Two stages of latent growth curve analysis were completed, and each is used for a slightly different
interpretation. Both stages predicted levels, and changes, in intermediate outcomes from 2009/10 to 2011/12; the first stage used 2009 staff experience variables as predictors, whereas the second stage used differences
from 2009 to 2010 (denoted with a‘D’ suffix in Appendix 3, Tables 35–38), to examine whether or not there
was any evidence of change in staff experience affecting longer-term change in intermediate outcomes. Owing to the complexity of the latent growth curve analysis procedure, there were occasionally statistical problems preventing the estimates being achieved, which was a common problem with latent variable procedures. In order to circumvent this, in some cases we had to omit control variables from the models to get estimates. These cases are clearly indicated in the relevant tables.
Table 7 shows the significant relationships between staff survey variables from 2009 and the starting level (intercept) in absenteeism and turnover. These indicate when there are significant cross-sectional
relationships between aggregate staff experience and behaviour in terms of absenteeism or leaving jobs. Note that the outcome variable for turnover is actually the stability index and, therefore, a positive
relationship for this suggests a negative result for turnover. The tables report what was found in the analysis in terms of stability (for the sake of accuracy), but the text reports these findings in terms of turnover instead. In summary, absenteeism is lower in trusts for which:
l a higher proportion of staff report working extra hours
l a higher percentage of staff report feeling valued by colleagues
l staff have well-designed jobs
l a higher proportion of staff work in a well-structured team environment
l a lower percentage of staff report experiencing physical violence from other staff
l a lower percentage of staff report experiencing harassment, bullying or abuse from patients or
their relatives
l a higher percentage of staff report good communication between management and staff
l a higher percentage of staff report that they are able to contribute towards improvements at work
l staff report that they are willing to recommend their trust as a place to work or receive treatment
l staff report a higher level of motivation at work
l staff report higher overall work engagement.
Almost all of these suggest that better experiences equate to lower absence. The only dubious finding is that when more staff report working extra hours, absenteeism is lower; however, this makes sense because, if more staff were absent, there would be less opportunity to work extra hours.
Turnover is lower in trusts for which:
l fewer staff work extra hours
l a higher percentage of staff receive any type of training and development (health and safety training
in particular)
l staff report lower levels of work pressure
l a higher percentage of staff are appraised, or have agreed a personal development plan
l fewer staff experience harassment, bullying or abuse from other staff
l staff perceive that effective action is taken from the employer towards violence and harassment
TABLE 7 The NHS staff survey key findings 2009 as predictors of starting levels (intercepts) of intermediate outcomes in latent growth curve models
Outcome Predictor Coefficient p-value Controls not included
Absenteeism % working extra hours –0.05 0.00 % receiving job relevant training in previous 12 months –0.03 0.01 % feeling valued by colleagues –0.04 0.00 Quality of job design (clear job content, feedback and
staff involvement)
–0.01 0.05
% working in a well-structured team environment –0.18 0.02 % experiencing physical violence from other staff in
previous 12 months
0.10 0.02 Teaching status, foundation status, doctors per bed % experiencing harassment, bullying or abuse from
patients or their relatives in previous 12 months
0.08 0.00 Doctors per bed
% reporting good communication between management and staff
–0.03 0.00 Foundation status, doctors per bed % able to contribute towards improvements at work –0.03 0.01
% able to contribute towards improvements at work (scale)
–0.02 0.02
Staff recommendation of the trust as a place to work
or receive treatment –0.01
0.03
Motivation at work –0.02 0.01 Overall engagement –0.01 0.01 Stability % working extra hours –23.65 0.00
% receiving any training or development in previous 12 months
20.29 0.02
Work pressure felt by staff –4.77 0.01 % appraised within previous 12 months 4.63 0.01 % with personal development plans agreed within
previous 12 months
5.41 0.00
% having had health and safety training in previous 12 months
6.76 0.00
% witnessing potentially harmful errors or near misses in previous month
–10.48 0.02
% experiencing harassment, bullying or abuse from
other staff in previous 12 months –16.78
0.01
Perceptions of effective action from employer towards violence and harassment
5.08 0.02
Intention to leave job –4.39 0.01 % believing trust provides equal opportunities for
career progression or promotion
11.15 0.04
% experiencing discrimination at work in last 12 months –28.94 0.00 Availability of hand-washing materials 10.88 0.00
l fewer staff experience discrimination at work
l availability of hand-washing materials is higher.
The‘extra hours’ finding makes more sense here because, even though absenteeism may be lower when
staff work extra hours, turnover is higher. All other findings are in the direction that suggests turnover is lower when staff experience is more positive.
Table 8 shows the significant relationships between staff survey variables from 2009 and the change (slope) in absenteeism and turnover. These indicate where starting levels of staff experience are associated with subsequent changes in absenteeism and turnover. These are more difficult to interpret because a drop in
absenteeism (for example) may be due to a very high starting level– in other words, regression to the mean.
Therefore, we recommend not interpreting these results particularly strongly, but instead focusing on the (far stronger) results in later tables. However, they are included for the sake of completeness.
A much stronger form of the analysis is using changes in staff experience (i.e. differences in staff survey variables between 2009 and 2010) as predictors of the change in intermediate outcomes (slopes). Table 9 shows the significant results from this analysis. In summary:
l An increase in staff agreeing that their role makes a difference to patients is associated with a decrease
in turnover in subsequent years.
l An increase in the percentage of staff feeling that there are good opportunities to develop their
potential at work is associated with a decrease in turnover in subsequent years.
l An increase in the percentage of staff suffering work-related injuries or illness is associated with a
decrease in turnover in subsequent years.
l An increase in the percentage of staff experiencing harassment, bullying or abuse from other staff is
associated with an increase in turnover in subsequent years.
l In trusts for which staff report an increase in their level of willingness to recommend the trust as a
place to work or receive treatment, there is a decrease in turnover in subsequent years.
l There were no significant findings with absenteeism as the outcome.
TABLE 8 The NHS staff survey key findings 2009 as predictors of changes (slopes) in intermediate outcomes
Outcome Predictor Coefficient p-value
Absenteeism % working extra hours –0.01 0.00 % experiencing physical violence from patients or their relatives in previous
12 months
–0.02 0.02
Stability % working extra hours 7.52 0.00 % receiving any training or development in previous 12 months –10.75 0.01 Opportunities for flexible working –6.50 0.01 % appraised within previous 12 months –2.32 0.01 % with personal development plans agreed within previous 12 months –2.38 0.01 % having had health and safety training in previous 12 months –2.67 0.01 % suffering work related injuries or illness –8.05 0.02 % experiencing physical violence from patients or their relatives in previous
12 months
–7.41 0.04
Intention to leave job 2.41 0.00 % receiving equality and diversity training –1.15 0.05 Availability of hand-washing materials –4.19 0.00
This clearly indicates that when the number of staff having meaningful jobs increases, when there are decreases in aggression from other staff and when belief in their employer as both a place to work and a place to receive treatment increases, then turnover tends to decrease over the 3-year period in question.