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Leadership support and satisfaction of healthcare professionals in China’s leading hospitals: a cross-sectional study

BMC Health Services Research volume 24, Article number: 1016 (2024) Cite this article

Abstract

Background

Healthcare professionals’ job satisfaction is a critical indicator of healthcare performance, pivotal in addressing challenges such as hospital quality outcomes, patient satisfaction, and staff retention rates. Existing evidence underscores the significant influence of healthcare leadership on job satisfaction. Our study aims to assess the impact of leadership support on the satisfaction of healthcare professionals, including physicians, nurses, and administrative staff, in China’s leading hospitals.

Methods

A cross-sectional survey study was conducted on healthcare professionals in three leading hospitals in China from July to December 2021. These hospitals represent three regions in China with varying levels of social and economic development, one in the eastern region, one in the central region, and the third in the western region. Within each hospital, we employed a convenience sampling method to conduct a questionnaire survey involving 487 healthcare professionals. We assessed perceived leadership support across five dimensions: resource support, environmental support, decision support, research support, and innovation encouragement. Simultaneously, we measured satisfaction using the MSQ among healthcare professionals.

Results

The overall satisfaction rate among surveyed healthcare professionals was 74.33%. Our study revealed significant support from senior leadership in hospitals for encouraging research (96.92%), inspiring innovation (96.30%), and fostering a positive work environment (93.63%). However, lower levels of support were perceived in decision-making (81.72%) and resource allocation (80.08%). Using binary logistic regression with satisfaction as the dependent variable and healthcare professionals’ perceived leadership support, hospital origin, job role, department, gender, age, education level, and professional designation as independent variables, the results indicated that support in resource provision (OR: 4.312, 95% CI: 2.412 ∼ 7.710) and environmental facilitation (OR: 4.052, 95% CI: 1.134 ∼ 14.471) significantly enhances healthcare personnel satisfaction.

Conclusion

The findings underscore the critical role of leadership support in enhancing job satisfaction among healthcare professionals. For hospital administrators and policymakers, the study highlights the need to focus on three key dimensions: providing adequate resources, creating a supportive environment, and involving healthcare professionals in decision-making processes.

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Introduction

In the era of accelerated globalization, the investigation of global leadership has assumed heightened significance [1]. Leadership, as a dynamic and evolving process, holds the potential to cultivate both the personal and professional growth of followers [2]. Effective healthcare leadership can enhance medical service quality, patient safety, and staff job satisfaction through skill development, vision establishment, and clear direction-setting [3,4,5]. Moreover, leadership support can effectively enhance staff well-being and work efficiency [6, 7]. For example, Mendes et al. found that the quality of healthcare is significantly influenced by four dimensions of leadership: communication, recognition, development, and innovation [8]. Additionally, Shanafelt et al. discovered that leaders can effectively reduce employee burnout and subsequently improve the quality of medical services by formulating and implementing targeted work interventions and motivating employees [9].

Job satisfaction among healthcare professionals is a crucial indicator of healthcare performance, playing a vital role in addressing challenges related to hospital quality outcomes, patient satisfaction, and nurse retention rates [10,11,12,13]. Researchers from different national backgrounds have conducted studies on the job satisfaction of healthcare workers across various disciplines. For example, Balasubramanian et al. examined the satisfaction of immigrant dentists in Australia [14], Mascari et al. studied physicians and hospital researchers in the United States [15], and Rosta et al. investigated the satisfaction of doctors in Norway [12]. Research has demonstrated that characteristics of the work environment, balanced workloads, relationships with colleagues, career opportunities, and leadership support all influence job satisfaction [16]. Several instruments are commonly used to measure job satisfaction, each relevant depending on the context and discipline. For instance, the Job Descriptive Index (JDI) focuses on different facets of job satisfaction such as work, pay, promotion, supervision, and co-workers [17]. The Job Satisfaction Survey (JSS) covers similar dimensions and is particularly useful in public sector organizations due to its comprehensive nature and ease of use [18]. The Minnesota Satisfaction Questionnaire (MSQ) is a comprehensive tool that assesses employee satisfaction across multiple dimensions including intrinsic and extrinsic satisfaction, and is commonly used for evaluating job satisfaction in the healthcare field [19].

Recent studies have linked leadership to healthcare professionals’ job satisfaction, highlighting the pivotal role of leadership in guiding, coordinating, and motivating employees [5]. For instance, the Mayo Clinic found that leadership from immediate supervisors could alleviate burnout and increase job satisfaction [20]. Choi’s research indicated that leadership empowerment significantly enhances nursing staff’s job satisfaction [21]. Additionally, Liu discovered that the support provided by hospital senior leadership is closely associated with employee satisfaction [22].

In China, while leadership research has gained some traction in areas such as business and education, it remains relatively scarce within healthcare institutions. Existing studies primarily focus on the nursing sector, and comprehensive assessments of leadership at the leading public hospitals (top 10% of Chinese hospitals) have not been extensively conducted [23, 24]. Research on leadership and healthcare professionals’ satisfaction often relies on single indicators to measure job satisfaction, such as overall job satisfaction or specific aspects like compensation satisfaction and burnout levels [25]. This narrow focus may fail to fully capture the multidimensional nature of employee satisfaction, which includes aspects such as workload, ability utilization, sense of achievement, initiative, training and self-development, and interpersonal communication [26]. Additionally, most existing studies focus on the job satisfaction of nurses or physicians in isolation, lacking comparative research across different groups within healthcare institutions, such as doctors, nurses, and administrative personnel [27,28,29].

Therefore, this study utilized the MSQ to conduct a thorough assessment of employee satisfaction and assess the impact of leadership support on the satisfaction of healthcare personnel in China’s leading public hospitals. Through this research, we aim to enhance the core competitiveness of hospitals and provide valuable data to support leadership assessments in developing countries’ healthcare institutions. Moreover, this study seeks to contribute to the broader international understanding of effective leadership practices in China’s leading public hospitals, with implications for global health management strategies.

Methods

Study design and participants

From July to December 2021, a cross-sectional survey study was conducted on healthcare professionals in China’s 3 leading hospitals. The 3 leading hospitals represent three regions in China with different levels of social and economic development, one in the eastern, one in the central, and one in the western. In each hospital, a convenience sampling method was used to conduct a questionnaire survey among physicians, nurses, and administrative staff.

Criteria for inclusion of healthcare professionals: (1) employed at the hospital for at least 1 year or more; (2) formal employees of the hospital (full-time staff); (3) possessing cognitive clarity and the ability to independently understand and respond to electronic questionnaires, as assessed by their leaders. Exclusion criteria: (1) diagnosed with mental health disorders that impair their ability to participate, as identified by the hospital’s mental health professionals; (2) unable to communicate effectively due to severe language barriers, hearing impairments, or other communication disorders, as determined by their direct supervisors or relevant medical evaluations; (3) visiting scholars, interns, or graduate students currently enrolled in a degree program.

Instrument development

Leadership support

In reference to the Malcolm Baldrige National Quality Award (MBNQA) framework and Supporting Relationship Theory [6, 30, 31], we determined the survey scale after three expert discussions involving 5–7 individuals. These experts included personnel from health administrative departments, leading public hospital leaders, middle management, and researchers specializing in hospital management. Their collective expertise ensured that the survey comprehensively assessed leadership support within hospitals from the perspective of healthcare personnel. The Leadership Support Scale consists of 5 items: Environmental Support: ‘My leaders provide a work environment that helps me perform my job,’ Resource Support: ‘My leaders provide the resources needed to improve my work,’ Decision Support: ‘My leaders support my decisions to satisfy patients,’ Research Support: ‘My leaders support my application for scientific research projects,’ and Innovation Encouragement: ‘My leaders encourage me to innovate actively and think about problems in new ways‘ (Supplementary material). All questionnaire items are rated on a 5-point Likert scale, ranging from 1 = Strongly Disagree to 5 = Strongly Agree. The Cronbach’s alpha coefficient for the 5-item scale is 0.753.

Job satisfaction

The measurement of job satisfaction was carried out using the Minnesota Satisfaction Questionnaire (MSQ) [32, 33], which has been widely used and has been shown by scholars to have good reliability and validity in China [34, 35]. The questionnaire consists of 20 items that measure healthcare personnel’s satisfaction with various aspects of their job, including individual job load, ability utilization, achievement, initiative, hospital training and self-development, authority, hospital policies and practices, compensation, teamwork, creativity, independence, moral standards, hospital rewards and punishments, personal responsibility, job security, social service contribution, social status, employee relations and communication, and hospital working conditions and environment. Responses to these items were balanced and rated on a scale from 1 to 5, with 1 = Very Dissatisfied, 2 = Dissatisfied, 3 = Neither Dissatisfied nor Satisfied, 4 = Satisfied, and 5 = Very Satisfied. Scores range from 20 to 100, with higher scores indicating higher satisfaction. In this study, a comprehensive assessment of healthcare personnel’s job satisfaction was made using a score of 80 and above [32], where a score of ≥ 80 was considered satisfied, and below 80 was considered dissatisfied. The Cronbach’s alpha coefficient for the questionnaire in this survey was 0.983.

Investigation process

The survey was administered through an online platform “Wenjuanxing”, and distributed by department heads to healthcare professionals within their respective departments. The selection of departments and potential participants followed a structured process: (1) Potential participants were identified based on the inclusion criteria, which were communicated to the department heads. (2) Department heads received a digital link to the survey, which they forwarded to eligible staff members via email or internal communication platforms. (3) The informed consent form was integrated into the survey link, detailing the research objectives, ensuring anonymity, and emphasizing voluntary participation. At the beginning of the online survey, participants were asked if they agreed to participate. Those who consented continued with the survey, while those who did not agree were directed to end the survey immediately.

According to Kendall’s experience and methodology, the sample size can be 5–10 times the number of independent variables (40 items) [36, 37]. Our sample size is ten times the number of independent variables. Considering potentially disqualified questionnaires, the sample size was increased by 10%, resulting in a minimum total sample size of 460. Therefore, we distributed 500 survey questionnaires.

Data analysis

We summarized the sociodemographic characteristics of healthcare personnel survey samples using descriptive statistical methods. For all variables, we calculated the frequencies and percentages of categorical variables. Different sociodemographic characteristics in relation to healthcare personnel’s perception of leadership support and satisfaction were analyzed using the Pearson χ² test. We employed a binary logistic regression model to estimate the risk ratio of healthcare personnel satisfaction under different levels of leadership support. Estimates from three sequentially adjusted models were reported to transparently demonstrate the impact of various adjustments: (1) unadjusted; (2) adjusted for hospital of origin; (3) adjusted for hospital of origin, gender, age, education level, job type, and department. For the binary logistic regression model, we employed a backward stepwise regression approach, with inclusion at P < 0.05 and exclusion at P > 0.10 criteria. In all analyses, a two-tailed p-value of < 0.05 was considered significant, and all analyses were conducted using SPSS 26.0 (IBM Corp., Armonk, NY, USA).

Results

Demographic characteristics and job satisfaction

This study recruited a total of 500 healthcare personnel from hospitals to participate in the survey, with 487 valid questionnaires collected, resulting in an effective response rate of 97.4%. The majority of participants were female (77.21%), with ages concentrated between 30 and 49 years old (73.71%). The predominant job titles were mid-level (45.17%) and junior-level (27.31%), and educational backgrounds were mostly at the undergraduate (45.17%) and graduate (48.25%) levels. The marital status of most participants was married (79.88%), and their primary departments were surgery (38.19%) and internal medicine (24.85%). The overall satisfaction rate among the sampled healthcare personnel was 74.33%. Differences in satisfaction were statistically significant among healthcare personnel of different genders, ages, educational levels, job types, hospitals, and departments (P < 0.05). Table 1 displays the participants’ demographic characteristics and job satisfaction.

Table 1 Participants’ demographic characteristics and job satisfaction
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By analyzed the satisfaction level of healthcare personnel in different dimensions, the results show that “Social service” (94.3%) and “Moral values” (92.0%) have the highest satisfaction. “Activity” (66.8%) and “Compensation” (71.9%) were the least satisfied. Table 2 shows participants’ job satisfaction in different dimensions.

Table 2 Participants’ job satisfaction in different dimensions
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Perception of different types of leadership support among healthcare professionals

Overall, surveyed healthcare personnel perceived significant levels of support from hospital leadership for research encouragement (96.92%), innovation inspiration (96.30%), and the work environment (93.63%), while perceiving lower levels of support for decision-making (81.72%) and resource allocation (80.08%). Female healthcare personnel perceived significantly higher levels of resource support compared to males (P < 0.05). Healthcare personnel in the 30–39 age group perceived significantly higher levels of resource, environmental, and research support compared to other age groups (P < 0.05). Healthcare personnel with senior-level job titles perceived significantly lower levels of resource and decision-making support compared to associate-level and lower job titles, and those with doctoral degrees perceived significantly lower levels of resource support compared to other educational backgrounds (P < 0.05).

Clinical doctors perceived significantly lower levels of resource and environmental support compared to administrative personnel and clinical nurses, while administrative personnel perceived significantly lower levels of decision-making support compared to clinical doctors and clinical nurses (P < 0.05). Among healthcare personnel in internal medicine, perceptions of resource, environmental, research, and innovation support were significantly lower than those in surgery, administration, and other departments, whereas perceptions of decision-making support in administrative departments were significantly lower than in internal medicine, surgery, and other departments (P < 0.05). Figure 1 displays the perception of leadership support among healthcare personnel with different demographic characteristics.

Fig. 1
figure 1

Perception of leadership support among healthcare professionals with different demographic characteristics in China’s leading public hospitals (* indicates P < 0.05, ** indicates P < 0.01, and *** indicates P < 0.001.)

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The impact of leadership support on job satisfaction among healthcare professionals

The study results indicate that healthcare personnel who perceive that their leaders provide sufficient resource, environmental, and decision-making support have significantly higher job satisfaction than those who feel that leaders have not provided enough support (P < 0.05). Similarly, healthcare personnel who perceive that their leaders provide sufficient research and innovation inspiration have significantly higher job satisfaction than those who believe leaders have not provided enough inspiration (P < 0.05). Table 3 displays the univariate analysis of leadership support on healthcare professional satisfaction.

Table 3 Univariate analysis of leadership support on healthcare professional satisfaction
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With healthcare personnel satisfaction as the dependent variable, leadership resource support, environmental support, decision-making support, research support, and innovation inspiration were included in the binary logistic regression model. After adjusting for hospital, gender, age, education level, job type, and department, leadership’s increased resource support (OR: 4.312, 95% CI: 2.412 ∼ 7.710) and environmental support (OR: 4.052, 95% CI: 1.134 ∼ 14.471) were found to enhance the satisfaction levels of healthcare personnel significantly. Additionally, healthcare professionals in Hospital 2 (OR: 3.654, 95% CI: 1.796 to 7.435) and Hospital 3 (OR: 2.354, 95% CI: 1.099 to 5.038) exhibited higher levels of satisfaction compared to those in Hospital 1. Table 4 displays the binary Logistic regression analysis of leadership support on satisfaction among healthcare professionals.

Table 4 Binary logistic regression analysis of leadership support on satisfaction among healthcare professional
Full size table

Discussion

This study aimed to determine the impact of support from hospital senior leadership on the job satisfaction of healthcare personnel and to explore the effects of demographic and different types of support on the job satisfaction of healthcare personnel in China. The research indicates that hospital leadership’s resource support, environmental support, and decision-making support have a significantly positive impact on the job satisfaction of healthcare personnel. These forms of support can assist healthcare personnel in better adapting to the constantly changing work environment and demands, thereby enhancing their job satisfaction, and ultimately, positively influencing the overall performance of the hospital and the quality of patient care.

Our research indicates that, using the same MSQ to measure job satisfaction, the job satisfaction among healthcare personnel in China’s top-tier hospitals is at 74.33%, which is higher than the results of a nationwide survey in 2016 (48.22%) [38] and a survey among doctors in Shanghai in 2013 (35.2%) in China [39]. This improvement is likely due to the Chinese government’s recent focus on healthcare personnel’s compensation and benefits, along with corresponding improvement measures, which have increased their job satisfaction. It’s worth noting that while job satisfaction among healthcare personnel in China’s top-tier hospitals is higher than the national average in China, it is slightly lower than the job satisfaction of doctors in the United States, as measured by the MSQ (81.73%) [40]. However, when compared to the job satisfaction by the MSQ of doctors in Southern Nigeria (26.7%) [32], nurses in South Korea (65.89%) [41], and nurses in Iran (59.7%) [42], the level of job satisfaction among healthcare personnel in China’s top-tier hospitals is significantly higher. This suggests that China has achieved some level of success in improving healthcare personnel’s job satisfaction. Studies have shown that for healthcare professionals, job satisfaction is influenced by work conditions, compensation, and opportunities for promotion, with varying levels of satisfaction observed across different cultural backgrounds and specialties [29, 43]. Furthermore, the observed differences in job satisfaction levels can be influenced by cultural factors unique to China, including hierarchical workplace structures and the emphasis on collective well-being over individual recognition.

Leadership support can influence employees’ work attitudes and emotions. Effective leaders can establish a positive work environment, and provide constructive feedback, thereby enhancing employee job satisfaction [44, 45]. Our research results show that clinical physicians perceive significantly lower levels of resource and environmental support compared to administrative staff and clinical nurses, while administrative staff perceive significantly lower levels of decision-making support compared to clinical physicians and clinical nurses. This difference can be attributed to their different roles and job nature within the healthcare team [9]. Nurses typically have direct patient care responsibilities, performing medical procedures, providing care, and monitoring patient conditions, making them in greater need of resource and environmental support to efficiently deliver high-quality care [46]. Doctors usually have responsibilities for clinical diagnosis and treatment, requiring better healthcare environments and resources due to their serious commitment to patients’ lives. Administrative staff often oversee the hospital’s day-to-day operations and management, including budgeting, resource allocation, and personnel management. Their work may be more organizationally oriented, involving strategic planning and management decisions. Therefore, they may require more decision-making support to succeed at the managerial level [47].

The job satisfaction of healthcare personnel is influenced by various factors, including the work environment, workload, career development, and leadership support [48, 49]. When healthcare personnel are satisfied with their work, their job enthusiasm increases, contributing to higher patient satisfaction. Healthcare organizations should assess the leadership and management qualities of each hospital to enhance their leadership capabilities. This will directly impact employee satisfaction, retention rates, and patient satisfaction [50]. Resource support provided by leaders, such as data, human resources, financial resources, equipment resources, supplies (such as medications), and training opportunities, significantly influences the job satisfaction of healthcare personnel [51]. From a theoretical perspective, researchers believe that leaders’ behavior, by providing resources to followers, is one of the primary ways to influence employee satisfaction [7]. These resources can assist healthcare personnel in better fulfilling their job responsibilities, improving work efficiency, and thereby enhancing their job satisfaction.

In hospital organizations, leaders play a crucial role in shaping the work environment for healthcare personnel and providing decision-making support [52, 53]. Hospital leaders are committed to ensuring the safety of the work environment for their employees by formulating and promoting policies and regulations. They also play a key role in actively identifying and addressing issues in the work environment, including conflicts among employees and resource shortages. These initiatives are aimed at continuously improving working conditions, enabling healthcare personnel to better fulfill their duties [54]. The actions of these leaders not only contribute to improving the job satisfaction of healthcare personnel but also create the necessary foundation for providing high-quality healthcare services.

It is worth noting that our research results show that in the context of leading public hospitals in China, leadership support for research, encouragement of innovation, and decision-making do not appear to significantly enhance the job satisfaction of healthcare personnel, which differs from some international literature [23, 55, 56]. International studies often suggest that fostering innovation is particularly important in influencing healthcare personnel’s job satisfaction [57, 58]. Inspiring a shared vision is particularly important in motivating nursing staff and enhancing their job satisfaction and organizational commitment [59]. This may reflect the Chinese healthcare personnel’s perception of leadership’s innovation encouragement, scientific research encouragement, and decision support, but it does not significantly improve their job satisfaction. However, material support (resources and environment) can significantly increase their satisfaction.

Strengths and limitations of this study

For the first time, we analyzed the role of perceived leadership support in enhancing healthcare providers in China’s leading public hospitals. We assessed the impact of perceived leadership on healthcare professional satisfaction across five dimensions: resources, environment, decision-making, research, and innovation. The sample includes physicians, nurses, and administrative staff, providing a comprehensive understanding of leadership support’s impact on diverse positions and professional groups.

However, it’s important to note that this study exclusively recruited healthcare professionals from three leading public hospitals in China, limiting the generalizability of the research findings. Additionally, the cross-sectional nature of the study means that causality cannot be established. There is also a potential for response bias as the data were collected through self-reported questionnaires. Furthermore, the use of convenience sampling may introduce selection bias, and the reliance on electronic questionnaires may exclude those less comfortable with digital technology.

Implications for research and practice

The results of this study provide important empirical evidence supporting the significance of leadership assessment in the context of Chinese hospitals. Specifically, the findings underscore the critical role of leadership support in enhancing job satisfaction among healthcare professionals, which has implications for hospital operational efficiency and the quality of patient care. For hospital administrators and policymakers, the study highlights the need to prioritize leadership development programs that focus on the three dimensions of leadership support: resources, environment, and decision-making. Implementing targeted interventions in these areas can lead to improved job satisfaction. Moreover, this study serves as a foundation for comparative research across different cultural and organizational contexts, contributing to a deeper understanding of how leadership practices can be optimized to meet the unique needs of healthcare professionals in various regions.

Conclusion

Our study found a close positive correlation between leadership support in Chinese leading public hospitals and employee job satisfaction. They achieve this by providing ample resources to ensure employees can effectively fulfill their job responsibilities. Furthermore, they create a comfortable work environment and encourage active employee participation. By nurturing outstanding leadership and support, hospitals can enhance employee job satisfaction, leading to improved overall performance and service quality. This is crucial for providing high-quality healthcare and meeting patient needs.

Data availability

Data are available upon reasonable request.

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Funding

This study was funded by the Fundamental Research Funds for the Central Universities (2020-RC630-001), the Fundamental Research Funds for the Central Universities (3332022166), and the Chinese Academy of Medical Sciences (CAMS) Innovation Fund for Medical Sciences (2021-I2M-1-046).

Author information

Authors and Affiliations

  1. Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China

    Jinhong Zhao

  2. School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China

    Jinhong Zhao, Tingfang Liu & Yuanli Liu

Authors
  1. Jinhong Zhao
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  2. Tingfang Liu
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  3. Yuanli Liu
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Contributions

JZ, TL, and YL designed the study. JZ collected the original data in China, reviewed the literature, performed the analyses, and wrote the first draft of the manuscript. TL and YL critically revised the manuscript. All authors contributed to the interpretation of data and the final approved version.

Corresponding authors

Correspondence to Tingfang Liu or Yuanli Liu.

Ethics declarations

Ethics approval

This study was conducted according to the guidelines of the Declaration of Helsinki and was approved by the Chinese Academy of Medical Sciences & Peking Union Medical College Institutional Review Board (CAMS & PUMC-IRC-2020-026). The survey was distributed by department heads and included informed consent and survey materials. The informed consent form described the research objectives, assured anonymity, emphasized voluntary participation, and instructed participants to complete the questionnaire through the online system. The statement ‘No signature is required, completing the survey implies consent to participate in the study’ implies implied consent.

Patient and public involvement Statement

Patients or the public were not involved in the design, or conduct of our study.

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Not applicable.

Competing interests

The authors declare no competing interests.

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Zhao, J., Liu, T. & Liu, Y. Leadership support and satisfaction of healthcare professionals in China’s leading hospitals: a cross-sectional study. BMC Health Serv Res 24, 1016 (2024). https://doi.org/10.1186/s12913-024-11449-3

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Keywords

BMC Health Services Research

ISSN: 1472-6963

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