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Satisfied hospital staff
– less patient mortality
The satisfaction levels among a hospital’s
staff are closely linked to the quality of
healthcare it provides, say a team of doctors
from Imperial College London.
In the first study of its kind, Dr Richard Pinder and colleagues at Imperial found
that hospitals in England with lower mortality
rates were more likely to have members
of staff satisfied with the quality of
care they provide.
Despite the researchers’ initial assumptions,
satisfaction levels among non-clinical staff
were found to be as closely tied to a hospital’s
performance as those of doctors. A stronger
correlation was found among nursing staff.
The paper appears in BMJ Quality and
Safety days after the long-awaited publication
of the Francis report into failures at
the Mid-Staffordshire Foundation Trust
between 2005 and 2009. In his report, Robert
Francis QC recommended that NHS
trusts across the UK renew their focus on
compassion and the creation of a caring
environment for patients. The report also
highlighted the central role of staff in raising
concerns about poor quality care.
In the new research, the team determined
levels of satisfaction by examining
data from the NHS’s 2009 staff survey. In
particular, they focused on whether or not
staff would recommend their NHS trust to
a friend or colleague, whether they felt that
care was their trust’s priority, and if they
were themselves happy with the standard
of care they provided to patients. Over
60,000 responses were collected across the
147 acute general NHS hospitals in England,
from doctors and nurses as well as
administrative and support staff.
These results were then compared with the individual Hospital Standardised
Ratios (HSMRs), a figure obtained
by comparing the expected rate of death
in a hospital with the actual rate of death.
Although this has been called a crude approach
to assessing the quality of healthcare,
the Department of Health continue
to use overall mortality figures to assess
hospital performance. Dr Pinder says:
“HSMR isn’t perfect, but it’s a useful indicator
that gives you a steer on performance
and has a role in identifying the best- and
worst-performing hospitals. In this paper,
what we are suggesting is that staff willingness
to recommend their hospital may actually
be a more sensitive indicator of the
quality of care than HSMR.”
Dr Pinder and his colleagues suggest that
further research would be needed to establish
the mechanism behind the correlation.
“What this work does is demonstrate that
staff satisfaction is correlated with organisational
performance. The logical next question
is about establishing whether happier
staff provide better care, or if better care creates
happier staff. We don’t know yet, but
it’s probably the case that both processes are
at work. Better organisations attract better
staff, who work harder. It’s a cycle of improvement
or a cycle of degeneration for
many of these hospitals,” he said.
The findings suggest that staff satisfaction
could be used as an early warning system
to help spot more serious institutional failings.
Regular surveys asking questions such as
‘would you recommend this hospital to friends
and family?’ might have been able to prevent
the deterioration of hospital standards that occurred
at the Mid-Staffordshire trust.
The researchers say their study might also help patients to make informed
“It’s difficult for patients to make decisions
based on the intricacies of adjusted
mortality rates. If you want to choose between
two hospitals, knowing that 98% of
doctors and nurses working there would
recommend their hospital, compared with
60% elsewhere is a useful thing to know,”
said Dr Pinder.
Reference: BMJ Quality & Safety “Staff
perceptions of quality of care: an observational
study of the NHS staff survey in
hospitals in England by Richard Jonathan
Pinder, Felix E Greaves (both Department
of Primary Care and Public Health at Imperial
College London), Paul P Aylin, Brian
Jarman, Alex Bottle (all three Dr Foster
Unit at Imperial College London).
of upload: 10th Apr 2013