It seems obvious to say that a happy worker is an efficient one, but all too often this is simply not the case. HR managers, particularly those responsible for healthcare facilities, face a major daily challenge in boosting the morale of all staff.


“Research on motivation has shown us that if you want to improve the experience of patients and the reputation of your service, pushing already motivated people to become even more so is crucial,” says Siân Thomas, deputy director of healthcare organisation NHS Employers.

“If you have happy nurses, then generally you have more satisfied patients.”

The agency is responsible for workforce and employment issues on behalf of NHS organisations across England and Wales. Its aim is to help improve the working of the service’s staff and provide a ‘path to better patient care’.

According to Thomas, the impact on patients of a demotivated workforce is clear. “If patients are dissatisfied with the service, then you might find a trend that correlates to staff who are demotivated,” she says. “If you have happy nurses, then generally you have more satisfied patients.”

However, she accepts that the two can be seen as yin and yang. “If patients are demanding, then that affects the experience of the nurses too,” adds Thomas.

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Recognising that nurses are clearly the largest staff pool – for the NHS at least – employers are doing their best to make sure they are adequately supported and motivated.

“In terms of the techniques that employers are using to achieve this, there are many that are general across all sectors, regardless of which service industry you are in,” says Thomas. “A high level of training, good teamwork, the prospect of good line manager support and high-quality HR appraisal systems are all common ways of motivating staff.”

But there are some key factors that Thomas says are specific to the healthcare sector, particularly in relation to managerial support around operational concerns. These issues can get in the way of staff doing their jobs effectively.

“The other thing that is prevalent is the need for ‘workaround’,” she says. “We have a fair amount of duplication through systems and processes that need to be better aligned to fit in with job designs. If you have well-designed processes that avoid this you’ll have staff that offer a better fit between their needs and aspirations and the needs of their patients.”


Research conducted by Professor Michael West and Dr Susan Michie in 2002 concluded that people management, the psychological consequences of well-being for staff and staff experience were ‘highly influential in influencing employee health and well-being but also have an effect on individual, group and organisational performance, and thereby patient care and patient outcomes.’

The report went on to say that there was substantial empirical support for a policy focus on people management and human resource management practices within NHS organisations.

Team bonding is vital to achieve this, as Thomas observes: “In any healthcare setting, private or public, I have no doubt that being part of a team is one of the biggest attractions of joining the service, and a major reason why people stay,” she says. “One of the outcomes of Michael West’s research was the link between teamwork, clear team goals and good leadership, ultimately leading to improved patient safety. If the team dynamics are right, more patients receive better outcomes.”

The West and Michie report suggested that patients were more satisfied with their care in units where nurses found their work to be more meaningful, felt less tired or less frequently expressed an intention to quit.

Quoting past research, the report also said that: “High levels of stress, depression and alcohol abuse have been linked to patient care. In a study of hospital doctors, 82 out of the 225 questioned reported stress incidents that had adversely affected patient care.”


“The ultimate consequence of demotivation for any healthcare organisation is service failure,” says Thomas. “This can be anything from the death of a patient, to a decline in quality of service over a period of time.”

Motivation and drive to fulfil a role can be direct or indirect factors in this. Continuity of service, and indeed the team, is crucial to ensuring a facility’s day-to-day operations run in accordance with the aim of individual managers right through to hospital boards and regional and federal government.

A further indication of low staff morale can be the inability of a healthcare provider to recruit or even retain staff. “During the mid-1990s I arrived at a hospital that had been suffering from a greater number of staff leaving each month than were arriving,” explains Thomas. “That is a very simple metric, but before too long the facility was unable to function properly.

“I’m sure that in a lot of hospitals where recruitment levels were poor, that was what managers were experiencing. On one level you can plug gaps in the short term with temporary staff, but if the loss of employees continues for an extended period of time, the consequence will be a deterioration of service.”


So the message is clear: a happy workforce can not only lead to better patient care, but also increase morale throughout the organisation. There is no doubt that a correlation between lower staff turnover and higher rates of patient satisfaction exists.

“Being part of a team is one of the biggest attractions of joining the service, and a major reason why people stay.”

But, insists Thomas, this has to be brought about through open dialogue with the local community and also those who treat them. “I think we [the NHS] need to work with our staff to empower them,” she says. “This will help to decrease the level of turnover with which we have had considerable success in recent years and improve on any negative experiences. The best way to improve patients’ experiences is to improve those of the healthcare professionals treating them.”

A further benefit to improving recruitment and retention can be gleaned from the financial aspects, argues Thomas. She says that while people have tried to attach a figure to individual departures from the NHS, the UK Government has not produced an official formula for calculating the cost of staff leaving: “However, most US healthcare organisations will tell you that this cost is several thousand dollars; every employee that leaves is worth about $20,000.”

Regardless of whether you are a public sector healthcare provider in the UK or a private one in the US, the challenges for the future remain the same. “If you ask most private healthcare organisations, they will tell you that getting the best from their staff for the least cost is what they are all about,” adds Thomas.

“In reality, service failure is just as damaging for the private sector as it is for the public sector. No hospital wants to see itself in the media because of a failure of any kind, so whether you are private or not these issues are critical.”’ Managing the workforce and a very public reputation are essentially the same issue for any healthcare provider.