The relationship between leader support, staff influence over decision making, work pressure and patient satisfaction: a cross-sectional analysis of NHS datasets in England
Open accessAbstract
Objective To explore the relationships between leader support, staff influence over decisions, work pressure and patient satisfaction. Design A cross-sectional study of large National Health Service (NHS) datasets in England in 2010. Setting and participants 158 NHS acute hospital trusts in England (n=63 156) from all staff groups. Primary and secondary outcome measures Survey data measuring leader support, staff influence over decision making, staff work pressure and objective outcome data measuring patient satisfaction. Results Multilevel serial mediation analysis showed a significantly positive association between leader support and staff influence over decisions ( B =0.74, SE =0.07, p <0.01). Furthermore, staff influence over decisions showed a negative association with staff work pressure ( B =−0.84, SE =0.41, p <0.05) which in turn was negatively linked to patient satisfaction ( B =−17.50, SE =4.34, p <0.01). Serial mediation showed a positive indirect effect of leader support on patient satisfaction via staff influence over decisions and work pressure ( B =10.96, SE =5.55, p <0.05). Conclusions and implications Our results provide evidence that leader support influences patient satisfaction through shaping staff experience, particularly staff influence over decisions and work pressure. Patients’ care is dependent on the health, well-being, and effectiveness of the NHS workforce. That, in turn, is determined by the extent to which leaders are supportive in ensuring that work environments are managed in a way which protects the well-being of staff.
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Evidence suggests that improving staff engagement and satisfaction leads to better care quality, patient satisfaction, financial performance and staff retention.
“However, evidence suggests that improving staff engagement and satisfaction leads to better care quality, patient satisfaction, financial performance and staff retention [143, 144].”
From Interventions to address empathy-based stress in mental health workers: A scoping review and research agenda (2024) · cites this paper as [143]
The Introduction (page unavailable) reports that staff job satisfaction and work engagement are associated with patient satisfaction and with fewer adverse care outcomes. It also links work pressure to intentions to quit. The paper does not establish that improving engagement or satisfaction causes these outcomes, and the passages found do not support the claim about financial performance. (LLM, conf=0.86)
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- Authors
- West, T. H. R., Daher, P., Dawson, J. F., Lyubovnikova, J., Buttigieg, S. C., & West, M. A.
- Affiliations
- University of Bristol (GB)
- University of Liverpool (GB)
- University of Sheffield (GB)
- Health Systems Management & Leadership, University of Malta, Msida, Malta
- Lancaster University (GB)
- Corresponding author
- West, Thomas H R
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2022-02
- Volume
- 12
- Issue
- 2
- Pages
- e052778
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC8808385
- OpenAlex
- W4210812164
- Cited by
- 27
- References
- 52
- Citations by year
- 2026: 9 · 2025: 10 · 2024: 2 · 2023: 3 · 2022: 3
- FWCI
- 4.85
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMJ Open (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- Explore Bristol Research (submittedVersion, cc-by-nc)
- OAR@UM (University of Malta) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Lancaster EPrints (Lancaster University) (submittedVersion)
- Bristol Research (University of Bristol) (submittedVersion, cc-by-nc)
- Topics
- Health Sciences › Nursing › Research and Theory › Nursing education and management
- Health Sciences › Health Professions › General Health Professions › Workplace Health and Well-being
- Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Job Satisfaction and Organizational Behavior
- Keywords
- leader support, occupational stress, patient satisfaction, employee well-being, healthcare leadership, serial mediation, hospital staff
- MeSH terms
- Cross-Sectional Studies, Decision Making, England, Humans, State Medicine, Patient Satisfaction
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