For an event run this week for healthcare professionals by the Electoral Reform Society, I have pulled together some key tips on how to encourage the active participation of users and staff – a process in a UK setting now often called ‘engagement’.
You can tell the story of any society or time by looking at how it handles the health and care of its people. If so, we are in a pretty shocking state today, because, for all the advances in health outcomes over time, we treat people involved in the health system in a shabby way. This is not just the indignities of waits and cancellations for patients, but the sufferance of staff in the system, often, in the care system in particular, on low wages and with poor conditions.
When looking at the UK data for staff working in Government, I find that staff working for the Department of Health have the lowest levels of staff engagement of any main department – down 25% over ten years and now at rock bottom. How did we end up with such shocking levels of disengagement, when people who work in the health sector have such rich motivations at the start, to care and to meet the needs of others?
So, how do we chart a way back from this?
My full presentation is up on Slideshare, but here are five simple steps that I would pick out. Yes, they will take time, but each of these steps is tried and tested.
Step 1 – Develop an engagement plan
Engagement is ‘a process through which people can interact with an organisation in a meaningful way for mutual benefit.’
So any organisation can ask…
- Is it a systematic process?
- Is engagement meaningful for those who participate?
- Does it lead to positive outcomes?
It can also track the journey to systematic engagement over time.
Step 2 – For service users, start by focusing on the experience of the service

Step 3 – Create decision making that is responsive, based on short feedback loops

Step 4 Pass over power and decision making to users, to the extent to which they want it
I call this the Participation Fruit Tree, rather than the classical Participation Ladder, as users may want different forms of power and participation than straight self-management.
When it comes to the top of the ladder, and high on the fruit tree, with self-management, then the best organisational form, which embeds member engagement at its heart, is a co-operative.
Step 5 – Invest in values
As I explore in my 2016 short book, Values, the way to engage people at a deeper, emotional level, whether employees or customers, is through the purpose and values of what people do together. We engage more if we feel we belong.
And three conclusions
These five steps come together into an engagement value chain.

What I have learned from my work on engagement over time, with the National Consumer Council, Co-operatives UK and as Chair of the participation charity Involve, are three facts that are hopeful that we can do better in health and public services and in society more widely.
1.Engaging users is not a trade-off, because a user focus is key to the satisfaction and motivation of staff.
2.Engaging staff is not a trade-off, because empowered staff are better able to satisfy service users.
3.Engagement works. We need to harness its potential to improve the daily public services that are so essential to people’s lives.
Comments welcome!