Better line managers would substantially reduce NHS staff quits, research finds

• Unit increase in line manager quality decreases quit intention by 17 percentage points
• Staff 27 per cent less likely to think about leaving the organisation if their manager is 'above average' quality
• Recognition for work is the strongest pull

Improving National Health Service (NHS) managers could significantly reduce employees’ intentions to quit, according to new research co-authored by Bayes Business School and the Department of Economics at City St George’s, University of London. Using annual NHS Survey data, the longitudinal study reveals that a one-point increase in perceived line manager quality on a 1-5 scale reduces employee quits by 17 percentage points.

The United Kingdom has fewer doctors and nurses per head than many international counterparts, with 10 per cent of positions vacant. This is causing greater demand, lower job satisfaction and staff burnout.

The study, carried out by Amanda Goodall, Professor of Leadership at Bayes, Dr Victoria Serra-Sastre, Reader in Economics at City St George’s, and Dr Agnes Bäker, Associate Professor of Leadership at Vrije Universiteit Amsterdam, analysed results of five NHS staff surveys between 2018 and 2022.

The questionnaire is one of the largest annual workforce surveys with publicly available data, measuring satisfaction of employees, doctors, nurses, allied professionals, non-clinical managers and others, including feedback on management, resources and wellbeing.

Key findings from responses, which totalled a sample of nearly 400,000 NHS staff in more than 120 hospital trusts by the end of the study period, show:

• A one-unit increase in line manager quality is associated with a decrease in NHS employee quit intention of 17 percentage points.
• Individuals with an above-average quality of line manager are 27 per cent less likely to think about leaving the organisation.
• The strongest related reason for this is staff being recognised for their work, followed by feeling valued and consulted by managers in decision-making.
• The importance of manager quality is a more significant determinant of staff retention than how employees perceive the quality of their job, even when removing pay as a factor.

Line manager quality was measured using five consistent items across all surveys: whether managers were encouraging, clear, consultative, interested in wellbeing, and valued employees' work. Responses used a 1-5 Likert scale (higher scores indicating better quality), and mean scores were computed. A 'trickle down' effect was explored by having staff rate senior management on visibility, organisational communication, consultation, and action on feedback.

Controlling for health conditions of respondents and additional care responsibilities, the researchers examined effects of extra time worked, quality of equipment with which to carry out roles and pay satisfaction. Further robustness tests were carried out to eliminate potential sample biases, such as gender, age and ethnicity of respondents.

The study is the first of its kind to demonstrate how manager quality directly affects NHS workers’ intention to quit or stay in their roles.

Professor Amanda Goodall said:

“As highlighted most recently by the Darzi Review of 2024, the National Health Service in England faces unprecedented challenges. Staff are leaving in their droves without being replaced, causing burnout, blame and patient backlogs.

“Previous studies tell us that poor managers lead to significantly lower workforce productivity, and that experienced managers bring greater satisfaction, but little has been explored about how the quality of a leader affects employee quits.

“While ongoing pay disputes and difficult working conditions are clearly hindering factors for NHS staff, our study demonstrates how it is the quality of management that truly determines continuity of staff.”

Dr Victoria Serra-Sastre said:

“Our findings suggest that NHS hospital trusts should invest more heavily in training, developing and selecting managers with practical knowledge to successfully lead both people and operations. Such improvements will enhance motivation, skills and behaviours off staff, helping retention and ultimately delivering better patient-level outcomes.

“To target and implement programmes, NHS performance assessments could include scores for manager quality to focus on trusts that require additional support. Developing future leaders from within could provide a long-term, cost-effective solution to NHS staff departures and shortages that threaten to derail healthcare in this country.”

‘Managing to stay: Does line-manager quality affect employees’ intention to quit in the NHS?’ by Dr Agnes Bäker, Professor Amanda Goodall and Dr Victoria Serra-Sastre is published in British Journal of Industrial Relations.

Find out about the Executive Master's in Medical Leadership at Bayes Business School.

Notes to editors

The sample size varies year-on-year. In 2018, data was collected from 275,641 staff responses to the NHS survey in 134 hospital trusts in 2018, and 395,063 staff in 124 trusts in 2022.