21When asked if they would recommend their Spire hospital, either to their friends and family or to a new consultant, 77% said they would. Looking back to 2008, this is an increase of over 15 percentage points.In terms of how we work with consultants, 86% believe we are working in partnership with them to support their practice. 94% of consultants feel that staff go out of their way to help them and believe that relationships with hospital staff have improved. The way we work with consultants is a fundamental part of Spire's goal to be the provider of choice for their private practice. These results show that our strategy for building strong local relationships with consultants and helping them to grow their practice is valued and appreciated.Employee engagementSince Spire Healthcare started in August 2007, we have been working to create a culture of high performance. In 2010 the effectiveness of our approach was demonstrated by a third successive year of significant improvements in the independent Spire Healthcare Employee Engagement Survey, which was completed in September 2010 by more than 5,200 employees. It showed that over 70% of our staff judge Spire to be a 'great place to work' compared with 62% one year ago. Employees also feel they have greater ownership and accountability for Spire Healthcare's business performance, an uplift of 29 percentage points (from 35% to 64%).Patients and consultants are surveyed on an annual basis at hospital level and, in addition, local hospitals collect feedback on a continuous basis through questionnaires, focus groups and personal visits.The satisfaction survey results for 2010 show that we have made excellent progress, with all-time high scores in both our patient and consultant satisfaction surveys. In 2010 over 11,000 patients shared their views of their experience with us. 90% of patients rated our overall service 'excellent' or 'very good' - an increase of three percentage points over last year's survey - and 85% of our patients said they would recommend their local Spire hospital - an increase of five percentage points from 2009. In addition, 96% of our patients agree that staff go out of their way to make a difference to their stay and 93% rate the cleanliness of the hospital as 'excellent' or 'very good'.Patients who value the service they receive in a Spire hospital are more likely to come to us again for treatment, to recommend us to their friends and family and to feed back positively to their referring GP. Consultant relationshipsOur consultant satisfaction survey, completed by over 3,000 consultants, also had strong results with 71% of consultants rating us 'excellent' or 'very good'. This is an uplift of six percentage points from last year and a significant increase from 51% in 2008.

22Spire Healthcare Annual Review 2010Business review continued Shareholder valueSpire Healthcare's improved end-to-end pathology service has attracted a significant number of external contracts in the last year including leading South East elective orthopaedic centre, The Horder Centre. Director of Operations Karen Planterose explains how Spire Pathology has helped to improve quality, as well as patient and clinician satisfaction."Delivering continuous quality improvement is at the heart of everything we do. The Horder Centre has an established reputation in elective orthopaedic care. With an increasing number of cases, we could identify the benefits of transferring our outsourced pathology service to ensure we could get same-day results and enhance the patient care pathway.Given our short timescales, we were impressed by the proactiveness of the team at Spire Healthcare. They listened and took on board our requirements for a full pathology service with same-day turnaround so that we could deliver some 5,000 in-patient episodes and 22,000 out-patient visits annually. Their cost-effective and web-based service has helped us to increase patient and clinician satisfaction, with clinicians able to quickly confirm patient operation dates. Ultimately, this service will increase the number of people we can help."Our strategy has been to take a more commercial approach and empower employees by devolving power and responsibility to individual Spire hospitals. We have also invested more than £500k in management development programmes in the past three years, the evaluation results of which show 75% of managers who responded now feel confident in managing performance and ensuring staff are aligned to organisational and business unit targets.We have successfully found and maintained the fine balance of increasing our employees' level of engagement while improving upon our financial results year-on-year - including a 33.3% improvement in EBITDAR (pre-exceptional items) since 2008, which has largely been gained through cost reduction.Spire Pathology, BusheyBy investing in state-of-the-art analyser technology we have increased the repertoire of tests offered in-house. Combined with electronic delivery of results, this helps to reduce turnaround times for our customers. Our laboratory at Spire Bushey Hospital is one of two national referral laboratories in our network that deliver specialist results to our customers across the country.