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Title: Relationship between employee engagement scores and service quality ratings: analysis of the National Health Service staff survey across 97 acute NHS Trusts in England and concurrent Care Quality Commission outcomes (2012–2016)
Authors: Wake, Mark
Green, William
First Published: 17-Jul-2019
Publisher: BMJ Publishing Group
Citation: BMJ Open 2019;9:e026472
Abstract: Objective This research explores measures of employee engagement in the National Health Service (NHS) acute Trusts in England and examines the association between organisation-level engagement scores and quality ratings by the Care Quality Commission (CQC). Design Cross-sectional. Setting 97 acute NHS Trusts in England. Participants 97 NHS acute Trusts in England (2012–2016). Data include provider details, staff survey results and CQC reports. Hybrid Trusts or organisations affected by recent mergers are excluded. Outcome measures Analysis uses organisation-level employee engagement and CQC quality ratings. Results Employee engagement is affected by organisational factors, including patient bed numbers (β=−0.46, p<0.05) and financial revenue (β=0.38, p<0.05). CQC ratings are predicted by overall employee engagement score (β=0.57, p<0.001) and financial deficit (β=−0.19, p<0.05). The most influential employee engagement dimension on provider ratings is ‘advocacy’ (λ=0.54, p<0.001). Analysis supports the notion that employee engagement can be predicted from advocacy scores alone (eigenvalue=4.03). Better still, combining advocacy scores from the previous year’s survey or adding in motivation scores is a highly reliable indication of overall employee engagement (95.4% of total variance). Conclusions NHS acute Trusts with high employee engagement scores tend to have better CQC ratings. Trusts with a high financial deficit tend to have lower ratings. Employee engagement subdimensions have different associations with CQC ratings, the most influential dimension being advocacy score. A two subdimension model of engagement efficiently predicts overall employee engagement in NHS acute Trusts in England. Healthcare leaders should pay close attention to the proportion of employees who would recommend their organisation as a place to work or receive treatment, because this is a proxy for the level of engagement, and it predicts CQC ratings.
DOI Link: 10.1136/bmjopen-2018-026472
ISSN: 2044-6055
Version: Publisher Version
Status: Peer-reviewed
Type: Journal Article
Rights: Copyright © the authors, 2019. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-commercial License (, which permits unrestricted use, distribution, and reproduction in any medium non-commercially, provided the original author and source are credited.
Description: Survey data are available from and
Appears in Collections:Published Articles, School of Management

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