Foreword

Recognition is about thanking people for their contribution at work. It is embedded in the organisational values of the NHS. By improving recognition we can deliver the NHS Long Term Workforce Plan’s ambition to attract and retain the workforce we need to deliver improved patient care.

One of the seven elements of the NHS People Promise is, ‘we are recognised and rewarded’. It defines recognition as:

“A simple thank you for our day-to-day work, formal recognition for our dedication…”

It is important that we recognise our staff because evidence shows that pay alone will not influence staff wellbeing, engagement, and retention in the long-term – praise and social approval have also proved to be critical factors (Bimpong et al 2019).

The NHS and wider health and care sector has faced unprecedented workforce shortages and pressures in recent years. Yet, the most recent NHS staff survey illustrates that approximately half of staff do not feel recognised at work.

NHS England has drawn on research and evidence and has worked with NHS organisations to develop this framework. It supports our colleagues and leaders in health and care to further their understanding of, and approaches to, staff recognition. It provides simple, easy-to-follow guidance and ideas for organisations to inform their own strategies and approaches.

Introduction

Recognition in the workplace is synonymous with appreciation and gratitude. It could be as simple as a verbal ‘thank you’ to someone for their day-to-day work or more formal recognition, such as by presenting them with a workplace award.

However, recognition and gratitude are complex because, like people themselves, people’s understanding and experience of these concepts are varied and diverse. Therefore, while you should strive to improve your approach to recognition, there is a need to be sensitive to the diverse needs of staff as well as the broader context. This framework should be used as an appreciative inquiry tool, helping you to identify and celebrate the successes you and your organisation have achieved while also exploring the challenges faced. The framework is flexible to allow you to tailor it to the needs of staff in your organisation.

Understanding the benefits of recognition

Recognition in the workplace has been shown to positively influence staff wellbeing, engagement and retention. Evidence suggests effective recognition can:

Make people feel valued and lead to improved performance

Social science theories suggest people are motivated to gain recognition (CIPD 2022, CIPD 2021). When we receive recognition at work, it enables us to develop trusting relationships, boost our self-esteem, and develop a stronger psychological attachment to our organisation. Employees are motivated to attain a higher level of performance to increase their chances of receiving recognition.

Improve people’s health and wellbeing

Recognition, when delivered well, can lead to improvements in people’s physical health and emotional wellbeing. When you express gratitude towards another person, it can improve their life satisfaction (Morgan 2017), social relationships (Algoe 2012), sleep patterns (Wood et al 2009), physical health (Hill et all 2018) and wellbeing at work (Waters 2012).

Motivate moral action leading to improved patient care

Recognition can also lead people to exhibit ‘prosocial’ behaviours’ (Tunney et al 2018). These are behaviours that benefit others. This includes a wide range of actions such as helping, sharing, comforting and cooperating. In a clinical setting, effective recognition can directly affect the ability of a nurse or clinician to build therapeutic, caring relationships with patients (Baggett 2018).

Understanding the benefits of effective recognition can help illustrate the importance of your own recognition behaviours and the effect these can have on both individual staff and subsequent patient/service user level. It could also enable you to support the case for change around improving recognition more broadly within your organisation.

Building a culture of recognition

The elements that make up our NHS People Promise tell us what NHS people value most. One of the commitments we make to each other is, ‘we are each recognised and rewarded’. This is vital because recognition positively affects staff behaviour and contributes to improvements in health and wellbeing. A lack of recognition or poorly delivered recognition, however, can cause people to disengage and feel undervalued. Below are some principles, to consider.

Examples of effective approaches:

Exhibit positive recognition behaviours

Leaders can embed a culture of recognition by role modelling positive recognition behaviours. Examples include:

• being visible and thanking staff at all levels every day for specific work or contributions
• creating mechanisms (ie notice boards or intranet sites) where staff can thank one another
• setting aside time on meeting agendas for recognition
• writing to staff at key work milestones (eg new starters within the first month, staff when they hit 10-year milestones, etc).

Take a compassionate, individualised approach to recognition

People’s experiences and preferences around recognition are subjective and diverse. For instance, introverts might not value public displays of recognition as much as extroverts – be aware of this and ask your staff how they would like to be recognised for their work.

Consider the wider context and narrative and involve your staff

During the pandemic, studies suggested the weekly 8pm ‘clap for carers’ (Day et al 2021) movement and use of the word ‘heroes’ (Cox 2020) were contentious approaches to staff recognition. The NHS is always in the media spotlight. Don’t let this put you off but do consider the broader political and economic context. Involve your staff in the design and evaluation of recognition initiatives to ensure they have the right approach.

Combine recognition with positive core experiences of work

Effective engagement from recognition is only possible for our staff when they also have:

• autonomy in their role (as far as their role allows)
• clear objectives
• a role that is the right fit for their skills
• a positive perception of their work-life balance
• a positive relationship with their line manager.

Conduct recognition consistently

Effective staff engagement must be sustained, meaningful and consistent for staff to value it and for it to make a real impact.

Always have a clear reason or rationale

Make sure you communicate your reasons for recognition to your staff and link them to your organisational strategy and values. This will ensure recognition is not seen as tokenistic or that it is offered for doing a task that is not linked to any organisational goals or standards.

Exercise equality in how you recognise staff

Consider all groups when exercising recognition. This doesn’t mean you should recognise all staff all the time. Instead, it means ensuring no group of staff is systematically overlooked in favour of other groups. Treating all groups equally will avoid the potential of them feeling disengaged at work.

Do take a proportionate approach

The figure below illustrates a proportionate approach to effective recognition. Everyday verbal or written recognition costs nothing and can be more effective and impactful than more costly initiatives. Everyday recognition should therefore be the broadest approach, followed by informal and formal approaches.

Image text

Formal recognition:

• national award ceremonies
• organisation award ceremonies
• long service milestone awards

Informal recognition:

• Sincere, timely team/individual recognition
• specific to individual achievements
• manager-led

Everyday recognition:

• instant, frequent and unlimited
• specific to behaviour or performance
• Peer or manager-led

Developing a recognition strategy

Outlining your approach to recognition can help to increase understanding and illustrate your aims. The overall goal should be for recognition to become embedded within the culture of your organisation. The seven principles below provide guidance for creating an employee recognition strategy that connects your people to your organisation’s purpose and to one another.

1. Align your recognition strategy to your organisation’s purpose and values

Tell the story of how you connect the recognition of your staff to your organisational purpose to deliver excellent care for patients/service users. Show specifically how your people’s dedication and contribution at work makes a difference to your organisation, patients/service users and the wider health and care system.

2. Recognise people for a multitude of accomplishments

Recognise people for their personal career achievements, team successes, effort and work milestones. Everyone, from the new nurse who has recently completed their preceptorship through to the nurse that has just hit a forty-year milestone, must be appreciated to enable them to feel valued.

3. Incorporate both manager and peer-to-peer recognition

Recognition can be meaningful for people when it comes from both their manager and their peers. Enable leaders and managers to create their own recognition approaches that are aligned to their own team’s objectives. Encourage people to recognise one another following their own positive experiences and interactions as part of strengthening working relationships and creating a culture of recognition.

4. Give everyone a chance to recognise and be recognised

Provide different tools to enable people to recognise one another. Different working arrangements should also be considered. For instance, an intranet system might work well for home-based staff, but not all employees will have access to the internet or the opportunity to check their phone during work hours.

5. Ensure any awards are appropriate

There is no one-size-fits-all award type. When designing formal awards, ensure that the specific award and experience are sensitive to the broader context. For example, consider for an awards ceremony, consider how this might be perceived by your staff and the wider public and the best use of staff time and taxpayer funds.

6. Involve your staff at every stage

What works in one organisation might not work in another. So, involve your staff in the concept, design, delivery and evaluation of any recognition strategy. This allows your strategy to be staff-led and sensitive to local need.

7. Evaluate and refresh your approach regularly

What worked last year might not work this year. Review your strategy regularly (at least annually) to ensure it is adaptive to changes in the need of staff and the broader context. Re-evaluate any tools or interventions to ensure people are still utilising them and finding them valuable.

Supporting leaders in practicing compassionate leadership

Compassionate leadership is crucial to enabling effective recognition to flourish

“Compassionate leadership involves a focus on relationships through careful listening to, understanding, empathising with and supporting other people, enabling those we lead to feel valued, respected and cared for, so they can reach their potential and do their best work.

There is clear evidence that compassionate leadership results in more engaged and motivated staff with high levels of wellbeing, which in turn results in high quality care.” (The Kings Fund).

Compassionate leadership involves four behaviours:

Attending

Compassionate leaders take time to listen to the challenges and frustrations that colleagues experience as well as listening to accounts of their successes and joys.

Understanding

Taking time to really explore staff experience. Valuing and analysing the conflicting perspectives about a situation rather than working from assumptions.

Empathising

Appropriately mirroring colleagues’ feelings to enable compassionate interventions.

Helping

Taking thoughtful and intelligent action to support individuals and teams. For instance, removing obstacles that prevent people doing their work and providing the resources people and services need (eg equipment, training).

Further resources, are available including free online learning for managers on developing compassionate leadership skills.

Developing formal recognition awards

Formal recognition awards can be valued by staff. If implemented, they should form part of a broader recognition approach for organisations that also incorporates everyday meaningful interactions. Below are seven principles to consider as part of developing a formal recognition awards process.

1. Underpin any awards with your organisational purpose and values

Make it clear why people are receiving an award. Tell the story of why staff recognition is important and how it is connected to your organisational values and the broader NHS People Promise.

2. Ensure you reward and incentivise excellence across a broad range of work and behaviours

Some staff groups might not directly contribute to patient/service user care, but make important contributions that affect it, for instance, cleaning or estates staff. Narrow inclusion criteria can result in some staff groups being excluded.

3. Ensure awards processes are transparent, staff-led, equitable and inclusive

Application and nomination processes should be simple, fair and inclusive. Involve your staff, HR representatives, trade union representatives and equality and diversity leads/champions where appropriate in the design. This should ensure award processes are representative of all staff and are not inadvertently discriminatory.

4. Vary the methods of award presentation

Some people value public praise while others might prefer a more discreet method. This could be as simple as giving staff the option to attend a public ceremony or to receive their recognition award in the post or from their line-manager.

5. Consider the accessibility of awards processes

How will you ensure staff who don’t have regular access to a computer aware of the existence of your awards? What about staff who work remotely or those with visual impairments? Work with your communications team to develop different methods of communication to ensure all staff have awareness of, and easy access to, awards and their associated processes.

6. Adapt awards to your staff needs while being sensitive to the broader context

Some organisations choose to issue certificates, letters or badges for significant milestones or achievements. Ask your staff about the type of award that would be important to them but consider this in line with your budget and usage of taxpayer money – for instance, use ESR to determine how many staff are due to hit significant milestones along with the associated cost implication. Also consider the broader context; for instance, think about how a particular award might be perceived by staff and the public. Communicate your thinking and reasoning to your staff so that they understand why a particular award was chosen so that they do not disengage with the process or misinterpret its meaning.

7. Evaluate your awards processes

Ensure you regularly (at least annually) review your awards processes to ensure they remain fit-for-purpose.

Evaluation case study

Recognition evaluation – North Tees and Hartlepool NHS Foundation Trust

In summer 2022, the trust launched a three-week sprint to gain insight on their recognition and reward offer. Essentially, they wanted to understand whether their current offer was both valued and being accessed by their staff. They took the following steps:

1. Established the current recognition and reward offer

Desktop research was carried out to understand and map out the current offer.

2. Conducted a local staff survey to understand staff perception of the current recognition and reward offer

• A survey was sent to all staff electronically and as a paper option.
• 896 staff out of 5,000 completed the survey (the highest response rate outside the staff survey ever received by the trust).
• The survey ran from the 13 – 30 June 2022, with a high-energy communications and engagement campaign to promote participation.
• It asked the following questions:
  • What is your age group?
  • Are you aware of the following trust benefits, rewards and recognition tools? (these were listed as multiple-choice options)
  • What benefits have you accessed?
  • What reward and recognition/benefits package would you be interested in? (multiple choices were offered as suggested ideas)
  • Are there any other benefits and rewards would you like to see implemented at the trust? (this was a free text question)
• These responses were grouped into the following six themes:
• Finance eg voucher schemes, debt advice
• Travel eg subsidised travel
• Work/life balance eg ‘no sickness record’ recognition
• Health and Wellbeing eg free staff health care checks
• Growth/development eg mentor programme
• Wild cards (other) eg competitions with prizes

3. Communicated the results

The trust then socialised the narrative, explaining the results of the survey back to staff in easy-to-understand language.

The trust is now in the process of working with staff and other key stakeholders in exploring and defining what is achievable in terms of improvements to the existing offer. They aim to test those concepts and then deliver the new offer to staff.

Sharing best practice

As we move towards integrated care systems, sharing your good practice and celebrating success can help to embed a culture of recognition at a system level.

NHS England has created a dedicated ‘Recognition and Reward’ space on NHS Futures Platform – find it below and share best practice.

This space allows health and care organisations to talk informally about their own work on recognition and reward, ask for support and share best practice.

Publication reference: PR2097