• R G Badgett, L Jonker, and S Xirasagar.
• Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS, USA. rbadgett@kumc.edu.
• J Gen Intern Med. 2020 Dec 1; 35 (12): 3465-3470.

BackgroundHealthcare workforce engagement may represent a proactive approach against provider burnout, a widely prevalent condition that is associated with poor patient outcomes.ObjectiveWe examine whether workforce engagement is associated with better hospital performance, measured as lower inpatient mortality, in English National Health Services (NHS) acute Trusts.DesignPanel study using cross-lagged regression, applying an optimally time-lagged value of the dependent variable as covariate to account for unmeasured Trust characteristics.ParticipantsNHS acute Trusts and respondents to the NHS Staff Surveys, 2012-2018.Main MeasuresWe measured engagement using three survey questions corresponding to validated engagement factors, and hospital performance using the Summary Hospital-level Mortality Indicator (SHMI). In the first analyses, associations of SHMI (dependent variable) with workforce engagement in the current, prior, and subsequent years were studied to find the optimum lag period for lagged regression analysis. In the subsequent cross-lagged regression analysis, bi-directional associations between SHMI and engagement were studied. Heterogeneity in engagement components across Trusts was studied in detail for the year 2017.Key ResultsIn the first analyses, current SHMI was negatively associated with engagement in the current year (ß = - 0.044; p = 0.035) more than with the prior year (ß = - 0.037; p = 0.049). In the second analysis, (a) engagement predicted same-year SHMI after controlling for prior-year SHMI (ß = - 0.044; p = 0.035). A 1-unit higher engagement score was associated with 4.4% lower SHMI. (b) SHMI predicted engagement in the same year (ß = - 0.066; p = 0.001) after controlling for prior-year engagement. More in-depth analysis showed high inter-trust heterogeneity on all three engagement factors (I2 > 85%).ConclusionHigher workforce engagement predicts lower mortality which in turn predicts engagement. Heterogeneity in workforce well-being suggests an opportunity to foster mutual learning across Trusts.

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