The relationship between leader support, staff influence over decision making, work pressure and patient...

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 (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).

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.