Evidence shows that NHS organisations deliver better quality care when staff engagement is high, staff are strongly committed to their work and are involved in decision-making.
The Staff Participation Engagement and Communication application (SPEaC-app), also known as Happy App by staff from University Hospitals Bristol NHS Foundation Trust (UH Bristol), collects real-time, work-related mood feedback from staff. The app was the brainchild of Anne Frampton, Consultant in Emergency Medicine, and Andrew Hollowood, Clinical Chair, both at UH Bristol, and was developed by software designer Christopher Smith-Clarke.
NIHR CLAHRC West was research and evaluation partner on the project to develop and roll out the app across the trust.
The app collects data from staff about problems and frustrations, as well as positive experiences on their shift. Staff can use the app at dedicated terminals in wards and departments. They can express how they are feeling anonymously by:
- Clicking on a happy, neutral, or sad face
- Choosing one of six categories that fits the reason for their mood, such as equipment or team working
- Adding an optional comment to give more details
Local managers, such as ward leaders or matrons, can access this information and address the issues it raises. They can share these issues with senior managers so action can be taken quickly and effectively to prevent more serious problems.
Trialled in two areas of the trust in January 2015, the SPEaC-app was then developed into a website to allow managers to monitor and feedback on the data more easily. It was then gradually rolled out across the trust.
The team won the prestigious Health Service Journal (HSJ) Award for Staff Engagement in November 2016. Other NHS organisations are interested in using the SPEaC-app.
The first stage of this project evaluated the initial trial period, where the app was in use in two departments at the trust. The project team worked to improve staff uptake and interaction with the app, by developing it to meet the needs of the end users through a series of workshops and data analysis.
The CLAHRC West research aimed to find out if the app was having a positive impact on staff engagement and patient experience. The overall aim was to see if the app is effective as an early warning tool to identify potential problems with patient flow and quality of care. This would give staff the opportunity to intervene early to address issues before they escalate.
What we did
CLAHRC West worked with the trust team to evaluate the pilot and roll out of SPEaC-app.
Usage data analysis explored how often staff used it, the number of posts they made and the reasons for these posts. The team also evaluated staff satisfaction with the app and the challenges and successes of using the app in different clinical areas, through workshops and an online survey.
How we involved people
UH Bristol staff were involved at all stages of this project through workshops, to advise on the design and improvement of SPEaC-app. Staff identified the factors affecting staff mood and satisfaction and advised on the best way to gather, collate and share feedback.
Once the first version of SPEaC-app was being trialled, workshops eplored what helped or hindered staff when using it.
Staff suggestions were incorporated during the design and development of the SPEaC-app website. Staff satisfaction was captured via a brief online survey at two different times.
The team also met with patients and members of the public to discuss the app and to get their views on what would be most useful to study. They were supportive of the initiative and felt that it could contribute to improved staff wellbeing and patient care.
What we found and what this means
The evaluation has shown that there have been real improvements in engagement locally between managers and their teams. It has inspired improvements in service delivery. On average the app is used by staff 15 times a day in each of the 23 clinical areas. Almost half of the entries made are positive and relate to good experiences with teamwork.
Access to the app, location of the terminals, reliability and perceived privacy are all important factors affecting whether staff use it. It is valued and used most in areas where staff get regular and rapid feedback from leaders and comments are acted upon, leading to change. This suggests that strong, consistent local management is needed to establish it in new areas.
SPEaC-app has the potential to support local engagement between managers and their service delivery teams, stimulate improvements in service delivery and support the process of change. We need longer term data to find out whether SPEaC-app can influence other factors such as staff turnover, recruitment and retention.
CLAHRC West continues to work with our colleagues at University Hospitals Bristol NHS Foundation Trust. Other NHS organisations are interested in introducing the SPEaC-app and evaluating its effects on staff engagement.
The app was mentioned in University Hospital Bristol NHS Foundation Trust’s Care Quality Commission (CQC) inspection in March 2017. CQC said:
“We saw an innovative method of engaging staff through the use of the ‘Happy App’ and proactive engagement with staff. We found because of this the culture of engagement had developed to be positive. Staff were proud to work at the hospital.”
CLAHRC BITE (Brokering Innovation Through Evidence)
Links and downloads
- Using real-time, anonymous staff feedback to improve staff experience and engagement Read the full paper
- Healthcare Manager magazine has published an article on the app and this project Healthcare Manager article
- SPEaC-app won the Staff Engagement Award at the Health Service Journal Awards HSJ Awards winners
- 2017 Care Quality Commission report for University Hospitals Bristol NHS Foundation Trust See page 14 of the CQC report (PDF)
- The National Institute for Health Research news story on this study Read the story on NIHR's website
- University Hospitals Bristol and the Happy App feature in CQC Driving improvement: Case studies from eight NHS trusts See the CQC case studies