Engagement can be fostered through good staff management; having well-structured appraisals is particularly important, as is working in a well-structured team. Supportive line management is also key here, as is having good job design – meaningful, clear tasks with some opportunity to be involved in appropriate decision-making. These factors are also linked to employee health, which is also important for engagement: high levels of work pressure and stress can lead to disaffection and disengagement.

Other factors that the wider research suggests are important include creating a positive work environment in which staff feels valued, respected, and supported. Employees also need to have the information necessary to help them do their jobs well, learning opportunities, feedback to build their confidence, support, and safety to innovate and develop new and improved ways of providing patient care, and trust in their supervisors and leaders.

At the organizational level, it is necessary to develop cultures of two-way trust. This will be influenced by what leaders pay attention to, what they monitor, and what they allocate resources to. It will also be influenced by the criteria for recruitment, selection, promotion, and disciplinary action.