Measuring the effects of health workers’ expectations and perceptions towards managers on their job satisfaction: a scale development and evaluation study

Why this study matters for everyday healthcare

Anyone who has spent time in a hospital knows that the attitude of staff can make a big difference to the care you receive. Behind the scenes, how healthcare workers feel about their managers strongly shapes their motivation, stress levels, and willingness to go the extra mile. This study set out to create a precise way to measure what health workers expect from their managers, how they actually experience them, and how any mismatch between the two affects job satisfaction.

Looking closely at the manager–worker relationship

Hospitals are intense workplaces: long hours, emotional strain, and high stakes for patient safety. In such settings, the relationship between staff and their managers is critical. Previous research showed that fairness, good communication, support, and strong leadership all matter, but existing questionnaires either focused on general leadership or on satisfaction alone. They rarely captured, in one tool, both what workers hope for from their managers and what they feel they are currently getting. The authors argue that this “expectation–perception gap” is a key but under-measured ingredient in understanding why some staff feel supported while others burn out.

Building a new measurement tool

To address this gap, the researchers followed a well-established, multi-step process for scale development with 311 healthcare workers from public and private hospitals in a Turkish city. They first drafted dozens of potential questions based on past studies and expert input, then asked eight specialists in health management to judge whether each item was essential. After dropping weaker items and piloting the draft with a small group of staff, they used statistical techniques to see how the remaining questions naturally grouped together. This work produced a final tool—the Expectation-Perception Scale in Health Management—made up of 22 questions organized into five areas: personal qualities of managers (such as honesty), professional competence, how processes are managed, core managerial functions like ensuring safety, and leadership behaviors.

What the new scale reveals about expectations and reality

When the authors tested the scale, it showed high reliability, meaning people answered consistently, and strong statistical fit to the five-area structure. They then used it to compare workers’ expectations with their perceptions of their current managers. Across the board, expectations were higher than perceptions, especially in leadership, process management, and day-to-day managerial functions. Workers tended to see their managers’ personal and professional qualities more positively than how those managers actually run systems, guide teams, or handle crises. The study also examined how these patterns vary by age, gender, education, profession, and years of experience. Differences by profession and experience emerged, but demographic factors overall explained only a small share of the variation, suggesting that organizational culture and management style likely play a larger role.

How gaps drain job satisfaction

Using further analyses, the researchers linked scores on their new scale to an established job satisfaction questionnaire. They found a strong connection: the larger the gap between what healthcare workers expected from their managers and what they felt they received, the lower their job satisfaction. High expectations alone were associated with reduced satisfaction if they were not matched by reality, while positive perceptions of managers boosted satisfaction. In other words, it is not just whether managers behave well in absolute terms, but whether their behavior meets the standards their staff hold for them that shapes how content those staff feel in their jobs.

What this means for better care

For non-specialists, the key message is straightforward: when managers in hospitals do not live up to what staff reasonably expect—particularly in leadership, process management, and everyday support—workers’ satisfaction drops, which can ultimately affect patient care. The new scale provides a practical way for health organizations to regularly check this “expectation–perception balance,” pinpoint where managers are falling short, and tailor training and leadership development accordingly. By using such tools to close the gap between what health workers need and what they experience, hospitals may foster happier staff, more stable teams, and better care for patients.

Citation: Turan, A., Turan, F. Measuring the effects of health workers’ expectations and perceptions towards managers on their job satisfaction: a scale development and evaluation study. Humanit Soc Sci Commun 13, 604 (2026). https://doi.org/10.1057/s41599-026-06852-6

Keywords: healthcare management, job satisfaction, leadership in hospitals, employee expectations, workplace well-being