Predictors of Perceived Senior Leader Honesty and Integrity: Results from a National Sample of Healthcare Workers

SUMMARY Goal: This retrospective study aims to understand the factors that are associated with healthcare workers’ perceptions of senior leaders who maintain high standards of honesty and integrity. Methods: We analyzed responses from 180,663 Veterans Health Administration employees who completed the 2023 Veterans Affairs All Employee Survey. Ordinal logistic regression was used to examine the association between perceptions of senior leader honesty and integrity and various factors related to manager effectiveness, work group dynamics, personal work experiences, and employee demographics. Dominance analysis was performed to identify the relative importance of variables in explaining the overall variance in perceptions of senior leader honesty and integrity. Principal Findings: Factors that contributed most to healthcare workers’ perceptions of senior leader honesty and integrity were satisfaction with the job performance of the manager above their direct supervisor (12.7% of variance), manager communication of organizational goals (12.4%), different work units collaborating well (10.5%), ability to disclose suspected violations without fear of reprisal (6.7%), satisfaction with recognition (5.9%), and satisfaction with involvement in decisions (5.81%). Demographic factors such as tenure, gender, minority status, age, and supervisory role were also associated with perceptions of senior leader integrity; however, these factors explained little of the overall variance. Practical Applications: The findings highlight the critical role of midlevel leaders and organizational communication in shaping employee perceptions of senior leader honesty and integrity. Healthcare organizations should focus on selecting and training effective midlevel leaders to cultivate trust at higher levels. Developing a culture of frequent appreciation and recognition can improve trust in senior leaders and other important outcomes noted in the literature. Creating an environment where employees feel safe to report violations without fear of reprisal is essential for fostering trust in senior leadership. Healthcare leaders should consider these factors when designing strategies to enhance perceptions of senior leader honesty and integrity within their organizations.