How do I boost low staff morale?

The pharmacy department at Wirral University Teaching Hospital faced a similar situation some years ago and worked hard to improve staff satisfaction/engagement. This resulted in NHS Staff Survey scores significantly improving, with staff describing:

• Effective teamworking;
• Staff being recognised for their contribution;
• High-quality appraisals (supporting equal opportunities and development);
• 100% of staff being able to contribute to improvements at work;
• Strong support from line management;
• Good communication between senior management and staff.

Communication is essential to improving staff satisfaction; weekly all-staff meetings support open lines of communication and are supported by smaller staff forums with similar staff groups providing opportunities to feed back in an open and non-threatening environment.

In staff huddles, staff are asked to describe three things that they are most proud of about their team/department and three things they feel could make it even better. This keeps the conversation constructive.

An improvement plan is developed every year — all staff are involved in taking actions forward to improve ownership, and progress updates are given via the staff meeting. This enables staff to see changes and feel that their opinion is valued.

Significant pieces of work have resulted from feedback, including local training for appraisal plus utilisation of an abridged 360 feedback model to support staff in being the best they can be. Significant efforts improved local education and training and staff have developed a range of shift options to support seven-day working. Observing suggested solutions being implemented promotes engagement.

Recognition was a main feature of feedback; we often talked about gaps in performance and we needed to discuss the positives more. The main initiatives implemented to support this included:

• Employee of the month;
• Idea of the month;
• Save of the week (this is a commendation for the clinical pharmacy intervention with the most impact reported in the previous seven days);
• The sunshine board where all external compliments are displayed.

Appreciate staff presentations — where staff groups describe their role so that others can see what they do and appreciate their contributions. Our medicines management technicians did a fantastic rap on YouTube.

We have learnt that small things matter too; putting a full-length mirror in the staff toilet to allow staff to check their uniform before work has been a simple action that staff have really valued.

Staff are our most valuable resource — if staff are happy and engaged this will have a positive impact on all other areas of work and lead to a better patient experience that improves outcomes for patients. Allowing time and space to listen to staff and their ideas is a worthwhile investment.

Sarah Hulse is the blood-borne virus lead pharmacist at Betsi Cadwaladr University Health Board and previously lead for education and training and pharmacy staff satisfaction at Wirral University Teaching Hospital NHS Foundation Trust.

Within the community setting, each pharmacy is unique. From my own experience, I have found it difficult to actively measure satisfaction and engagement in a community setting; rather, it is more useful to observe the general behaviour of the team.

Staff satisfaction leads to a positive environment in the workplace where staff have increased productivity levels, are able to focus on the tasks at hand and seldom feel disgruntled.

Engagement is based on trust, integrity and commitment. It is a two-way communication process between staff and the business.

One example is when a new staff member with no previous pharmacy experience joined a community pharmacy. After successfully completing her probationary period, she was introduced to the pharmacy team and started working in the dispensary. She got on well with all the staff members but did not seem engaged and always appeared to be on edge. Looking through the near-miss logs, which is a routine task, I noticed the new staff member had not reported any near misses since starting.

I politely let her know that completing a near-miss log is an important part of the job and it helps make the pharmacy safer. She replied that she did not think that completing near-miss logs was part of the job and did not want to do so.

Addressing this issue required a non-confrontational approach. I decided to ask other staff if they too had problems filling in the form. It became apparent that most of the staff did not like completing the near-miss logs, but they still did it. After a discussion with the team it was clear that staff felt the near-miss log would be used by our head office against individual team members. I asked how I could allay their fears and one suggestion was to make sure that staff involved could not be identified.

After speaking to the superintendent, it was agreed to anonymise the logs and monitor the pharmacy as a whole for a specified time period. Initially, as expected, there was an increase in near misses as everyone started reporting but, with time, the number of near misses reduced greatly thanks to actions taken to address incidents — for example, separating tablets and capsules with similar packaging.

Staff morale was noticeably improved, and staff were more engaged and supportive of each other and the company. A level of trust had been developed between the staff, myself and the business.

Bhupendra Bhudia is a pharmacy manager at Ribble Village Pharmacy, Lancashire, with more than 20 years’ experience in community pharmacy.

Having an engaged workforce has significant associations with better outcomes, including improved patient satisfaction, patient mortality and infection rates, and staff absenteeism and turnover^[1]
. Managers can enable a culture of engagement by authentic, open, inclusive and compassionate leadership^[2],[3]
.

Developing a culture of engagement requires an understanding of the current culture. Discovering ‘what is really going on’ by simply paying attention can offer valuable insights. 

During my time as the manager of a resident pharmacy service, there were significant signs of unhappiness within the group of resident pharmacists. To try to understand this, I often used morning handovers to listen to the residents, allowing them to offer valuable insight into issues that impacted upon their morale, wellbeing and their daily working practice, in addition to identifying opportunities to improve. This insight — plus information from sources such as feedback from tutors of the residents, the staff survey and from general conversations in the tearoom — led to a focus group with the residents about the current status quo.

In the focus group, we used a traffic-light approach to categorising what was happening: red issues were identified as ones that the residents could not tolerate at all; amber ones were issues that frustrated them but they could live with; and green issues were things they really liked about the service. There were no issues they could not tolerate (red), but several things they really liked (green) — for example, the lieu time arrangements for a residency shift. The residents identified many issues they would like improved (amber), allowing us to have an open conversation about what was within or outside of our control and how we should prioritise what to address. This allowed us to make changes that were achievable and of significant impact, as suggested and agreed by the group.

This approach opened ideas for initial improvements, but also encouraged the residents to speak up openly with future suggestions and comments because they felt listened to and that we were responsive to them. These open conversations are ongoing because improving staff engagement should not be a series of engagement activities. Staff need to co-produce what an engagement culture looks like, as they know best what will engage them rather than having it imposed upon them. This culture needs to be based on integrity and trust, and must include regular discussion and reflection^[4]
.

Phil Southworth is associate director of pharmacy — Medicines Resource Centre at Buckinghamshire Integrated Care System.