• Analysis of staff survey data highlights “strong association” between manager communication and safety
  • Experts stress good leadership is “essential” for good safety culture

There is a “strong association” between staff experience of senior management and whether an organisation acts on error reporting, exclusive analysis for HSJ of the staff survey data suggests.

Analysis by health and social care charity Picker Institute examined statistical relationships between responses to staff survey questions regarding staff communication with managers and those relating to error reporting.

The analysis, which included all trust types, looked at the relationships between statements such as “communication between senior managers and staff is effective” and “I know who the senior managers are here” to “When errors, near misses or incidents are reported, my organisation takes action to ensure they do not happen again” and other similar indicators.

A high correlation to the questions does not categorically prove a direct causal relationship but the data suggested “strong associations”, Picker Institute chief statistician Steve Sizmur told HSJ.

He said: “There are a number of strong associations in the latest staff survey data, to the extent that there is likely to be a link between staff experiences of senior management and their views about error reporting and whether the organisation addresses their concerns.”

“A correlation of above 0.7 means that the two indicators have at least half their variation in common, and is at the level where we would suspect that there is something going on, although it is not necessarily obvious what causes what here,” Mr Sizmur explained.

The attached spreadsheet gives a full breakdown of which questions were compared and their correlations. The methodology is set out in the box below.  

When looking at all trust types, the strongest correlation (0.8) was found between staff agreeing “communication between senior management and staff is effective” and also with “when errors, near misses or incidents are reported, my organisation takes action to ensure that they do not happen again”.

The analysis found acute trusts and community trusts also reported a particularly high association between staff agreeing with these two statements.

However, there were some unexpected findings. Ambulance trusts, which were clustered at the bottom of staff survey tables for staff wellbeing measures, reported a strong correlation between staff agreeing communication with their manager was effective and agreeing their organisation encourages them to report errors.

On the other hand, specialist trusts, which usually perform well on staff experience measures, did not have a strong association between error reporting and communication with managers.

Alison Leary, professor of healthcare modelling at London Southbank University, said the data shows the “variability” in the experiences of people at different organisations.

“The perception of better management culture appears to be associated with incident reporting culture,” Professor Leary said. “But there is incredible variability with both of these things.”

“We should be aiming for a safety culture where people feel that their manager takes incident reporting seriously,” she told HSJ.

“We know previous research has shown good leadership culture means people are more likely to report things,” Professor Leary said. “Other safety critical industries even incentivise reporting of incidents and near misses.”

Most significant relationship

Jon Restell, chief executive of Managers in Partnership, said: “Within the NHS, your line manager is the single most significant relationship that many staff have, and it is crucial to ensuring that staff feel valued and heard within their roles.”

“There exists good evidence for a link between an increased number of managers and increasing patient safety — for example, the research of Ian Kirkpatrick, of Warwick Business School, found that larger numbers of managers led to improved patient satisfaction, a 5 per cent improvement in hospital efficiency and a 15 per cent reduction in infection rates,” Mr Restell said.

Unison national officer for health, Alan Lofthouse, said of the findings that a “positive safety culture is led from the top and supported throughout all parts of an organisation”.

“When managers are listening and acting on feedback, it builds trust and provides reassurance for staff that they can raise concerns safely,” he said.


  • The correlations are reported in the attached spreadsheet.

  • The heat-map shading indicates thresholds of 0.5, 0.7 and 0.8. Values above 0.5 are above the “background” level of correlation and indicate the two variables have at least 25 per cent of their variation in common.

  • Values above 0.7 indicate the two variables have at least 50 per cent of their variation in common. Values above 0.8 are high correlations.

  • Negative correlations indicate that an increase in one variable is associated with a decrease in the other. Correlations between -0.2 and 0.2 are negligible.