Inside Health: does improving staff satisfaction improve patient care?

Inside Health this week covered NHS staff morale – and there was lots of interesting discussion of the challenges that staff face. However, the programme presented evidence that staff satisfaction correlates with better care as showing that improving staff morale causes better care. I therefore think the programme overstated the evidence it presented: it didn’t address problems with the direction of causality. Staff might be happier because they work in organisations that look after patients better, for example.


Martin Powell of Birmingham University was interviewed about his interesting research on staff satisfaction and performance. Mark Porter (hosting the show) suggested that this was “hard evidence…that staff morale can have an impact on clinical outcomes”. Powell agreed, and went on to refer to how this was discussed in various policy documents. However, Powell et al.’s 2014 paper on this topic is clear that

conclusions about the direction of causality were less clear (except for absenteeism). This is probably due in part to the relatively blunt nature of the data used

The paper explicity mentions concerns about reverse causality where staff might be more satisfied because they are working for better-performing organisations – it might be the good performance that makes staff happy, rather than the other way round. While policies to support staff better and improve staff morale are very likely a positive thing, it’s important not to overstate the evidence in favour of these measures.

Postscript

I feel a bit bad posting this – Inside Health generally has some of the best discussions of research in the mainstream media, and has had excellent discussion of questions around, for example, whether screening leads to reduced mortality. I’m certainly not convinced I’d do any better than Powell if I was trying to discuss complicated research in an interview. If I’ve missed out relevant research, I’m happy to be corrected of course – but I can’t find convincing evidence about about the direction of causility here.

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