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BMJ Open Qual. 2019 Jun 3;8(2):e000621. doi: 10.1136/bmjoq-2018-000621. eCollection 2019.

Monitoring work well-being, job confidence and care provided by care home staff using a self-report survey.

Author information

R-Outcomes Ltd, Thatcham, UK.
Institute of Health Informatics, UCL, London, UK.
Wessex AHSN, Southampton, UK.
City University School of Health Sciences, London, UK.


Background and method:

In care homes, staff well-being, job confidence and opinion of the care provided to residents are central to morale and care quality. In this study, care home staff in the East Midlands region of England completed self-reported outcome and experience surveys in two rounds. Mean scores for each home are shown using a scale from 0 (all chose lowest option) to 100 (all chose highest option). High scores are good.


In round 1, 332 staff in 15 homes submitted responses; in round 2, 207 staff in 9 homes. Mean scores in round 1 and round 2 were similar, although those of some homes scores differed significantly, cancelling each other out. Overall, Work Wellbeing mean score was 83 (care home range 48-97), with worthwhileness (92) the highest ranked item and anxiety at work (78) the lowest. Job Confidence mean score was 84 (range 59-94), with able to manage the work (86) highest and involvement in decisions that affect staff (79) lowest. Care Provided mean score was 86 (range 59-97), with treat people kindly (91) highest and well organised (80) lowest. Homes rated as outstanding by the Care Quality Commission had higher scores on average than those rated good, which were higher than those rated as needing improvement.


This study has demonstrated the practicality of measuring staff views of their Work Wellbeing, Job Confidence and Care Provided in care homes. Rather than wait for adverse quality outcomes to be detected, this approach offers a way to track staff morale and declared capability over time.


evaluation methodology; nursing homes; performance measures; quality management; surveys

Conflict of interest statement

Competing interests: TB reports grants from East Midlands AHSN, during the conduct of the study; he is a director and shareholder of R-Outcomes Ltd, which owns the copyright of the Work Wellbeing, Job Confidence and Care Provided measures and provides quality improvement and evaluation services in the health and social care sectors. JD and JS worked for R-Outcomes on this project. CB is a non-executive director of AKARI Care Homes, FINCCH and Invatech Health, all of which have interests in care homes and social care. Please contact R-Outcomes Ltd if you wish to use these measures in care homes.

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