Cross-lagged correlations compare the relationship between two variables in subsequent years, testing whether or not there is a stronger effect in one direction than the other. Again, full results are in
Appendix 2, but Tables 10 and 11 show the significantly different cross-lagged correlations between staff experience and intermediate outcomes. All differences are for the two most recent years, i.e. staff survey variables from 2010 and 2011, and outcomes from 2010/11 and 2011/12.
TABLE 10 Cross-lagged correlations between staff survey variables and employment stability, 2010/11–2011/12. Note: p-value represents test of the null hypothesis that the correlations are equal
Staff survey variable
Survey 2010 and stability 2011/12
Stability 2010/11
and survey 2011 p-value
Quality of work–life balance –0.25 –0.07 0.01 % agreeing their role makes a difference to patients 0.26 0.08 0.02 % witnessing potentially harmful errors or near misses in
previous month
0.32 0.01 0.00
Opportunities for flexible working –0.32 0.00 0.00 Impact of health and well-being on ability to perform work or
daily activities –0.22
0.02 0.00
% able to contribute towards improvements at work –0.30 –0.06 0.00 Availability of hand-washing materials 0.26 –0.04 0.00 % suffering work related injuries or illness 0.32 0.05 0.00 Intention to leave job –0.42 –0.10 0.00 Job satisfaction –0.21 –0.05 0.03 % feeling pressure to attend work when feeling unwell 0.25 0.04 0.00 Staff recommendation of the trust as a place to work or
receive treatment
0.12 –0.04 0.03
% feeling satisfied with quality of work and patient care they are able to deliver
0.23 0.08 0.05
% suffering work related stress in previous 12 months –0.15 0.10 0.00 Support from supervisors –0.21 –0.05 0.03 % working in a well-structured team environment –0.18 –0.03 0.05
TABLE 9 The NHS staff survey key findings (changes from 2009 to 2010) as predictors of changes (slopes) in intermediate outcomes
Outcome Predictor Coefficient p-value
Stability % agreeing their role makes a difference to patients 7.46 0.05 % feeling there are good opportunities to develop potential at work 3.97 0.04 % suffering work related injuries or illness 7.34 0.01 Staff recommendation of the trust as a place to work or receive treatment 1.80 0.04
These findings reveal some unexpected results, particularly with regard to turnover. For example, the first
finding in the table shows that the quality of work–life balance has a negative relationship with stability
the next year, whereas the converse finding (stability in 2010/11 and quality of work–life balance in 2011)
is that of a relationship close to zero. This suggests that in trusts for which the climate for work–life balance is better, turnover tends to subsequently increase.
Owing to the large number of separate tests here, and some seemingly contradictory or unexpected results, it makes most sense to concentrate on those for which there are obvious patterns. For this purpose, we define a pattern for which two distinct but theoretically similar staff survey variables have the same pattern of results with the same outcome, or one staff survey variable has the same pattern of results with both outcomes (i.e. higher stability/lower absenteeism, or vice versa). With this in mind, the patterns can be summarised as follows:
l Quality of work–life balance and opportunities for flexible working are both more closely related with
higher subsequent turnover than vice versa. However, they are both also more closely related with lower subsequent absenteeism than vice versa, so there may be a contextual effect on turnover due to changes in the NHS.
TABLE 11 Cross-lagged correlations between staff survey variables and staff absenteeism, 2010/11–2011/12. Note: p-value represents test of the null hypothesis that the correlations are equal
Staff survey variable
Survey 2010 and absenteeism 2011/12 Absenteeism 2010/11 and survey 2011 p-value
Quality of work–life balance –0.19 –0.03 0.00 % reporting good communication between management and staff –0.34 –0.19 0.00 % experiencing discrimination at work 0.18 0.07 0.02 % believing that trust provides equal opportunities for career
progression or promotion
–0.19 –0.07 0.01
% witnessing potentially harmful errors or near misses in previous month
0.08 –0.10 0.00
% staff working extra hours –0.06 –0.19 0.01 Opportunities for flexible working –0.29 –0.01 0.00 % experiencing harassment, bullying or abuse from patients or their
relatives in previous 12 months
0.50 0.30 0.00
% able to contribute towards improvements at work –0.42 –0.21 0.00 % suffering work related injuries or illness 0.15 0.02 0.00 Intention to leave job –0.18 –0.04 0.00 Job satisfaction –0.26 –0.10 0.00 % feeling pressure to attend work when feeling unwell 0.08 –0.03 0.03 % reporting errors, near misses or incidents witnessed in the
last month
–0.19 –0.04 0.04
% feeling satisfied with quality of work and patient care they are able to deliver
0.06 –0.04 0.07
Support from supervisors –0.16 –0.04 0.01 % working in a well-structured team environment –0.25 –0.15 0.04 % experiencing physical violence from patients or their relatives in
previous 12 months
0.59 0.40 0.00
l When staff agree that their role makes a difference to patients, or when they feel satisfied with the quality of care delivered, or would recommend their trust as a place to work or receive treatment, this is more negatively associated with subsequent turnover than vice versa.
l When staff say their health negatively impacts their ability to do their job or when they suffer from
work-related stress, this is more positively associated with subsequent turnover than vice versa.
l Job satisfaction, support from supervisors and working in well-structure teams is more positively
associated with subsequent turnover than vice versa.
l Absenteeism results are far more straightforward. In addition to those already mentioned, having good
communication, less discrimination, fewer errors, less extra-hour working, less work pressure, less harassment and violence from patients, fewer injuries, higher job satisfaction and ability to contribute towards improvements, lower turnover intentions, less pressure to attend work when feeling unwell, better support from supervisors, and more well-structured teamworking are all associated with lower subsequent absenteeism than vice versa.