What is employee engagement in healthcare – and what is it not?

I have an aversion to buzz words.

The more people talk about something, the more I get suspicious that it may be – well, fluffy: all noise, not much substance.

‘Employee engagement’ is one such word. I spend my working day talking to healthcare professionals, and I’m often struck by the misconceptions about what ‘engagement’ actually means.

I understand why. It’s one of those slippery phrases that’s hard to pin down. In fact, that I’ve seen it used interchangeably with… well, almost every positive behavior an employee could display.

For instance, the NHS Engagement Toolkit defines engaged employees as better organized, happier, more satisfied, more loyal, healthier, more motivated, more productive, better at communicating, more prepared to go the extra mile, and bend over backward… 

And it’s true that some of these behaviors are a symptom of engagement. But is it the same thing?


Why using employee engagement as a ‘catch-all’ for positive behavior does it a disservice.

First, it makes ‘engagement’ effectively unattainable, because who exhibits all these behaviors, most of the time? 

Second, if we couch ‘engagement’ in vague aspirational terms, it’s easy to view it as a ‘nice to have’ rather than the must-have it is. When that happens, healthcare leaders are more likely to dismiss it as a performance indicator rather than an opportunity for a practical initiative. 

Finally, it’s impossible to quantify the sum of all these behaviors at once. And if you can’t measure something, it’s tricky to improve it.

Little girl getting a vaccine in a healthcare clinic

The good news? The reality is far less complicated. Employee engagement in healthcare is achievable, specific, and measurable. 

I will explain in a moment. But first, let’s look at what it isn’t.

Employee engagement in healthcare isn’t:


A satisfied nurse will show up for their shift without complaint. They will do the work required. And they will accept a job at another hospital that offers a slightly better schedule, because they are unengaged.


A care worker may feel happy at work because they have a lot of free time to go on their phone – but that doesn’t make them engaged. 


A medic may feel motivated to work hard because they want to get promoted, but that won’t necessarily correlate with higher engagement levels. Motivation is forward-looking, while engagement happens in the present.


An organization might empower their physios to make more autonomous decisions when working with clients. But the physio will only take that opportunity when they also feel engaged. Empowerment doesn’t always translate into action; engagement does.

An absence of stress

A brain surgeon may feel stressed when operating but still be highly engaged. In fact, some degree of stress can increase engagement. Gallup ] found in early May 2020 – i.e., mid-pandemic – the percentage of “engaged” workers reached 38% – the highest since tracking began 20 years ago.


A hospital porter may be highly productive – i.e., put in lots of working hours – without ever being engaged. The same porter may work two hours a week and stay with the same hospital for 20 years because he is engaged.

A fixed state

Engagement isn’t an intrinsic trait or something that is ‘achieved’ and then forgotten. It ebbs and flows.

The same for everyone

Engagement manifests differently in different people. Industry, role, type of organization – all these all affect how an engaged individual will behave. This is another reason why blanket definitions don’t work; an effective engagement strategy is personalized.

HR’s job

An employee engagement strategy needs to stretch across the whole organization, starting at the top. That means it’s the responsibility of C-suite execs to initiate strategies and up to line managers to make them happen.

So – what is it?

Engagement boils down to a sense of purpose.

When this is in place, they can maintain an engaged state of mind – at least for a finite period.  

This explains why, during the height of the Covid-19 pandemic, staff engagement levels in healthcare went up. The urgency of saving lives in never-before-seen conditions gave created a heightened sense of purpose.

But a sense of purpose in itself won’t sustain engagement. We see nine months later, when exhaustion, worry, trauma, and burnout have reduced staff engagement in the NHS to Great Recession-era lows

Instead, it’s helpful to think of engagement as a double-sided coin. On the one side, behavior: the emotional commitment an employee feels towards their organization.

On the other, attitude: how much effort they are willing to dedicate to their patients. For engagement to be successful, both sides of the coin need to be in play. 

That happens when a sense of purpose is supplemented by other, more practical factors:

  • clarity about your role; 
  • receiving adequate support;
  • having the right equipment; 
  • working in a position that plays to your strengths; and
  • working alongside committed colleagues. 

How can you tell if a healthcare worker is engaged?

We’ve established they won’t necessarily be smiling, stress-free, or working longer hours. 

So, what does engagement in healthcare look like? Here are some signs of high engagement at play: 

  • escorting lost family members to where they need to go
  • never forgetting to wash their hands or check IV lines
  • noticing the yellow “fall risk” bracelet on a patient in the lobby and helping them back to their room
  • unrushed listening when patients ask about their medications and discharge orders
  • being mindful of the need to be quiet at night
  • ensuring all meals are delivered while still hot
  • making fewer mistakes with the administration of medications
  • wheeling a bed-bound patient out of the care home to feel snow for the first time in years
  • giving a resident with dementia a hand or foot massage in a quiet moment.