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#HaloEffect #RipplesInThePond

Engagement means different things to different people. However, most definitions agree that engaged staff are those who are enthusiastic about – and committed to – the work they are doing. Disengagement, in contrast, is associated with lower profitability and productivity, as well as increased staff turnover and absenteeism rates.[1] In another poll, Forbes estimated that each disengaged employee costs their organisation 34% of their annual salary cost. And in healthcare the stakes rise. The Institute for Healthcare Improvement’s Framework for Improving Joy in Work highlights that lower levels of staff engagement are linked with lower-quality patient care.

Ripples in the pond

But how do we ensure staff feel engaged? Often the most powerful mechanisms are those started not at the top, but at the frontline of an organisation – and the impact of such initiatives can be remarkable. An analogy we like to use at ImproveWell is ‘ripples in the pond’. 

In late 2020, the King’s Fund published a report called The Courage of Compassion – it shared three foundations for positive staff experience:

  • Autonomy: having control over one’s work life and being able to consistently act with one’s values.
  • Belonging: feeling valued and supported – and connected to and cared for – by colleagues and vice versa.
  • Contribution: experiencing effectiveness in work and delivering valued outcomes.

If we give staff a voice, support them to suggest solutions to the challenges they face and involve them in decision making, we can create a ripple effect; improving staff experience, the quality of care delivery and patient outcomes.

Image 1: The ripple effect in action

Introducing a solution such as ImproveWell can help organisations to create the right environment for staff wellbeing and improvement. By gathering real-time insights from the frontline and involving them in decision making processes, you improve staff experience and wellbeing at work. You also engage all staff in Quality Improvement, harnessing collective intelligence and encouraging a culture of continuous improvement. In turn, these strong foundations lead to better patient outcomes.

Ripples become halos

When considering an engagement programme, adoption rates are the number one area of focus. What is a meaningful adoption rate? According to Forbes the average employee survey, traditionally a one-way process, garners a response rate of 30%-40%. In creating a culture of continuous improvement, ideally embracing two-way feedback mechanisms, the good news is that you don’t need 100% adoption for everyone to benefit. Even starting with a small group of participants, the subsequent impact can be profound. We call this the ‘halo effect of engagement’.

For example, if you have a large enough sample population, representative of your target audience, you’ll be able to understand what matters and prioritise actions. Importantly, everyone will benefit. With even a handful of champion participants, increasing numbers of colleagues will start to:

  • feel the benefit from the improvements made;
  • become aware of a new way to improve;
  • feel lifted by the enthusiasm of engaged participants and energised by their sense of ownership;
  • feel part of a collaborative environment; and
  • feel encouraged to get involved as well.
Image 2: The Halo Effect

Before you know it, there’s a momentum of influence that exceeds direct participation, and a culture of engagement is born, creating an ever-expanding effect which improves staff experience, care delivery and patient outcomes.

University of Minnesota: the ripples and halos take hold

The University of Minnesota (UMN) Department of Orthopedic Surgery launched their ImproveWell programme in October 2018 to help foster a culture of innovation and engagement. While everyone has the opportunity to participate, about 55% of the workforce is active on the platform. Nevertheless, the department has seen the benefits of the programme expand outward as the spill-over of engagement has moved from the programme leads to the frontline users – and beyond.

A few years into their ImproveWell programme, the department has seen significant improvement in its staff survey scores. In the first two years, the innovation and engagement questions increased by up to 24%. And there’s more.

  • 91% of respondents feel that they are encouraged to be innovative in finding more effective ways of doing things (compared to just 67% in 2017).
  • 82% of respondents believe that their department uses innovative approaches to improve internal effectiveness (compared to just 65% in 2017).
  • 86% of respondents feel the department has a strategy and goals that address the most important challenges and opportunities (compared to 67% in 2017).

A widening response

When asked how ImproveWell has encouraged individuals and teams to innovate and participate in Quality Improvement, a respondent noted that one way people are encouraged to participate is through seeing action taken on ideas their colleagues have shared. Demonstrating that as ideas are actually implemented, the wider group benefits both from the impact of the changes being made and by seeing the positive outcomes of their colleagues’ efforts.

“We’ve seen a remarkable increase in favourability in our employee engagement surveys related to innovation. Additionally, members of our department that aren’t active on the ImproveWell platform have found ways to be part of our innovation programme by attending workshops, requesting access, sharing ideas, referring new members, and helping vet/assess submitted ideas. There are many ways to get engaged and participate in our culture of innovation; ImproveWell is a fundamental and valuable tool in our department,” remarked one respondent.

Another of our partners agrees that this wide-reaching change-making effect is palpable. In a South West Academic Heath Science Network study of ImproveWell’s impact at Royal Cornwall Hospitals NHS Trust, staff members who did not engage with the application still noticed an improved atmosphere and recognised the positive effect. In addition, this halo effect itself further drives adoption and engagement rates.

Time and again, we’ve witnessed a particular pattern as the effects of ImproveWell spread; real-time insights improve wellbeing at work, which in turn stimulates quality improvement, which then positively affects patient outcomes. Getting champions on board at the beginning is the most crucial step: early adopters will help spread the word and encourage participation among their colleagues, but not everyone has to be hands-on. Once this process begins, engagement starts to flow throughout the organisation, creating a transformation in quality and experience for the workforce and patients alike. Like throwing a pebble in a pond.


[1] https://www.gallup.com/workplace/236927/employee-engagement-drives-growth.aspx

Photo by Scott Webb on Unsplash