title: The mediating role of demand and control in the relationship between leadership behaviour and employee distress: a cross-sectional study.
abstract: BACKGROUND
  The relationship between leadership and employee distress is well established, however, the processes involved in this relationship remain largely unclear. For a stretched nursing workforce, understanding in what ways leadership may influence employee distress is particularly important.
  
  
  OBJECTIVE
  To examine possible mediating effects of the work environment factors demand and control in the relationship between leadership behaviour in change, production, and employee orientation and employee distress.
  
  
  METHODS
  Cross-sectional study design.
  
  
  METHODS
  The study was conducted at a large county council in Sweden providing both institutional and non-institutional care.
  
  
  METHODS
  A random sample of 1249 employees (primarily nurses, but also a wide range of other healthcare professionals and administrative staff), who had a healthcare manager that was about to enter a leadership development programme (n=171), responded to a web-based questionnaire. The response rate was 62%.
  
  
  METHODS
  The employees rated their healthcare managers' behaviour in change, production, and employee orientation, as well as their own perceptions of level of demand, control (subdivided into decision authority and skill discretion), and five distress outcomes. Multilevel analysis was performed.
  
  
  RESULTS
  The mediators demand, decision authority, and skill discretion were significant predictors of all five distress outcomes for all three leadership orientations. In eight of 15 regressions, the mediators fully explained the relationships between leadership orientations and outcomes. Four of five relationships with distress outcomes were fully mediated for change-oriented leadership, whereas two of five outcomes were fully mediated for production- and employee-oriented leadership. In all three leadership orientations, the relationship between the mediator skill discretion and the distress measure disengagement were particularly strong, with B-coefficients (-.44, p<.001) twice as high as for any of the other relationships.
  
  
  CONCLUSIONS
  It seems that the way that employees perceive healthcare managers' change-oriented behaviour, and how that aspect is related to employee distress, is primarily explained by perception of demand and control. Furthermore, regardless of leadership behaviour orientation, how employees perceive their opportunity to use specific job skills plays an important role in the interplay between perception of healthcare managers' behaviour and disengagement.
authors.affiliation: Department of Learning, Informatics, Management, and Ethics, Karolinska Institute, Sweden. Electronic address: Caroline.lornudd@ki.se.
authors.forename: Caroline
authors.initials: C
authors.lastname: Lornudd
authors.affiliation: Department of Psychology, Umeå University, Sweden.
authors.forename: Susanne
authors.initials: S
authors.lastname: Tafvelin
authors.affiliation: Department of Learning, Informatics, Management, and Ethics, Karolinska Institute, Sweden; Department of Psychology, Stockholm University, Sweden.
authors.forename: Ulrica
authors.initials: U
authors.lastname: von Thiele Schwarz
authors.affiliation: Department of Learning, Informatics, Management, and Ethics, Karolinska Institute, Sweden.
authors.forename: David
authors.initials: D
authors.lastname: Bergman
mesh_terms: D003430:Cross-Sectional Studies; D004648:Employee Grievances; D007857:Leadership; D017008:Negotiating; D009741:Nursing Staff, Hospital
keywords: Demand-control; Employee distress; Healthcare; Leadership behaviour; Mediation