Original Article
Relationship between staff thriving, through engagement and research activity, and hospital-related outcome measures: A retrospective cross-sectional study

https://doi.org/10.1016/j.jhqr.2021.02.002Get rights and content

Abstract

Introduction and objectives

Both the standardised hospital mortality index (SHMI) and Care Quality Commission (CQC) ratings are used by the National Health Service (NHS) to monitor performance in English hospitals. We assessed if staff thriving, the concept of vitality and learning at work, through application of the surrogate measures engagement and research activity is associated with more favourable hospital performance outcomes.

Methods

This concerned a retrospective cross-sectional study using data for 129 English NHS hospital Trusts from the year 2019. Outcome measures were SHMI (linear regression, unstandardised coefficient beta) and CQC (binary logistic regression, odds ratio [OR]), whereas the independent variables considered were hospital location, degree of patient deprivation, research activity (drawn from National Institute for Health Research records and controlled for hospital size), and staff engagement scores (based on three survey questions corresponding to validated engagement factors).

Results

Staff engagement accounted for over half of the 13% variance R2 for the whole model related to improved CQC rating (OR 13.75, p-value 0.002). Increased research activity was associated with a lower SHMI score (unstandardized beta −0.024, p-value 0.007, R2 5% for each point change in research activity quotient), but independently from the higher SHMI seen for Northern hospital Trusts (beta 0.063, p-value 0.003, R2 11.6%). The degree of patient deprivation did not influence SHMI or CQC outcomes in the regression models.

Conclusion

Increased staff thriving exhibits a modest, yet significantly, association with improved hospital performance; this was observed despite an underlying regional dichotomy in mortality rates.

Introduction

In England, the performance of each National Health Service (NHS) hospital Trust – or hospital for short – is monitored closely by various organisational bodies and through use of different outcome measure tools. The Care Quality Commission (CQC) is an organisation independent from the NHS and they determine if a hospital is effective, well-led, caring, and responsive to people's needs.1 A hospital's mortality rates are expressed by the Standardised Hospital Mortality Index, which is the ratio between the number of patients who die following hospitalisation and the number that would be expected to die on the basis of the average in England.2 Hospital related outcome measures have been subject to criticism in the past.3, 4, 5 The use of SHMI, like other forms of standardised mortality indices, for measuring and comparing a hospital's performance is limited by many issues such as the fact that the majority of deaths are unavoidable.6, 7 A difference in case mix and levels of deprivation (the latter not accounted for in SHMI) amongst populations hospitals serve, have also been suggested to hamper the usefulness of SHMI – particularly in terms of comparing scores between hospitals.2, 6 Regional differences may come into play here – since England is almost bipolar in the distribution of deprivation, poor health status and (unstandardized) mortality – with the North being worse affected than the South.8

As Sauro and colleagues noted recently, ‘There is merit to soldiering on in our attempts to produce evidence and data to inform our pursuit of safer care for all’.9 Indeed, in recent years various variables related to staff behaviour and organisational culture have been shown to correlate with improved CQC rating and/or SHMI scores. Higher levels of staff engagement are linked to better CQC ratings and lower mortality.1, 10, 11 In addition, an interdependence between increased research activity and lower SHMI and better CQC rating, respectively, was observed.12 These variables have as of yet not been compared together to determine how they may interlink; furthermore, the potential impact of North–South England and deprivation on these variables have not been taken into account before. Therefore, the aims of this study were to conduct an association study to: determine if – when analysed together as a surrogate for staff thriving13 – staff engagement and research activity are associated with hospital performance by virtue of CQC rating and SHMI score.

Section snippets

Ethics statement

This concerns a retrospective cross-sectional study involving data from 129 English NHS hospital Trusts (although the term hospital is used throughout the text, many NHS hospital Trusts manage multiple hospitals). All data used in this study is readily available to the public via NHS and NIHR electronic depositories. No personal identifiable information has been used as part of this study. Therefore, this is a service evaluation and no formal ethics-clearance was obtained.

Data sources

CQC ratings were

Results.

Table 2 shows how certain variables are related to each other when only two were considered at one time. Being a binary independent variable, North and South regions were used for stratification. At first the degree of patient deprivation appears to be associated with increased SHMI when England as a whole is considered. However, this is a dichotomous pattern based on the North and South regions; when regions are considered individually, deprivation does not correlate with an increase in

Discussion

Determining a causal interaction between a variable and a complex outcome measure such as quality of care provision (through CQC rating) and/or mortality (through SHMI) in hospitals is challenging and therefore a recognised study constraint.3, 4, 5, 6 However, despite these challenges there are certain NHS staff (and organisational) behaviours that have been shown to associate – sometimes through different methodological approaches – favourably with better CQC rating and lower SHMI. In this

Conclusions

This present study, which takes the North–South divide and deprivation levels into account, confirms earlier work showing significant associations between staff engagement, research activity, SHMI and CQC. Any potential for synergistic effect of engagement and clinical research activity, as well as other behaviours which fit under the term thriving and its components vitality & learning, should be explored to optimise the positive staff behaviour and accompanying hospital performance.

Data availability statement

The data that supports the findings of this study are available in the supplementary material of this article.

Funding disclosure

None to declare.

Conflicts of interest

Both LJ and SJF are in receipt of NIHR funding through their regional Clinical Research Network for delivery of NIHR national portfolio studies. RB has not conflicts of interest to declare.

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  • Cited by (3)

    • Hospital clinical research activity, rather than staff motivational engagement, significantly links effective staff communication and favourable patient feedback; a cross-sectional study

      2022, Journal of Healthcare Quality Research
      Citation Excerpt :

      Apart from research activity, other staff related variables may contribute to improved hospital performance and outcomes; one of those, staff motivational engagement, is linked to better CQC ratings and lower mortality.2,3,10 Since research activity (learning) and motivational engagement (vitality) can combined potentially be seen as a degree of staff thriving,3 both variables were included in the analyses. For this retrospective cross-sectional study, publicly available anonymous outcome data for 129 English NHS hospital Trusts was collated.

    1

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