The relationship between leader support, staff influence over decision making, work pressure and patient satisfaction: a cross-sectional analysis of NHS datasets in England.

Abstract

To explore the relationships between leader support, staff influence over decisions, work pressure and patient satisfaction. A cross-sectional study of large National Health Service (NHS) datasets in England in 2010. 158 NHS acute hospital trusts in England (n=63 156) from all staff groups. Survey data measuring leader support, staff influence over decision making, staff work pressure and objective outcome data measuring patient satisfaction. Multilevel serial mediation analysis showed a significantly positive association between leader support and staff influence over decisions (<i>B</i>=0.74, <i>SE</i>=0.07, <i>p</i><0.01). Furthermore, staff influence over decisions showed a negative association with staff work pressure (<i>B</i>=-0.84, <i>SE</i>=0.41, <i>p</i><0.05) which in turn was negatively linked to patient satisfaction (<i>B</i>=-17.50, <i>SE</i>=4.34, <i>p</i><0.01). Serial mediation showed a positive indirect effect of leader support on patient satisfaction via staff influence over decisions and work pressure (<i>B</i>=10.96, <i>SE</i>=5.55, <i>p</i><0.05). 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.