Purpose – Addressing the continuing productivity challenge the purpose of this paper is to analyze data from the National Health Service (NHS) on employee involvement (EI) in order to gain critical insights into how employees’ shared perception of employee involvement in organizational decision-making (labelled EI climate) might address two persistent issues: how to enhance positive staff attitudes and improve organizational performance. In doing so we respond to recent calls for more multilevel research and extend previous research on EI climate by attending to both EI climate level and EI climate strength. Design/methodology/approach – Data from 4702 employees nested in 33 UK hospitals was used to test the moderating role of EI climate strength in the (a) crosslevel EI climate level-employee attitudes relationship and in the (b) organizationallevel EI climate-organizational effectiveness relationship. Findings – The results of the multilevel analyses showed that EI climate level was positively associated with individual-level employee attitudes (i.e. job satisfaction, affective commitment). Further the results of the hierarchical regression analysis and the ordinal logistic regression analysis showed that EI climate level was also related to organizational effectiveness (i.e. lower outpatient waiting times; higher performance quality). In addition, both analyses demonstrated the moderating role of EI climate strength, in that the positive impact of EI climate level on employee attitudes and organizational effectiveness was more marked in the presence of a strong compared to a weak EI climate. Practical implications – By creating and maintaining a positive and strong climate for involvement hospital managers can tackle the productivity challenge that UK hospitals and health care institutions more generally are currently facing while improving the attitudes of their employees who are critical in the transformative process and ultimately underpin organizational success. Originality/value – This is the first study which provides evidence that favorable and consistent collective recognition of EI opportunities by staff contributes to enhance both employee attitudes and hospital performance. Results highlight the role of EI climate strength and underscore its importance in future research and practice.