Title: Evaluating the evidence on employee engagement and its potential benefits to NHS staff: a narrative synthesis of the literature
Funder: Department of Health (England)

Abstract: In order to develop a comprehensive Evidence Synthesis we will conduct a systematic and replicable literature review (Lavis et al. 2005) on staff engagement and its impact on morale and performance. A core aspect of the Evidence Synthesis will be to critically evaluate the quality of evidence currently available from a variety of sources in order to ensure that the report and other outputs from the study are based on best evidence. We intend to follow the methodology for systematic review advocated by Briner (2011) for the conduct of such reviews within the field of management adhering to the principles of: replicability minimisation of bias transparency and comprehensiveness. The review will involve five stages: planning locating studies evaluating contributions analysing and synthesising evidence and reporting best evidence. Planning: The purpose of the planning stage is to agree the search strategy and criteria (Crilly et al. 2010). We will review and finesse the research questions proposed in this bid document into detailed propositions suitable for systematic review (Greenhalgh 1997; Patterson et al. 2007). In consultation with the Advisory Group we will develop a set of search terms relating to each of the propositions including for instance ‘employee engagement’ ‘work engagement’ ‘staff engagement’. Briner (2011) advocates the use of an Advisory Group in the development and refinement of search terms We will adopt the CIMO (context interventions mechanisms and outcomes) framework advocated by Denyer and Tranfield (2009) to help focus the questions for this purpose. In order to verify the appropriateness of the chosen search terms we will pre-test them on one of the databases ProQuest before finalising the terms in collaboration with the Advisory Group (Briner 2011). During this stage we will finalise the strategy for the search that will feed into the review protocol. Our initial plan is to include sources dating from 1990 when Kahn’s seminal paper on engagement was published but this will be verified through a preliminary scoping exercise. Given the topicality of engagement (a Google search for ‘employee engagement currently yields some 22.5 million hits) it is vital to scope the review in such a way to ensure that it is manageable and focuses on high-quality outputs.Locating Studies via Structured Search: The second stage of the study involves three phases. First the development of a review protocol that includes a description and rationale for the review questions the proposed methods and details of how studies will be located recorded and synthesised as well as outlining the eligibility criteria (Pettigrew and Roberts 2006; Briner 2011; Greenhalgh 1997). This will be based on the outcomes of the planning stage and will be agreed with the Advisory Group. The protocol will ensure the review is systematic transparent and replicable (Briner 2011). Patterson et al (2007: 25) note that protocols for reviews in the management field need to be ‘broad flexible and open to change’ given the heterogeneous nature of the subject area. Second we will undertake a structured scoping study to ensure that the review includes all potentially relevant sources. We will identify the relevant academic electronic journal databases through a preliminary analysis of their area of focus coupled with a pilot investigation using the key search criteria and in consultation with the Advisory Group. Those that are found to be relevant and to yield some likely articles will be included in the next phase and will include for instance EBSCO Web of Science Medline and PsychINFO. These databases include peer-reviewed academic journal articles alongside non-scholarly publications. We will complement this with a scan of potentially relevant business and health care practitioner-oriented electronic databases such as the European Case Clearing House Harvard Business Review Dept of Health NHS Employers NHS Institute CIPD and BIS etc all of which have published material on engagement. These will be a potential source of grey literature. We will also look for grey literature through conference proceedings and databases of theses and dissertations. Briner (2011) argues that the grey literature is especially important in systematic evidence reviews. This phase will yield a set of electronic resources within which the detailed search will take place (Crilly et al. 2010).The third phase will comprise the structured search within these electronic resources using agreed search terms with a focus on ‘engagement’ and ‘healthcare’. During this phase we will complement the search of electronic resources with internet based searches and searches of books and other materials using the structured search terms citation tracking and scanning reference lists and also requests for information from personal contacts with experts in the field (Patterson et al. 2007). Evaluating Contributions against Eligibility Criteria: inclusion and exclusion criteria are required in order to evaluate the relevance and quality of each contribution (Briner 2011; Greenhalgh 1997). This will take place in two phases. First titles and abstracts will be downloaded and printed. These will be read independently by two members of the research team and evaluated against a pro forma (Patterson et al. 2007). Items will be included if they are felt by both researchers to be of direct relevance to the research questions and to include either empirical evidence or a theoretical contribution to the field. Opinion-pieces or cases with a limited evidence-base will be excluded at this stage. A record will be kept of all decisions made. In cases of disagreement a third team member will be involved.In phase 2 the complete version of all material identified as potentially relevant in phase 1 will be critically appraised. Since this is likely to include a wide range of evidence from quantitative studies through to qualitative or mixed methods studies it is important that the method of critical appraisal allows for this variation (Briner et al. 2009). To facilitate analysis the evidence to be evaluated will be organised under three headings corresponding to research questions 1-3. A data extraction form will be used to document the contents methodology research design data and contribution within each item and summarise information about authors publication etc. Two researchers will evaluate the quality of each resource using a critical appraisal checklist relevant to the methodology used in the study (Briner 2011). The pro forma and the checklist will be finalised in consultation with the Advisory Group. Items will be evaluated against a range of relevant criteria to determine inclusion with a focus on quality: methodology (robustness of design and analysis); relevance to healthcare; relevance to the research questions. For qualitative studies relevant criteria will include the appropriateness and level of rigour of the methods; validity and credibility; verification and reliability; theoretical and practical importance (Briner 2011). For quantitative studies relevant criteria will include appropriateness of sample selection; reliability and validity of measures; appropriateness of research design and analysis. Following Patterson et al (2007) we will adopt a system of weighting by study design. For research question 2 where we seek evidence as to the relevance of engagement for morale and performance and which seeks to establish a causal link we may restrict our search to longitudinal studies along similar lines to those adopted by Patterson et al (2007) in an evidence synthesis on the link between HRM and performance.The final decision over inclusion and exclusion criteria will be made by the Investigators with particular reference to Prof. Currie’s advice and in consultation with the Advisory Group. The methods used for the appraisal of studies will be documented in detail with a clear description of the criteria and process used in order to ensure that the decision-making processes are clear and replicable. Analysis and Thematic Coding: at this stage the focus will be on examining the evidence to identify underlying themes and on relating the findings from the various studies together to develop new insights into engagement within the context of health care. Each paper or contribution will be read by two researchers and coded in order to identify its primary contribution to knowledge. In cases of disagreement a third team member will be involved and agreement will be reached through discussion within the team. This process of coding will be followed by a synthesis. We will adopt a narrative approach to the data synthesis which is a reflexive and critical methodology and the most common approach within the management field (Briner 2011; Patterson et al. 2007). This will enable us to work from the evidence gathered to build up a summary of crucial findings under each of the research questions.Reporting: the team will compile the results of the evidence synthesis into a comprehensive report that addresses the research questions and includes the results of the data extraction exercise in tabular form as appendices.Methods for practitioner outputsPractitioner guides and tools will be developed with reference to the Evidence Synthesis to meet the needs of NHS managers HRM professionals and Trust Boards and Directors and will be accompanied by four podcasts. A conference webinar and workshop will also be held.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE