Congruency of resources and demands and their effects on staff turnover within the English health care sector

Determining the relative salience of recognised push variables on health professional decisions to leave the UK National Health Service (NHS) using the method of paired comparisons

OBJECTIVE

The primary and secondary impacts from the COVID-19 pandemic are claimed to have had a detrimental impact on health professional retention within the UK National Health Service (NHS). This study set out to identify priorities for intervention by scaling the relative importance of widely cited push (leave) influences.

DESIGN

During Summer/Autumn 2021, a UK-wide opportunity sample (n=1958) of NHS health professionals completed an online paired-comparisons exercise to determine the relative salience of work-related stress, workload intensity, time pressure, staffing levels, working hours, work-homelife balance, recognition of effort and pay as reasons why health professionals leave NHS employment.

SETTING

The study is believed to be the first large-scale systematic assessment of factors driving staff exits from the NHS since the COVID-19 pandemic.

RESULTS

All professions gave primacy to work-related stress, workload intensity and staffing levels. Pay was typically located around the midpoint of the respective scales; recognition of effort and working hours were ranked lowest. However, differences were apparent in the rank order and relative weighting of push variables between health professions and care delivery functions. Ambulance paramedics present as an outlier, notably with respect to staffing level (F-stat 4.47, p=0.004) and the primacy of work-homelife balance. Relative to staffing level, other push variables exert a stronger influence on paramedics than nurses or doctors (f 4.29, p=0.006).

CONCLUSION

Findings are relevant to future NHS health professional retention intervention strategy. Excepting paramedics/ambulance services, rankings of leave variables across the different health professional families and organisation types exhibit strong alignment at the ordinal level. However, demographic differences in the weightings and rankings, ascribed to push factors by professional family and organisation type, suggests that, in addition to signposting universal (all-staff) priorities for intervention, bespoke solutions for different professions and functions may be needed.

The relationship between leader support, staff influence over decision making, work pressure and patient satisfaction: a cross-sectional analysis of NHS datasets in England

OBJECTIVE

To explore the relationships between leader support, staff influence over decisions, work pressure and patient satisfaction.

DESIGN

A cross-sectional study of large National Health Service (NHS) datasets in England in 2010.

SETTING AND PARTICIPANTS

158 NHS acute hospital trusts in England (n=63 156) from all staff groups.

PRIMARY AND SECONDARY OUTCOME MEASURES

Survey data measuring leader support, staff influence over decision making, staff work pressure and objective outcome data measuring patient satisfaction.

RESULTS

Multilevel serial mediation analysis showed a significantly positive association between leader support and staff influence over decisions (B=0.74, SE=0.07, p<0.01). Furthermore, staff influence over decisions showed a negative association with staff work pressure (B=-0.84, SE=0.41, p<0.05) which in turn was negatively linked to patient satisfaction (B=-17.50, SE=4.34, p<0.01). Serial mediation showed a positive indirect effect of leader support on patient satisfaction via staff influence over decisions and work pressure (B=10.96, SE=5.55, p<0.05).

CONCLUSIONS AND IMPLICATIONS

Our results provide evidence that leader support influences patient satisfaction through shaping staff experience, particularly staff influence over decisions and work pressure. Patients' care is dependent on the health, well-being, and effectiveness of the NHS workforce. That, in turn, is determined by the extent to which leaders are supportive in ensuring that work environments are managed in a way which protects the well-being of staff.

One-way pendulum?

Purpose

Staff shortage in the UK National Health Service has a long history, but is widely predicted to become acute over the next decade. Falling enrolment rates in health professional training and restrictions to migrant labour recruitment have brought the, traditionally neglected, issue of staff retention into sharp relief. The purpose of this paper is to represent the first large scale systematic appraisal of the relative salience of recognised headline drivers of employee exodus from the NHS.

Design/methodology/approach

The data were collected from an opportunity sample of 1,594 health professionals, managers and administrators employed by the NHS. Participants completed a paired ranking task (Case V method of paired comparisons, Thurston, 1927) to determine the relative importance of eight widely cited reasons for exit. The item set was derived from focus groups conducted as a component of the wider study.

Findings

Findings revealed almost universal consensus regarding the primacy of shortage of resources, job demands and time pressure. Pay was ranked lower than predicted. Flexible working arrangements do not presented as a key solution, and there is no support for claims of generational differences.

Research limitations/implications

Survivor population effects could constitute a source of sample bias, i.e. all participants were current NHS employees. It is possible that those who remain may be more resilient or hold different dispositions to leavers. Thus, comparisons by age and grade may not be comparing like with like. Tapping respondent beliefs about the actions of peers can embody some degree of inaccuracy and attribution bias. However, effects can be considered to operate as a source of common, rather than systematic, error across the demographics compared. The medical and dental sample was too small to give confidence in detected differences.

Practical implications

Findings challenge the claim that wider availability of flexible working hours will significantly reduce exit rates. Pay, being a source of dissatisfaction, does not constitute a key push variable in itself, rather its salience reflects the effort reward-imbalance produced by rises in job demands.

Social implications

Staff shortages in the NHS represent a threat to: public well-being – waiting lists and demand for care; the well-being of who continue to work in the NHS – job demands and resources; the employment prospects of staff who leave involuntarily, e.g. on grounds of incapacity and threats to health and well-being – extending to impacts on their dependents.

Originality/value

Issues of staff retention within the NHS are topical and under researched. The findings provide an up to date picture of the relative influence of headline drivers of early exit from the NHS. The study draws upon a more diverse and comprehensive sample of NHS employees that any other known previous studies of early exit. Findings are of potential international relevance to other State health systems. The authors believe this to be the largest (sample) known application of the method of paired comparisons.

Prevention of Occupational Strain: Can Psychological Empowerment and Organizational Commitment Decrease Dissatisfaction and Intention to Quit?

In the present study, the demands-control-support model has served as the basis for the assessment of occupational strain. This model has been used as a predictor of health problems. It has also been associated with organizational outcomes and behaviors. The purpose of this study is to relate job demands and resources with job satisfaction and intention to quit the union. We intend to test a multiple mediation model with psychological empowerment and union commitment as mediator variables. The investigation was carried out with 953 delegates of a Spanish trade union (healthcare professionals). We collected 401 questionnaires. Multiple mediation analyses were performed with bootstrapping techniques using the SPSS PROCESS macro. The results underlined the effects of multiple mediation of empowerment and commitment in the relation between resources and job satisfaction. This mediation was also observed in the relation between resources and intention to quit. The lack of relation between demands and satisfaction or intention to quit is of interest. In the presence of adequate resources, delegates are empowered and committed to their union, which leads to lower dissatisfaction and lower rates of quitting. This study advises organizations to give greater importance to motivational and attitudinal factors to attenuate occupational strain.