Hospital Workforce Engagement and Inpatient Mortality Rate: Findings from the English National Health Service Staff Surv
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Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS, USA; 2Research & Development Department, North Cumbria Integrated Care NHS Foundation Trust, Carlisle, UK; 3Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
BACKGROUND: Healthcare workforce engagement may represent a proactive approach against provider burnout, a widely prevalent condition that is associated with poor patient outcomes. OBJECTIVE: We examine whether workforce engagement is associated with better hospital performance, measured as lower inpatient mortality, in English National Health Services (NHS) acute Trusts. DESIGN: Panel study using cross-lagged regression, applying an optimally time-lagged value of the dependent variable as covariate to account for unmeasured Trust characteristics. PARTICIPANTS: NHS acute Trusts and respondents to the NHS Staff Surveys, 2012–2018. MAIN MEASURES: We measured engagement using three survey questions corresponding to validated engagement factors, and hospital performance using the Summary Hospital-level Mortality Indicator (SHMI). In the first analyses, associations of SHMI (dependent variable) with workforce engagement in the current, prior, and subsequent years were studied to find the optimum lag period for lagged regression analysis. In the subsequent cross-lagged regression analysis, bi-directional associations between SHMI and engagement were studied. Heterogeneity in engagement components across Trusts was studied in detail for the year 2017. KEY RESULTS: In the first analyses, current SHMI was negatively associated with engagement in the current year (ß = − 0.044; p = 0.035) more than with the prior year (ß = − 0.037; p = 0.049). In the second analysis, (a) engagement predicted same-year SHMI after controlling for prior-year SHMI (ß = − 0.044; p = 0.035). A 1-unit higher engagement score was associated with 4.4% lower SHMI. (b) SHMI predicted engagement in the same year (ß = − 0.066; p = 0.001) after controlling for prior-year engagement. More in-depth analysis showed high inter-trust heterogeneity on all three engagement factors (I2 > 85%). CONCLUSION: Higher workforce engagement predicts lower mortality which in turn predicts engagement. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11606-020-06045-0) contains supplementary material, which is available to authorized users. Received November 8, 2019 Accepted July 7, 2020
Heterogeneity in workforce well-being suggests an opportunity to foster mutual learning across Trusts. J Gen Intern Med DOI: 10.1007/s11606-020-06045-0 © Society of General Internal Medicine 2020
BACKGROUND
Healthcare management research has focused on burnout as nearly half of physicians and one-third of the US working population report burnout.1 Similarly, about 40% of consultants in the National Health Service (NHS) report burnout.2 Burnout also affects the worker’s role performance and may reduce organizatio
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