By Kate Henry
Internal comms is often overlooked and undervalued but in a vast network of organisations like the NHS it is invaluable. Critically it helps employees buy into a shared vision and values.
• How to manage internal comms across a vast array of disparate organisations
• The type of challenges faced by internal communications practitioners
• How investment into internal comms can help an organisation of any size achieve its objectives
1.7 million staff and counting
The NHS is the UK’s largest employer, with more than 1.7 million staff across the UK.  It is the fifth largest employer in the world, behind the US Department of Defense (3.2m), China’s People’s Liberation Army (2.3m), Walmart (2.1m) and McDonalds (1.9m). 
That in itself presents a massive internal communication challenge, even before considering that the NHS is not a single entity. It is made up of hundreds of separate organisations – more than 200 of which buy health services and around 250 that provide care. That’s not including nearly 7,500 GP practices across the country. 
In England, these organisations are bound by the NHS Constitution, which sets out the core principles and values of the NHS. It also covers the extensive rights of staff along with a series of pledges that the NHS is committed to achieving. These pledges to staff talk about promoting an open culture, engaging staff in decisions that affect them and empowering staff to put forward ways to deliver better services.
Effective internal comms and staff engagement is crucial in healthcare; there’s overwhelming evidence which shows that engaged staff deliver better care:
“NHS providers with high levels of staff engagement tend to have lower levels of patient mortality, make better use of resources and deliver stronger financial performance. Engaged staff are more likely to have the emotional resources to show empathy and compassion, despite the pressures they work under. So it is no surprise that Trusts with more engaged staff tend to have higher patient satisfaction, with more patients reporting that they were treated with dignity and respect.” 
As in any large and complex organisation, communicating effectively isn’t always a simple task; there are endless challenges to contend with. In the NHS, these include vast geographical footprints, varying cultures and sub-cultures, leadership changes, dwindling resources and service pressures impacting on people’s capacity to communicate and engage.
There’s also the diversity and differing requirements of a large number of professional groups; the NHS has hundreds of different roles, from nurses to analysts, doctors to porters and microbiologists to librarians.
Comms teams therefore have a significant role to play in any NHS organisation, needing to make sure that internal comms stays high on the priority list. They can make sure there’s two-way comms up and down the organisation, from ward to Board and back again.
Equally, they’re uniquely placed to encourage and support networks and connect people across all parts of the organisation. Comms teams also have a key role to play in sharing their professional knowledge and skills, helping staff (particularly managers and team leaders) to become better communicators.
Breaking it down - a case in point
South West Yorkshire Partnership NHS Foundation Trust provides mental and physical healthcare services in hospitals, in local communities and in people’s homes. It covers a population of 1.2 million people living across Barnsley, Wakefield, Calderdale and Kirklees, as well as providing specialist services across Yorkshire and the Humber. To do this, it employs around 4,700 staff.
In 2015, the organisation identified a need to improve its internal communication. The comms team set about this by firstly doing a stock take and asking people what they thought.
More than 375 staff shared their views. They were asked general questions on how they felt about internal communications and their satisfaction levels, as well as specific questions on the channels in place at the time. They were also asked about what they would like to see in the future.
The results were enlightening, with only 57% of staff feeling that they were kept up to date with what was happening across the organisation and 45% feeling satisfied with the way the Trust communicated and engaged with them. There were lots of positive comments, as well as some really constructive feedback about areas for improvement.
The information was used to inform a channel revamp, overhauling existing channels and introducing new ones to embed a more consistent rhythm of internal communication. These included:
• Revamping the weekly staff newsletter, The Headlines, now emailed every Monday
• Introducing staff huddles with the chief executive – informal discussions that take place for half an hour every Monday, rotating around the Trust’s key sites
• Introducing The View, a more personal, blog-style email sent every Friday from either the chief executive or member of the Board
• Giving the staff intranet a facelift and restructure, in line with a new visual identity implemented
• Introducing a new monthly team brief cascade, that provides updates on key discussions and decisions made by the Board and executive management team. The brief starts at a meeting for senior leaders and is then cascaded to all teams, ideally face to face and within two weeks
• Introducing annual staff listening events, which take place in each of the areas the organisation covers every May / June. These are led by the chief executive and help to communicate the priorities for the year ahead
• Revamping the annual staff Excellence awards to celebrate outstanding teams and individuals.
It isn’t rocket science - it works
A year later, staff at the Trust were asked for their views again and the results showed an impressive improvement. There was a 26% increase in staff feeling up to date with what was happening across the organisation and a 21% increase in staff feeling satisfied with the way the Trust communicates and engages with them.
External sources also confirmed improvements. The organisation’s results from the 2016 national NHS Staff Survey showed a statistically significant increase in the number of staff reporting good communication with senior managers.
In addition, the Care Quality Commission, which re-rated the organisation from ‘Requires Improvement’ to ‘Good’ in April 2017, noted in their inspection report  that:
“Staff at all levels told us how the internal communication within the Trust had improved since the last inspection”
“…increased communication had enhanced the transparent and open culture that existed across the Trust.”
“…staff articulated a change in culture across the organisation and demonstrated a clear understanding of the organisation’s vision and values and the Trust’s direction of travel.”
The work is by no means complete and the comms team continue to listen and respond to staff feedback. This is reflected by the continued improvements seen when staff were once again asked the same questions in December 2017.
Moving forward, the team will now focus their efforts on supporting managers and leaders to communicate effectively and making better use of technology to support internal comms, such as staff apps and internal social networks.
FIGURE 1 Increase in % of staff feeling kept up to date with what is happening across the Trust
Do you feel that you are kept up to date with what is happening across the Trust?
FIGURE 2 Increase in % of staff feeling satisfied with the way the Trust communicates and engages with them
How do you feel about the way the Trust communicates and engages with you?
So how do NHS communicators reach 1.7 million staff and counting? By breaking it down and taking an insight-based approach to make internal comms manageable and measurable. Oh and by having fun and meeting great people along the way.
 The Nuffield Trust, The NHS Workforce in Numbers, published 30 October 2017, accessed 18 January 2018
 Forbes, The World’s Biggest Employers, published 23 June 2015, accessed 18 January 2018
 NHS Confederation, NHS statistics, facts and figures, published 14 July 2017, accessed 18 January 2018
 The King’s Fund, Staff engagement: Six building blocks for harnessing the creativity and enthusiasm of NHS staff, published February 2015
Kate Henry is Director of Marketing, Comms and Engagement at South West Yorkshire Partnership NHS Foundation Trust. She has worked locally, regionally and nationally in a variety of NHS communications roles over the past decade.