 studies that looked at performance and engagement, the strongest support was found for a link between engagement and individual in-role performance and a negative link between engagement and counterproductive performance outcomes. A link between engagement and higher-level performance outcomes was also found. Of 155 studies that explored approaches and interventions that promote engagement, the strongest support was found for the following: positive psychological states including resilience; job-related resources and job design features; positive leadership; perceived organisational support; team-level engagement; training and development. Only a small proportion of studies were based in health-care settings, making the application of evidence to wider contexts limited. Studies identified in the grey literature suggested that the focus of practitioner material was more on wider managerial issues than on psychological factors.
CONCLUSIONS:
The synthesis highlights the complex nature of the engagement evidence base. The quality of evidence was mixed. Most studies were cross-sectional, self-report surveys, although the minority of studies that used more complex methods such as longitudinal study designs or multiple respondents were able to lend more weight to inferences of causality. The evidence from the health-care sector was relatively sparse. Only a few studies used complex methods and just two had taken place in the UK. The evidence synthesis suggests that employers might consider several factors in efforts to raise levels of engagement including development and coaching to raise levels of employee resilience, the provision of adequate job resources, and fostering positive and supportive leadership styles.
FUNDING:
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research (HSDR) programme.
Copyright © Queen’s Printer and Controller of HMSO 2015. This work was produced by Bailey et al. under the terms of a commissioning contract issued by the Secretary of State for Health. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.

ABSTRACT Nello scenario di trasformazione della Medicina di Laboratorio, il ruolo della pianificazione, organizzazione e gestione non è solamente quello “organizzativo-gestionale”, di manutenzione della struttura esistente o, al massimo, di ottimizzazione dei processi e dell’efficienza complessiva dell’organizzazione. Si tratta, piuttosto, di un ruolo essenziale, che parte dalla consapevolezza della mission generale, delle prospettive della Medicina di Laboratorio e di quelle della specifica struttura in cui si opera, e da una vision ancorata alla propria storia, aperta al futuro e fondata sulle evidenze (EBLM). è, dunque, necessario avere in mente una “idea” di Medicina di Laboratorio da declinare nella propria specificità, tenendo sempre presente il proprio focus: il servizio al paziente. In particolare deve esservi la consapevolezza delle diverse declinazioni in cui la Medicina di Laboratorio oggi si esprime. Nel (ri)disegnare l’organizzazione del Laboratorio bisogna tener conto che si ha a che fare con pazienti, non con provette, che la costruzione inizia dai sistemi informatici per discendere poi alle componenti hardware, con l’obiettivo di piattaforme scalabili e futuribili, e che è fondamentale un attento ri-esame dell’organizzazione presente, per comprenderne nei dettagli i limiti e i miglioramenti da perseguire. Un sistema qualità robusto (accreditamento CAP o certificazione ISO 15189) e l’utilizzo di metodologie di ottimizzazione dei flussi, come il lean thinking, sono strumenti insostituibili. Con questo viatico si può pianificare la costruzione, scegliendo, a seconda dei vincoli esterni e delle condizioni culturali e politiche del Laboratorio, della Azienda e della realtà circostante, un percorso di dynamic stability oppure un percorso di disruptive innovation. La prima fase realizzativa è l’acquisizione della strumentazione. Le gare sono il momento chiave. è necessario da un lato conoscere il mercato e la compatibilità dei prodotti con l’idea da realizzare, e, dall’altro, le norme che consentono di stendere un capitolato che centri l’obiettivo senza cadere nell’identificazione a priori dell’aggiudicatario. La seconda fase realizzativa è la messa in opera della nuova organizzazione: strumenti, interconnessioni, personale e servizio al “cliente”. In questa fase, la cui lunghezza dipende da quanto è rivoluzionaria la nuova organizzazione, è essenziale il concorso dell’équipe, che sarà stata preparata da un percorso educativo iniziato ben prima della partenza delle gare e che sarà stata coinvolta nell’esame delle prospettive del Laboratorio e delle opportunità delle scelte organizzative conseguenti. In particolare, le attività formative di educazione e addestramento si rivolgeranno non solo ai contenuti tecnici e medici dell’organizzazione, ma alla necessità di rendere sempre conto delle proprie attività, sotto il profilo legale, economico, di responsabilità professionale (accountability) e delle possibilità di nuove professioni. Una volta posta in opera la nuova organizzazione, è di nuovo il lavoro coordinato e condiviso dell’équipe interdisciplinare e interprofessionale, tenuta insieme dalla propria mission e dalla leadership, che garantisce nel tempo gli outcome previsti. Gli aspetti delicati nelle innovazioni organizzative del Laboratorio di oggi (preminenza dell’information technology, automazione totale o modulare pre- e post-analitica, interdisciplinarietà delle strumentazioni consolidate ed integrate, interconnessione con i sistemi di analisi decentrate, evoluzione delle aree specialistiche rimanenti) risiedono principalmente nelle resistenze del personale, che è dotato di una autonomia professionale i cui modi non si coniugano mai facilmente con le traiettorie dell’organizzazione. Una conoscenza della teoria delle competenze, della gestione delle risorse umane e del lavoro in team consente di coagulare la gran parte delle persone intorno all’innovazione.

This report, commissioned by the NHS Leadership Academy, sets out the evidence base for Building Leadership For Inclusion (BLFI) – an ambitious new programme of work that aims to (1) raise the level of ambition, (2) quicken the pace of change, and (3) ensure that NHS leadership is equipped to achieve and leave an ever-increasing and sustainable legacy in relation to equality, diversity and inclusion. The report has been written by a research team based at the University of the West of England and is informed by an extensive review of relevant literature, interviews with academic experts and preliminary action research with the BLFI team and partners.

This article analyses the representation of the British National Health
Service (NHS) in Government communication and news media in Britain
as a crucial discursive figure of British national identity both during the
months preceding the Brexit referendum of June 2016 and in the early
months of the diffusion of the Covid-19 pandemic in 2020. We focus
on a number of issues regarding the ways in which the NHS has been
portrayed in the public arena. Both during the Brexit campaign and at the
onset of the coronavirus pandemic, the NHS was adopted as a powerful
unifying national symbol to be protected, thanks to a populist language
based on the adoption of quasi-religious tropes and mythical themes, war
metaphors, and praise for heroism. This populist language was charged
with rhetorical messages and slogans which turned the NHS into an image
of Britishness, as emerges especially from an analysis of the leading frontpage articles from the right-wing newspaper Daily Mail in the early phases of the pandemic.