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Nonresponse Bias in Healthcare Employee Well-being Surveys: Study Reveals Skewed Results

Strategic Insights

— 2 min read

Employee well-being surveys, a crucial tool for healthcare leaders to assess workforce functioning, often suffer from low response rates, which can significantly skew results. A new study published in the Journal of Healthcare Management in 2025 aimed to investigate whether nonrespondents and respondents differed in key outcomes of interest to healthcare leaders. The research, conducted by Xi Hu and colleagues from Harvard University, analyzed data from a longitudinal study of 348 physicians and 143 advanced practitioners in obstetrics and gynecology clinics in the Midwest and Northwest United States. The study found that nonrespondents were more likely to have a higher risk of turnover and lower productivity, and that relying solely on survey data may lead to incorrect conclusions about workforce functioning. The study's findings suggest that healthcare leaders should leverage alternative data-collection methods, such as electronic health records and human resources information systems, to augment survey data and gain a more comprehensive understanding of employee functioning.

Key Takeaways:

  • Employee well-being surveys often have low response rates, which can lead to nonresponse bias and skewed results.
  • Nonrespondents were more likely to have a higher risk of turnover and lower productivity compared to respondents.
  • The study found significant demographic differences between nonrespondents and respondents, with nonrespondents being older and more likely to be married among advanced practitioners.
  • The study's findings suggest that relying solely on survey data may lead to incorrect conclusions about workforce functioning and interventions.
  • Healthcare leaders should consider leveraging alternative data-collection methods, such as EHRs and HRIS data, to augment survey data and gain a more comprehensive understanding of employee functioning.
  • The study has implications for the development of more effective employee well-being surveys and interventions that meet the needs of those most at risk within the organization.
  • The study included physicians and advanced practitioners from obstetrics and gynecology clinics in the Midwest and Northwest United States.

Statistics:

  • The study analyzed data from 491 participants, including 348 physicians and 143 advanced practitioners.
  • Nonrespondents had a nearly 10 times higher risk of turnover in the full sample and a 12 times risk in the below-retirement age sample compared to respondents.
  • Physician nonrespondents below retirement age had a 5 times relative risk of turnover in the two quarters postsurvey.
  • The study found significant differences in productivity and workplace variables between respondents and nonrespondents.

Sources:

  • Hu, X. et al. (2025). Who's Not Talking? Nonresponse Bias in Healthcare Employee Well-being Surveys. Journal of Healthcare Management, 70(5), 337-353.
  • Lippincott Williams & Wilkins, Two Commerce Sq, 2001 Market St, Philadelphia, PA 19103, USA.
  • Xi Hu, National Bureau of Economic Research, Cambridge, Massachusetts, Center for Labor and a Just Economy, Harvard University, Cambridge, Massachusetts and Atalan Tech, Philadelphia, Pennsylvania.

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