Staff satisfaction and organisational performance: evidence from a longitudinal secondary analysis of the NHS staff survey and outcome data

Abstract

BackgroundThe search for causal links between human resource management (HRM) and organisational performance has dominated academic and practitioner debates for many years. However, much of this work comes from contexts outside health care and/or the UK.ObjectivesThis study tested the later stages of a well-established HRM model, testing whether or not there was evidence of causal links between staff experience and intermediate (staff) and final (patient and organisational) outcomes, and whether or not these differed in parts of the NHS. We used large-scale longitudinal secondary data sets in order to answer these questions in a thorough way.Data sourcesSearches were conducted using Health Management Information Consortium, MEDLINE, PsycINFO, Social Sciences Citation Index and EBSCOhost(from inception to May 2012).MethodsStaff experience data came from the national NHS staff surveys of 2009, 2010 and 2011, with trust-level measures of staff absenteeism, turnover, patient satisfaction, mortality and infection rates gathered from the same NHS years. Several analytical methods were used, including multilevel analysis, mediated regression, latent growth curve modelling and cross-lagged correlation analysis.ResultsIn general, the pattern was that better staff experiences are associated with better outcomes for employees and patients. Multilevel analysis found that the positive effects of staff perceiving equal opportunities on employee outcomes were especially strong, as were the negative effects of aggression and discrimination. Organisational-level analysis showed that better staff experiences (particularly those associated with better well-being and better job design, and more positive attitudes about the organisation generally) were linked to lower levels of absenteeism and greater patient satisfaction. There was some evidence that the relationship with absenteeism is causal, although the causal link with patient satisfaction was less clear-cut. Some relationships between staff experience and turnover, and some between staff experience and patient mortality, were also found (and a few with infection rates), with longitudinal analysis comparatively unclear about the direction of causality. Although many staff experiences were associated with absenteeism and patient satisfaction, these effects were not mediated and the reason staff experiences are linked to patient satisfaction appears to be separate from the link with absenteeism. In general, there is no single group of staff (or geographical region) for which staff experiences are the most important. However, nurses’ experiences generally had the strongest effects on absenteeism, followed by medical/dental staff. Few clear or explainable patterns for other staff group effects were found. Absenteeism was most readily predicted by staff experience in the West Midlands. Two Action Learning Sets of managers, and patient and public involvement representatives broadly supported the emerging findings of the factors that seemed to be important indicators of staff satisfaction and organisational outcomes.LimitationsThe relatively blunt nature of the data used meant that conclusions about the direction of causality were less clear. More specific limitations included that we had to limit outcome variables to those that were available already, that many variables were available for acute trusts, and that we could not break down data further within trusts or years.ConclusionsOverall, the research confirmed many expected links between staff experiences and outcomes, providing support for that part of the overall HRM model in the NHS. However, conclusions about the direction of causality were less clear (except for absenteeism). This is probably due in part to the relatively blunt nature of the data used. Future research may involve the careful evaluation of interventions designed to improve staff experience on more specific groups of staff, and the continued use of secondary data sources, such as those used in this report, to answer more specific, theoretically driven questions.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

Integrated and isolated impact of high-performance work practices on employee health and well-being: A comparative study.

“…Ten HRM practices were derived for Study 2 -job autonomy, team working, staff training, career development, flexible working, performance appraisal, grievance systems, supportive management, information sharing, and participative decision-making. In selecting items for these variables, we followed the precedents in previous analysis of the 2004WERS data (Guest & Conway, 2007Wood & De Menezes, 2011;Wood et al, 2012) and the 2010 NHS Staff survey (Powell et al, 2014). See Appendices 1 and 2 for full details of all HRM practices in Studies 1 and 2, respectively.…”

The international knowledge base for new care models relevant to primary care-led integrated models: a realist synthesis

“…The value of a MDT is in the opportunity for interdisciplinary diversity, with multidisciplinary participation emphasised as a key benefit of MDT meetings, 337 supporting a range of social functions such as peer support, team-building and bonding, 337 which can, in turn, have an impact on health outcomes. 350 Several studies report reductions in service utilisation associated with integrated care via MDTs (hospital admission, 326,334,355 A&E attendance, 339 readmission 341 and length of stay) 326 with a potentially higher impact in those 'with at least moderate disease'. 326 Few cost-effectiveness studies explore the effect of MDTs.…”

Team efficacy and leadership in managing aggressive situations in the general hospital setting: A qualitative descriptive analysis of focus groups with ward managers

“…The current evidence on patient and visitor aggression (PVA) concerning interactions with staff underscores its damaging effects. Not only does PVA cause human suffering, including depression, burnout or post-traumatic stress disorder (Lanctôt & Guay, 2014), it may turn staff away from their employer or even from the healthcare profession altogether (Estryn-Behar et al, 2008;Powell, Dawson, Topakas, Durose, & Fewtrell, 2014). PVA causes considerable harm and substantial financial burden for the system and for society.…”