Medical Engagement Scale

Research has shown that medical engagement is one of the key factors to influence organisational performance.

“NHS management includes both those who have clinical backgrounds and those who do not. Regardless of whether they have a clinical or non-clinical background, managers and frontline clinicians must forge a strong partnership, sharing successes or setbacks. In all cases, managers must be involved in the core business of clinical practice, helping, supporting and challenging clinicians to deliver the best possible care for patients"
Next Stage Review: High Quality Care for All Final Report, Department of Health, 2008.


Why is medical engagement important?

Enhancing medical engagement is seen as crucial in ensuring that health service changes are properly planned and effectively implemented. This has been highlighted in the recent High Quality Care for All: NHS Next Stage Review Final Report. Organisations where clinicians are engaged in strategic planning and decision making perform better than those where clinicians are alienated from strategic processes of the organisation .

Why was the scale developed?

A series of semi structured interviews with senior leaders from several of the high and low performing trusts across the country (as defined by the Health Care Commission, 2006) were undertaken in 2006.  The findings from these interviews were embedded within the instrument subsequently developed.

The NHS Institute consequently commissioned the development of a reliable and valid measure of medical engagement that would be quick and relatively unobtrusive to complete but would be capable of providing useful information about both the cultural environment of the organisation (which may either foster or constrain professional engagement) and the personal feelings of medical staff (which may either empower or inhibit the motivation to fully perform). Previously development work on over 20,000 NHS staff had established high levels of reliability of the items and scales. The resulting Medical Engagement Scale is designed specifically to help NHS organisations evaluate levels of medical engagement and develop strategies to improve it. A modified measure for use in Primary Care has also been developed.

What does the scale measure?

The Medical Engagement Scale (MES) is designed to assess medical engagement in management and leadership in NHS organisations. The MES differentiates between the individual’s personal desire to be engaged and the organisation’s encouragement of involvement. It also includes a framework of organisational strategies to enhance medical engagement and performance. The scale is particularly useful in respect to strategic planning and service delivery.

Who developed the MES?

The tool has been developed by an external and independent company Applied Research Ltd who conduct all data analysis, prepare summary reports for each trust and maintain a national database.

How does the Medical Engagement Scale fit within broader objectives in enhancing engagement in medical leadership?

Enhancing medical engagement is seen as crucial in ensuring that service changes are properly planned and effectively implemented. This has been highlighted in the recent High Quality Care For All: NHS Next Stage Review Final Report .

How was it tested?

The MES was piloted in four trusts and was shown to have both face and construct validity. Subsequently 30 trusts undertook the MES in late 2008, with the resulting data being used to establish a normative database. A range of trusts (sizes and services) were included and this database will continue to develop as more trusts undertake the scale. This data has shown an empirical link to performance.   

How is it conducted?

The MES is given to all doctors, with the exception of locums and foundation year doctors, and a sample of senior managers; this allows for an assessment of the alignment between the views of doctors and the executive of the organisation. All returned questionnaires are confidential, with Applied Research Ltd undertaking the analysis. Raw data is not available to the trust.

It is important that all questions are answered, with as many doctors as possible completing the survey. All answers are anonymous and the final report, including recommendations to improve engagement, is delivered to the trust Chief Executive and nominated executives.

The MES can be conducted via paper questionnaires and electronically.  The position of the trust against national norms will be identified, along with each of the sub-scale scores that make up the overall Medical Engagement Index.

What does the report include?

The report will identify areas where development or improvement is required and assist trusts with their leadership agenda. Also provided is a framework of organisational strategies that senior leaders may undertake to enhance medical engagement and performance at work.

How much does it cost?

The NHS Institute is making the MES available for a cost of £5,000 per trust. This includes

  • Questionnaires supplied to your trust, in both paper and electronic form, to be distributed to all doctors in your trust (with the exception of locums and foundation year doctors)
  • Management questionnaires supplied, in both paper and electronic form, to be distributed to a sample of managers in your trusts (approximately 10-20 senior managers who are not doctors)
  • A report identifying areas where development or improvement is required, and strategies that may be utilised to enhance medical engagement and performance.
  • Opportunity for facilitated feedback from the NHS Institute or Applied Research Ltd.

If you are interested in having your trust undertake the Medical Engagement Scale, please contact Applied Research, Ltd. at research@perform.gotadsl.co.uk or on 0121 434 3511.

What happens to the data collected?

The scale currently has a confidential, normative database of in excess of 35 trusts (over 4,000 doctors), which expands with each new trust. Feedback from initial trusts has been positive, and we are now working with a selection of these to further understand how they are engaging their staff, or how they intend to improve their engagement. From these results, Applied Research Ltd have compared levels of engagement with levels of performance and have been able to show a link between engagement and performance.

Is there a scale available for Primary Care Trusts (PCT)?

The PCT version of the MES has also been tested and shown to be valid and we are now working towards developing a normative database. If you are a PCT interested in undertaking the scale, please contact Applied Research, Ltd. to discuss how you can be involved.  Their contact details are given above.