Where are we now?
It’s widely acknowledged that NHS Secondary Care productivity has struggled to bounce back post-Covid, and many would argue that the decline began even before the pandemic hit. Earlier this year, Lord Darzi’s independent report flagged several critical issues in secondary care, but the one that really stood out to me was the issue of staff motivation.
“Too many staff have become disengaged, and there are distressingly high levels of sickness absence – as much as one working month a year for each nurse and midwife in the NHS.” (Independent Investigation of the NHS in England, Lord Darzi, 2024)
You don’t need to be an expert to know that high sickness levels are a major barrier to productivity. But here’s the thing: it’s not just about having healthy bodies on the wards. If staff are motivated, they’re more likely to mentally present, engaged, and actively working toward improving processes and outcomes.
What is the impact of low staff motivation on productivity?
In simple terms, productivity is the efficiency with which services are delivered. In secondary care, it’s about the quality and speed of clinical interactions with patients. But motivation goes beyond just turning up for work. Motivated staff consistently go the extra mile—they exert physical effort to get things done, are mentally engaged in their mission, and emotionally invested in the outcomes.
Whether through suggesting process improvements or implementing small but impactful changes, motivated teams can make the difference between a system that functions and one that falters.
How Staff Motivation Affects Productivity: A Case Study
We all know staff who sprint down corridors (physical), can recite the trust’s values off by heart (cognitive), and tackle the toughest patient scenarios with confidence (emotional). But when motivation starts to slip, so too does effort. Work becomes routine, and inefficiencies are left unchallenged.
Let’s consider a recent example of how low motivation can impact productivity.
I was recently working with a trust on redesigning an inefficient endoscopy process. We began by mapping out the process from the point a GP makes the referral to a consultant. After just five steps, we discovered something startling: numerous referrals were being sent to a Medical Secretary, who would then send them back to the GP, informing them they’d used the wrong form. I expected this to be a rare occurrence, but the reality was shocking—around 40 requests were being rejected every day, consuming most of the Medical Secretary’s time.
What was even more concerning was the reaction from the staff involved, including the supervisor and manager—they simply thought this was “normal.” This “accepted waste” highlights a lack of motivation to question inefficiencies or seek solutions. In contrast, motivated staff would have asked, “Why is this happening?” and worked to resolve it.
We often see this kind of accepted waste in the workplace. It’s like a slow leak that gradually erodes productivity. Addressing inefficiencies doesn’t necessarily require working harder or hiring more people; it demands staff motivation to identify and eliminate waste before it becomes entrenched.
The Cost of Wasted Effort
In another recent audit, we found a small storeroom (just 3×4 meters) in an outpatient service containing over £1,000 worth of expired or spoiled inventory. That might seem minor until you consider the scale of the problem. Multiply that by all the storerooms, then factor in that nurses were managing stock—a task that, under the PFI contract, was supposed to be handled by someone else. This meant nurses were spending valuable time on tasks outside their remit, while the trust incurred financial losses. Remember, this occurred in a service already £35 million short on funding.
Without motivated staff to challenge the status quo and take ownership of these issues, productivity will continue to decline.
Causes of Low Productivity in Secondary Care: Examples of Wasted Effort
- Defects in Process: For instance, incorrect dates or locations for outpatient appointments lead to “rework” or “corrective work” that consumes time and resources.
- Manual Processes: Despite having tools like voice recognition technology, many processes remain manual. Staff are often too disengaged or unmotivated to adopt these tools, missing opportunities to save time and effort.
- Poorly Designed Processes: Even highly motivated staff struggle with flawed systems. However, motivated staff are more likely to highlight these issues and push for better solutions.
Research shows that organisations can carry up to 40% waste in their operations, whether in time, effort, or resources. At Xytal, we specialise in identifying the root causes of waste and developing strategies to eliminate it. Our approach also focuses on fostering staff motivation, as motivated employees are the ones who actively drive improvements and tackle inefficiencies.
How Staff Motivation can improve Productivity?
At the heart of this issue is motivation. Without motivated staff, inefficiencies and waste become the norm. But when staff are motivated, they’re more likely to spot these issues and work together to eliminate them. They’re not just doing their jobs—they’re engaged in improving them.
By prioritising staff motivation, secondary care organisations can begin to reverse the productivity crisis. Motivated staff will not only improve processes but also create a culture of continuous improvement, enhancing patient care and driving long-term success, with a positive financial impact through reduced staff turnover, lower recruitment costs, and enhanced efficiency.
At Xytal, our integrated approach combines leadership development with process transformation to unlock staff potential. We believe that the right balance of leadership and process improvement is the key to sustained productivity. When people are motivated and engaged, productivity thrives.
