BMJ Qual Saf doi:10.1136/bmjqs-2012-001540
  • Original research

Staff perceptions of quality of care: an observational study of the NHS Staff Survey in hospitals in England

  1. Alex Bottle2
  1. 1Department of Primary Care and Public Health, Imperial College London, London, UK
  2. 2Dr Foster Unit at Imperial College London, Imperial College London, London, UK
  1. Correspondence to Dr Richard J Pinder, Department of Primary Care and Public Health, Imperial College London, Reynolds Building, St Dunstan's Road, London W6 8RP, UK; richard.pinder{at}
  • Received 24 September 2012
  • Revised 9 January 2013
  • Accepted 13 January 2012
  • Published Online First 20 February 2013


Background There is some evidence to suggest that higher job satisfaction among healthcare staff in specific settings may be linked to improved patient outcomes. This study aimed to assess the potential of staff satisfaction to be used as an indicator of institutional performance across all acute National Health Service (NHS) hospitals in England.

Methods Using staff responses from the NHS Staff Survey 2009, and correlating these with hospital standardised mortality ratios (HSMR), correlation analyses were conducted at institutional level with further analyses of staff subgroups.

Results Over 60 000 respondents from 147 NHS trusts were included in the analysis. There was a weak negative correlation with HSMR where staff agreed that patient care was their trust's top priority (Kendall τ = −0.22, p<0.001), and where they would be happy with the care for a friend or relative (Kendall τ = −0.30, p<0.001). These correlations were identified across clinical and non-clinical groups, with nursing staff demonstrating the most robust correlation. There was no correlation between satisfaction with the quality of care delivered by oneself and institutional HSMR.

Conclusions In the context of the continued debate about the relationship of HSMR to hospital performance, these findings of a weak correlation between staff satisfaction and HSMR are intriguing and warrant further investigation. Such measures in the future have the advantage of being intuitive for lay and specialist audiences alike, and may be useful in facilitating patient choice. Whether higher staff satisfaction drives quality or merely reflects it remains unclear.

Free sample

This recent issue is free to all users to allow everyone the opportunity to see the full scope and typical content of BMJ Quality & Safety.
View free sample issue >>

Email alerts

Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.


Navigate This Article