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

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

Bailey, Catherine, Madden, Adrian ORCID: 0000-0002-3193-5808, Alfes, Kerstin, Fletcher, Luke, Robinson, Dilys, Holmes, Jenny, Buzzeo, Jonathan and Currie, Graeme (2015) Evaluating the evidence on employee engagement and its potential benefits to NHS staff: A narrative synthesis of the literature. Health Services and Delivery Research, 3 (26). pp. 1-424. ISSN 2050-4349 (Print), 2050-4357 (Online) (doi:

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Objectives and research questions
To review and evaluate evidence and underpinning theories of employee engagement within the NHS and the general workforce to inform policy and practice. The study was underpinned by four research questions which explored definitions and models of engagement within the academic literature; the evidence of links between engagement and staff morale and performance; the approaches and interventions that have greatest potential to create and embed high levels of engagement within the NHS, and to identify the most useful tools and resources to NHS managers in order to improve engagement.

Review methods
Evidence was identified and evaluated using a narrative synthesis approach involving a structured search of relevant academic databases and grey literature. After systematic sifting of 5,771 items of academic literature for quality and relevance, data was extracted from a final dataset of 214 items, comprising 172 empirical papers, 38 theoretical articles and four meta-analyses. Three books were also used. From a large body of grey literature only 14 items were used in the analysis. Data were extracted from all items using structured data extraction forms.

Main findings
There is no one agreed definition or measure of engagement. Existing approaches can be grouped under three headings: engagement as a psychological state, as a composite attitudinal and behavioural construct, or as 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.
Of 35 studies included in the final dataset that considered engagement and morale the most consistent finding was a positive link between engagement and life satisfaction, and a negative link between engagement and burnout. Some studies examined the link between engagement and work-related attitudes and findings suggested that engagement was positively associated with organisational commitment and job satisfaction and negatively linked to turnover intentions. Of forty-two studies that looked at performance and engagement, 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, strongest support was found for the following factors: 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 overall were based in healthcare contexts, 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 of engagement.

Overall, the synthesis highlights the complex and confusing 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 healthcare sector was relatively sparse. Only a few studies used complex methods and just two had taken place in the UK.

Item Type: Article
Uncontrolled Keywords: Employee engagement, NHS, Evidence synthesis, Narrative review
Faculty / School / Research Centre / Research Group: Faculty of Business
Faculty of Business > Centre for Work and Employment Research (CREW)
Faculty of Business > Department of Human Resources & Organisational Behaviour
Last Modified: 19 May 2020 14:59

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