Getting 360 feedback right within the NHS brings its own unique challenges and opportunities. It goes far beyond using a provider with a good 360 platform. Success depends on designing a process that aligns NHS culture and values. It is about aligning national frameworks with local priorities, ensuring psychological safety and making it feel genuinely NHS rather than a corporate import.
Drawing on our experience of working with multiple Trusts, this article shares what we have learned about what makes NHS 360 feedback work in practice.
Having supported numerous NHS organisations to design and deliver tailored 360 feedback solutions, we have seen first-hand what makes the difference between a successful and an ineffective approach. We have had the pleasure of working with a range of NHS organisations, including:
The NHS is not simply another large employer. It is a uniquely complex environment with diverse professional cultures, strong regulatory oversight and a shared moral purpose focused on patient care. The key factors to consider when developing a bespoke 360 process within an NHS Trust includes:
Balancing national frameworks with local priorities
It is important to ensure that the question set captures the core expectations from frameworks such as the Healthcare Leadership Model (HLM), NHS Values, and the 6Cs, while also reflecting each Trust’s local framework or the specific behaviours that currently require greater emphasis.
Aligning to the cultural landscape
With a culturally diverse workforce rooted in compassion, professionalism and public service, the NHS tends to value compassionate behaviour more highly than purely improvement-focused feedback. Each Trust is also on its own evolving journey from a historically hierarchical, target-driven environment where poor performance was not always managed effectively, towards one that prioritises openness, inclusion and learning. Taking both the current and desired culture into account is key to developing the right 360 solution.
Designing around purpose
We have developed NHS surveys that support culture change, manager development, consultant and senior clinician appraisal, CPD, board member development, CEO appraisals, aspiring manager development and personal contributor development. The purpose fundamentally shapes how each survey is designed and developed, from the question set and rating scale to how participants and their respondents are engaged in the process.
Creating psychological safety for honest feedback
In some areas of the NHS, individuals can still be hesitant to give honest, critical feedback for fear of some form of retribution. Establishing the right level of psychological safety helps to change this and encourages everyone to provide well-intentioned, developmental feedback that genuinely supports learning.
For further information on this, see our article 360 Feedback Anonymity - Everything You Need to Know
Making the most of skilled 360 feedback facilitators
The NHS already has a strong base of experienced coaches, many of whom are trained to facilitate 360 feedback. Tapping into this internal capability is an excellent way to ensure participants are supported to make the most of their feedback experience.
Customising the system for the NHS context
Because of its uniqueness, it is important that the look, feel and terminology fit the NHS context and are not simply adapted from a corporate solution. Elements such as the question set, feedback group names, anonymity levels, branding, tone and style should all feel authentic and aligned.
Really nice people who rate highly - encouraging balanced and honest ratings
This is not a criticism, but our data shows a cultural norm towards generous, top-end ratings. Engaging respondents thoughtfully, with on-screen, just-in-time advice and guidance on how to give balanced, constructive feedback, is another essential part of getting 360 degree feedback right in the NHS.
From our experience across the NHS, several principles consistently make the difference between a process that is simply useful and one that is genuinely developmental.
Q. What level of anonymity works best within NHS 360 feedback?
A. It depends on the organisation’s feedback maturity. In cultures where people already feel psychologically safe, partial anonymity can work well. In settings where openness is still developing, full anonymity within the NHS 360 feedback process encourages some to provide authentic, balanced feedback without fear.
Q. Why does the design of the NHS 360 feedback process matter so much?
A. Without great design, key components such as clarity of purpose, alignment with NHS frameworks, psychological safety and authentic language can easily be missed. The design needs to reflect both national expectations, local Trust priorities, culture and the organisations current level of feedback maturity.
Q. How can we encourage honest and balanced feedback in NHS 360 feedback?
A. Within the NHS, there is a natural tendency for people to be kind and supportive, which can lead to overly positive ratings. Encouraging balance starts with creating psychological safety and making it clear that the aim is development, not judgement. When people understand that constructive feedback is part of compassionate leadership, NHS 360 feedback becomes more authentic and useful.
