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Organisational values of National Health Service trusts in England: semantic analysis and relation to performance indicators
  1. Amina Waheed1,
  2. Edward Presswood2,
  3. Gregory Scott3
  1. 1 Imperial College School of Medicine, Imperial College London, London, UK
  2. 2 Dorothy House Hospice Care, Bradford on Avon, UK
  3. 3 Department of Brain Sciences, Imperial College London, London, UK
  1. Correspondence to Dr Gregory Scott, Department of Brain Sciences, Imperial College London, London W12 0TE, UK; gregory.scott99{at}


Background Organisational values are widely assumed to have positive effects on performance and staff. National Health Service (NHS) trusts in England have accordingly chosen their own organisational values. However, there has been no survey of the values adopted, and there is little evidence that the choice of values per se has consequences for outcomes. We comprehensively described trusts’ organisational values, using natural language processing to identify common themes. We tested whether the choice of themes was associated with outcomes for patients and staff.

Methods We collected data on trusts’ values (from their websites), performance (Summary Hospital-level Mortality Indicator (SHMI) statistics, Care Quality Commission (CQC) ratings), sickness absence rates (SAR) and staff opinions (NHS Staff Survey responses). We first characterised values based on lexical properties then progressed to semantic analysis, using Google’s Universal Sentence Encoder, to transform values to high-dimensional embeddings, and k-means clustering of embeddings to semantically cluster values into 12 common themes. We tested for associations between trusts’ use of these themes and outcomes.

Results Organisational values were obtained for 221 of 228 NHS trusts, with 985 values in total (480 unique). Semantic clustering identified themes including ‘care’, ‘value respect’ and ‘togetherness’. There was no significant association between themes and SHMI or CQC ratings. However, themes predicted trusts’ SAR (p=0.001, R2=0.159), with use of ‘care’,value respect’, ‘aspirational’ and ‘people’ all significant predictors of increased sickness absence; themes also predicted staff opinions on ‘Equality, diversity and inclusion’ (p=0.011, R2=0.116), but with ‘supportive’ and ‘openness’ predicting more negative responses.

Conclusion A trust’s adoption of individualised organisational values does not seem to make a positive difference to its patients or staff. These findings should give NHS managers pause for thought, challenging them to reconsider their reliance on value-defining initiatives, and to seek evidence that a focus on values has measurable benefits on outcomes.

  • values
  • safety
  • health policy
  • clinical leadership
  • performance

Data availability statement

Data are available in a public, open access repository. All data necessary to recreate the analyses, including all collected values, are available in a spreadsheet at

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Data availability statement

Data are available in a public, open access repository. All data necessary to recreate the analyses, including all collected values, are available in a spreadsheet at

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  • Contributors GS, AW and EP collected the data and prepared the first draft of the manuscript. GS carried out the quantitative analyses and generated figures and tables. GS and EP conceived the study. The corresponding author attests that all the listed authors meet the authorship criteria and that no others meeting the criteria have been omitted. GS is the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.