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Do associations between staff and inpatient feedback have the potential for improving patient experience? An analysis of surveys in NHS acute trusts in England
  1. V S Raleigh1,2,
  2. D Hussey3,
  3. I Seccombe4,
  4. R Qi4
  1. 1
    The King's Fund, London, UK
  2. 2
    Postgraduate Medical School, University of Surrey, Guildford, Surrey, UK
  3. 3
    NatCen, London, UK
  4. 4
    Care Quality Commission, London, UK
  1. Correspondence to Veena S Raleigh, Senior Fellow, The King’s Fund, 11–13 Cavendish Square, London W1G 0AN, UK; v.raleigh{at}


Objective: To examine whether staff feedback on quality, safety and workforce issues is reflected in patient-reported experience.

Setting: 166 NHS acute trusts in England.

Participants: Respondents to the 2006 surveys of adult inpatients and staff in 166 NHS acute trusts in England.

Methods: Multiple linear regression was used to model the relationship between responses by “frontline” staff and inpatients at trust level. Staff survey items were the explanatory variables and inpatient responses the dependent variables. Adjustments were made for location (London and non-London) and trust type.

Results: 69 500 staff and 81 000 patients responded to the surveys. There were several significant associations between staff and patients’ responses, including that staff availability of hand-washing materials was positively associated with patient feedback on cleanliness and hand washing by doctors/nurses (p<0.00). It was a significant predictor of patient experience also in several other models. Other significant predictors of patient experience were managerial support, witnessing and reporting of errors (positively associated with patient experience), working extra hours and stress (negatively associated). London trusts performed worse on patient experience than trusts outside London and specialist trusts performed better than other acute trusts.

Conclusions: Staff feedback was associated with patient-reported experience. Positive staff feedback on availability of hand-washing materials was broadly reflective of positive patient experience. Negative staff experience was reflected in poorer patient experience and vice versa. Although we cannot demonstrate causality, the consistent direction of the findings is indicative of it. Management boards of trusts and clinicians and other staff should monitor and act on the results of their staff surveys. This has the potential for improving quality, safety and patient experience.

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  • ▸ Additional appendices are published online only at

  • Funding The NHS Staff Survey Advice Centre at Aston University Business School and the Acute Patient Surveys Co-ordination Centre at the Picker Institute were both funded by the Healthcare Commission. The NHS staff and patient surveys were funded locally by the NHS trusts involved.

  • Competing interests None.

  • Ethics approval The NHS Staff survey and the acute hospital inpatient surveys both have approval from the North-West Multi-Centre Research Ethics Committee.