Health and social care staff experience: report 2019

iMatter EEI per organisation

The Employee Engagement Index (EEI) is calculated based on the number of responses for each point on the scale (Strongly Agree to Strongly Disagree) multiplied by its number value (6 to 1).  These scores are added together and divided by the overall number of responses to give the score to show level of engagement.

The overall EEI score of 76 for Health and Social Care is one point higher than in 2017. There was no reported score for 2018 as the threshold response rate of 60% was not achieved.

NHS Education for Scotland now has the highest ever reported Board EEI score of 82. NHS Health Scotland has the second highest score this year, remaining at 81.

Among the Geographic Boards NHS Lanarkshire has achieved the highest EEI score (79).

NHS Dumfries & Galloway and NHS Highland have the lowest reported EEI scores at 74. It is noted that the lowest EEI score in 2018 was the Scottish Ambulance Service (67) which did not reach the response rate threshold to receive a report this year.

Whilst there is a tendency overall for National Boards to have higher EEI scores than Geographic Boards, there is not a clear and obvious link between the EEI score and the size of a Board.

Comparing 2019 EEI to Previous Years

Of those Boards that received an EEI score this year 5 have increased by 1 point over their previous score (achieved in either 2018 or 2017). 8 Boards remain unchanged from their previous score. Four Boards have a lower EEI score than previously, three having gone down by 1 point and one Board (Healthcare Improvement Scotland) by 2 points.

EEI Score	2017	2018	2019	Movement from previous reported EEI*
Health and Social Care	75	No Report	76	+1
Golden Jubilee Foundation	78	78	77	-1
Healthcare Improvement Scotland	80	80	78	-2
NHS 24	75	77	78	+1
NHS Ayrshire & Arran	76	No Report	76	0
NHS Borders	74	No Report	No Report
NHS Dumfries & Galloway	75	No Report	74	-1
NHS Education for Scotland	80	81	82	+1
NHS Fife	75	No Report	76	+1
NHS Forth Valley	75	75	75	0
NHS Grampian	76	77	77	0
NHS Greater Glasgow & Clyde	No Report	No Report	No Report
NHS Health Scotland	81	81	81	0
NHS Highland	No Report	No Report	74
NHS Lanarkshire	77	78	79	+1
NHS Lothian	76	77	77	0
NHS National Services Scotland	77	76	76	0
NHS Orkney	75	76	75	-1
NHS Shetland	78	No Report	78	0
NHS Tayside	74	No Report	75	+1
NHS Western Isles	No Report	No Report	No Report
Scottish Ambulance Service	67	67	No Report
The State Hospital	76	77	77	0

*Movement is shown from the most recent year each Board previously received a report. 

Looking at the Boards who have received reports in all 3 years, it is notable that NHS 24, NHS Education for Scotland and NHS Lanarkshire have shown continuous improvement in their EEI score across all 3 years. NHS 24 have the largest reported improvement overall from 75 in 2017 to 78 in 2019

Two Boards; NHS Health Scotland and NHS Forth Valley have no reported change in their EEI score across all 3 years.

Several team stories highlight progress over 3 or 4 years of the iMatter programme, demonstrating the value in continued focus in driving sustained change as illustrated below (further examples are included within the Team Story section on this report).

The team has successfully focused on continuous improvement, by having regular reviews and open discussion. Through this process they have “identified alternative, more effective & efficient ways of working to reduce staff pressures, alongside achieving better outcomes for service users and releasing time to care.”

This has been reflected in considerable progress in iMatter metrics:

East Dunbartonshire Alcohol & Drugs Service HSCP, ‘The Road to Success’ 

Whilst NHS Dumfries and Galloway have seen a drop of 1 point from 2017 when an EEI report was last received to 2019, the Board are utilising the QI Hub process to support staff:

Case Study 8: NHS Dumfries and Galloway QI Hub

“The Board has a local QI Hub which provides networking sessions and drop-in opportunities for staff to receive QI advice and support for their projects. There are also formal courses; around 150 staff to date have taken the Scottish Improvement Skills course.  The Board is encouraging 2-3 members of a team to attend the course to build up whole team QI skills.  The Board has also introduced the Scottish Coaching and Leading for Improvement course which provides more advanced training.  The aim is to help local teams integrate QI skills within their projects from the outset.” 

NHS Dumfries and Galloway

Relationship between Response Rate and EEI

Across the Boards who have received reports in all three years, there is no consistent relationship between response rate movement and EEI movement.

	Response Rate			EEI
Organisation	2017	2018	2019	2017	2018	2019
Golden Jubilee Foundation	68%	63%	67%	78	78	77
Healthcare Improvement Scotland	80%	86%	90%	80	80	78
NHS 24	67%	70%	65%	75	77	78
NHS Education for Scotland	81%	84%	87%	80	81	82
NHS Forth Valley	65%	62%	68%	75	75	75
NHS Grampian	64%	60%	62%	76	77	77
NHS Health Scotland	85%	91%	93%	81	81	81
NHS Lanarkshire	65%	62%	65%	77	78	79
NHS Lothian	65%	63%	63%	76	77	77
NHS National Services Scotland	76%	77%	82%	77	76	76
NHS Orkney	73%	83%	66%	75	76	75
The State Hospital	78%	77%	79%	76	77	77

Of the 4 Boards that have seen improvement in response rate year-on-year across the three years: 

- NHS Education for Scotland has also seen an increase in EEI year-on-year
- Healthcare Improvement Scotland’s EEI has declined each year
- The EEI for NHS Health Scotland has remained unchanged across the three years
- NHS National Services Scotland saw a drop of 1 in EEI from 2017 to 2018 and in 2019 it remained unchanged

Therefore it is reasonable to assume that continuing to increase response rates in future years will NOT have a direct detrimental effect on EEI score. 

iMatter Report of EEI scores for Teams per Organisation 

Across the whole of Health and Social Care (including both Boards that did receive a report and those that did not) the distribution of teams across each of the score bands is as shown below. The vast majority of teams that received a report score in Strive to Celebrate (67-100). Across the whole of Health and Social Care there are only 59 teams that have an EEI score between 34 and 50 (less than 1% of all teams) and just one team with a score of 33 or less.

Organisation	Number of Teams	Percentage of Teams
Strive & Celebrate (67-100)	8,438	59%
Monitor to Further Improve (51-66)	988	7%
Improve to Monitor (34-50)	59	0%
Focus to Improve (0-33)	1	0%
No Report	4,902	34%
Total Health and Social Care	14,388	100%

Of the 60 teams that scored 50 or less, 16 of them (27%) are in Boards that did not receive a report in 2019. This compares with 25% of the teams scoring Strive and Celebrate and 33% of the teams scoring Monitor to Further Improve being in Boards that did not receive a report. 

The table below shows the distribution of team scores for each Board that received a report in 2019.

NHS Health Scotland is the only board with all teams in the Strive and Celebrate band. Additionally, there is one Geographic Board and three National Boards that have all teams with reports scoring either Strive and Celebrate or Monitor to Further Improve:

- NHS Orkney 
- NHS 24
- NHS Education for Scotland 
- The State Hospital 

90% of the volume of teams in reported Boards are in Geographic Boards and only 10% in National Boards. Of teams scoring Strive and Celebrate, 89% are in Geographic Boards reflecting the slightly lower overall EEI among Geographic Boards.

The above threshold categories were developed and recommended in the Staff Experience Project Report and Recommendations 2013 and approved in June 2013 by the Scottish Workforce and Staff Governance Committee.

Boards that received a report in 2019	Strive & Celebrate 67-100	Monitor to Further Improve 51-66	Improve to Monitor 34-50	Focus to Improve 0-33	No Report	Total
Golden Jubilee Foundation	95	7	2	0	42	146
	65%	5%	1%	0%	29%	100%
Healthcare Improvement Scotland	63	8	1	0	17	89
	71%	9%	1%	0%	19%	100%
NHS 24	110	11	0	0	93	214
	51%	5%	0%	0%	43%	100%
NHS Ayrshire & Arran	566	58	3	0	321	948
	60%	6%	0%	0%	34%	100%
NHS Dumfries & Galloway	187	25	1	0	72	285
	66%	9%	0%	0%	25%	100%
NHS Education for Scotland	91	1	0	0	10	102
	89%	1%	0%	0%	10%	100%
NHS Fife	475	45	4	0	294	818
	58%	6%	0%	0%	36%	100%
NHS Forth Valley	343	49	3	0	141	536
	64%	9%	1%	0%	26%	100%
NHS Grampian	799	76	2	0	462	1,339
	60%	6%	0%	0%	35%	100%
NHS Health Scotland	31	0	0	0	0	31
	100%	0%	0%	0%	0%	100%
NHS Highland	415	69	2	0	285	771
	54%	9%	0%	0%	37%	100%
NHS Lanarkshire	704	37	6	0	326	1,073
	66%	3%	1%	0%	30%	100%
NHS Lothian	1,313	129	10	0	736	2,188
	60%	6%	0%	0%	34%	100%
NHS National Services Scotland	285	23	2	0	45	355
	80%	6%	1%	0%	13%	100%
NHS Orkney	49	5	0	0	23	77
	64%	6%	0%	0%	30%	100%
NHS Shetland	84	6	1	0	44	135
	62%	4%	1%	0%	33%	100%
NHS Tayside	693	105	7	0	501	1,306
	53%	8%	1%	0%	38%	100%
The State Hospital	54	4	0	0	5	63
	86%	6%	0%	0%	8%	100%

EEI scores for Teams per Organisation comparison over time

The table below shows the EEI scores for the Boards that achieved reports in all three years. Percentages are based on the teams receiving a report. Overall there is consistency in the distribution of team scores over time. However, 3 Boards have increased the proportion of teams with reports scoring Strive and Celebrate across all three years

- NHS 24 (87% in 2017, 89% in 2018, 91% in 2019)
- NHS Education for Scotland (93%, 94%, 99%)
- The State Hospital (87%, 90%, 93%)

The proportion of teams with reports who have scored in the Strive and Celebrate band has decreased each year for The Golden Jubilee Foundation (95% in 2017, 93% in 2018 and 91% in 2019), leading to increases in the percentage of teams in the Monitor to Further Improve and Improve to Monitor bands.

Percentages based on all Teams receiving a report		Strive & Celebrate 67-100	Monitor to Further Improve 51-66	Improve to Monitor 34-50	Focus to Improve 0-33
Golden Jubilee Foundation	2017	95%	4%	1%	0%
	2018	93%	6%	1%	0%
	2019	91%	7%	2%	0%
Healthcare Improvement Scotland	2017	90%	10%	0%	0%
	2018	93%	7%	0%	0%
	2019	88%	11%	1%	0%
NHS 24	2017	87%	13%	0%	0%
	2018	89%	11%	0%	0%
	2019	91%	9%	0%	0%
NHS Education for Scotland	2017	93%	6%	1%	0%
	2018	94%	6%	0%	0%
	2019	99%	1%	0%	0%
NHS Forth Valley	2017	90%	10%	0%	0%
	2018	87%	12%	1%	0%
	2019	87%	12%	1%	0%
NHS Grampian	2017	91%	7%	0%	0%
	2018	93%	7%	0%	0%
	2019	91%	9%	0%	0%
NHS Health Scotland	2017	100%	0%	0%	0%
	2018	100%	0%	0%	0%
	2019	100%	0%	0%	0%
NHS Lanarkshire	2017	93%	7%	0%	0%
	2018	95%	5%	0%	0%
	2019	94%	5%	1%	0%
NHS Lothian	2017	90%	10%	1%	0%
	2018	91%	8%	0%	0%
	2019	90%	9%	1%	0%
NHS National Services Scotland	2017	93%	7%	0%	0%
	2018	91%	9%	0%	0%
	2019	92%	7%	1%	0%
NHS Orkney	2017	74%	10%	1%	0%
	2018	96%	4%	0%	0%
	2019	91%	9%	0%	0%
The State Hospital	2017	87%	12%	1%	0%
	2018	90%	8%	1%	0%
	2019	93%	7%	0%	0%

Overall Experience

The overall experience question has shown a small improvement from 2018 to 2019 with an increase in the mean of 0.1 to 6.89. This increase is being driven by small increases in the percentages scoring 9 or 10 and a decrease in the percentages scoring 2 or 3.

Across the Boards receiving a report, the overall experience mean score ranges from 7.75 for NHS Education for Scotland to 6.64 for NHS Highland.

The distribution of responses across the 11 point scale illustrates the differences between the highest and lowest scoring Boards. To demonstrate this point, the chart below compares the distributions for NHS Education for Scotland and NHS Tayside with the overall NHS Scotland distribution.

The high NHS Education for Scotland score is driven by a greater proportion of staff using the top end of the scale, with 59% of staff in this Board scoring 10, 9 or 8, compared to 41% of Health and Social Care staff overall. In contrast only 37% of NHS Tayside staff score 8, 9 or 10.

Distributions for all Boards receiving an EEI report are shown in Appendix 6.

Summary

The 2019 iMatter EEI score for Health and Social Care is 76, one point higher than the last reported score of 75 from 2017. Of the Boards that received an EEI score the highest is NHS Education for Scotland at 82 and the lowest NHS Dumfries and Galloway and NHS Highland, both with a score of 74. Five Boards have an improved EEI score this year, 8 are unchanged and 4 have a lower score than last time they received a report.

Several Boards show evidence of continuous improvement year on year in their EEI score, with individual Team Stories illustrating how this can be achieved through continued long-term commitment to improvement Action Plans. 

At team level, the vast majority (89%) of those that receive a report score in the Strive and Celebrate band (67-100) with just 60 teams across the whole of Health and Social Care scoring 50 or less.