Evaluating the evidence on employee engagement and its potential benefits to NHS staff: a narrative synthesis of the literature

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.

Leadership and Employee Engagement

Leadership is one of the most studied topics in the organization sciences, and employee engagement one of the more recent. However, the relationship between leadership and employee engagement has not been widely investigated. As many organizations invest significant resources in retaining, developing, and engaging employees, human resource development (HRD) professionals are tasked to develop and partner with leaders to deliver those strategies effectively. Thus, a comprehensive understanding on the relationship and mechanism between leadership and engagement is essential to HRD professionals informing leaders on how best to cultivate positive results in followers. In this vein, this research conducted an extensive review of empirical and conceptual studies that examined the relationship between leadership and employee engagement, analyzed/synthesized the studies into integrated frameworks for the leadership–engagement relationship, and proposed future research agendas.

The relationship of the job demands-control-support model with vigor across time: testing for reciprocality

We used a longitudinal design to investigate the hypotheses that the components of the Job Demands-Control-Support model and changes in their levels over time predict subsequent changes in levels of positive affect of vigor over time, and vice versa. Our study was conducted on a sample of adults working in a variety of occupations (N = 909, 68% men) at three points in time (T1, T2, and T3), over a period of about four years, controlling for neuroticism and other potential confounding variables. Job control at T1 and increase in its levels from T1 to T2 predicted an increase from T2 to T3 in the levels of vigor, whereas for social support, only its level at T1 predicted an increase from T2 to T3 in levels of vigor. An increase from T1 to T2 in levels of job demands predicted an increase from T2 to T3 in levels of vigor only for those rated low on neuroticism. Vigor at T1 predicted an increase from T2 to T3 in levels of job control and social support, but not changes from T2 to T3 in levels of job demands. The reciprocal causal relationship between job resources and vigor exists regardless of the demands of the work environment.

A Comparison of Three Job Engagement Measures: Examining their Factorial and Criterion-Related Validity

BACKGROUND

Engagement is an emerging job attitude that purports to measure employees' psychological presence at and involvement in their work. This research compares three academic approaches to engagement, and makes recommendations regarding the most appropriate conceptualisation and measurement of the construct in future research. The current research also investigates whether any of these three approaches to engagement contribute unique variance to the prediction of turnover intentions above and beyond the predictive capacity of alternative constructs.

METHODS

An online survey was taken by 382 employees and managers from a mid-sized financial institution.

RESULTS

Results failed to support either a multi- or unidimensional factor structure for the Utrecht Work Engagement Scale (UWES) engagement measure. For the Shirom-Melamed Vigor Measure (SMVM), a multi-dimensional structure was identified as a good fit, while a unidimensional structure fit poorly. The uni-factorial structure of Britt's engagement measure was confirmed. The Schaufeli measure of engagement was a strong predictor of work outcomes; however, when controlling for job satisfaction and affective commitment, that measure lost its ability to predict intentions to leave. Two components of the Shirom vigor measure held their predictive validity.

CONCLUSIONS

Collectively, these findings suggest that the Shirom vigor measure may provide better insight into whether and how much a person is 'into' his or her job. The Schaufeli measure was a good predictor of important work outcomes, but when job satisfaction and affective commitment were controlled, it lost its predictive validity. We were not able to confirm the three-factor structure of the Schaufeli measure. Two components of the Shirom vigor measure predicted turnover intentions after controlling for job satisfaction and affective commitment, suggesting less overlap with those constructs than the Schaufeli measure of engagement. This research adds important information on the nature of engagement and is expected to contribute toward a better understanding of the construct itself, as well as its measurement.

Fitting Engagement Into a Nomological Network

Engagement is an emerging job attitude that has been theoretically linked to both leadership and personality variables as well as important work outcomes. However, given the variations in construct definitions of engagement as well as limited existing empirical research, the authors empirically examined the nomological network of multiple measures of engagement based on Schaufeli’s three-factor engagement, Shirom’s vigor, and Britt’s one-factor engagement. Using data from an online survey of 382 working professionals, the authors conducted a series of hierarchical regression analyses and structural equation modeling to test the hypotheses. Results indicate strong relationships between engagement measures and personality (especially positive affect) and weaker relationships between engagement and leadership. Furthermore, multiple measures of engagement demonstrated significant relationships with the important work outcomes of turnover intentions, job satisfaction, and affective commitment. This research contributes to the literature on engagement by simultaneously examining multiple conceptualizations and measurements of work engagement and demonstrating leverage points for leaders to influence the state-like construct of engagement. Results suggested that engagement is related to important organizational outcomes and that engagement mediates the relationship between personality and organizational outcomes. Implications and suggestions for practice and future research are provided.

Self-engagement as a predictor of performance and emotional reactions to performance outcomes

Three studies examined the relationship between engagement in different types of tasks, performance on those tasks, and reactions to performance outcomes. The three studies included voting in the 2004 presidential election, test performance in an undergraduate course, and completion of personal projects during the course of the semester. Engagement in voting predicted voting in the presidential election and magnified positive feelings of voting for the winning candidate. Test engagement predicted performance on the test, and magnified positive feelings of not showing a discrepancy between expected and actual test performance. Engagement in personal projects interacted with task complexity to predict project completion, with engagement being related to goal completion for tasks high in complexity. Project engagement also magnified the positive effects of a high probability of completing the project. The results provide support for task engagement as a predictor of performance and as a facilitator of positive feelings following success.