Antecedents, mediators, and outcomes of authentic leadership in healthcare: A systematic review

Positive aspects of authentic leadership in nursing work: integrative review

ABSTRACT Objective: To identify and analyze the existing scientific production on the positive aspects of authentic leadership in the nurse’s work process. Method: This is an integrative literature review. The databases used were Scientific Electronic Library Online; Latin American and Caribbean Literature on Health Sciences; and National Library of Medicine - National Institutes of Health. Results: In this study, 17 articles were selected for analysis; 1 study (6%) was published in a national journal, and 16 (94%) were international studies. Of the 17 (100%) articles studied, 11 (65%) were developed in Canada. The hospital environment was present in the 17 (100%) articles. Final considerations: Authentic leadership has several positive aspects that significantly influence the nurse’s work process, such as engagement and job satisfaction, retention of new nurses, organizational commitment, among others.

Bridging the Gap between Authentic Leadership and Employees Communal Relationships through Trust

Authentic leadership has emerged as a positive relational-leadership approach that has gained the attention of academicians and practitioners by stimulating a healthy work environment. This study examined the direct influence of authentic leadership on employees’ communal relationships. In addition, the study examined the mediating role of affective- and cognitive-based trust on these relationships. We adopted a cross-sectional study design and collected data from 200 employees working in the private banking sector in Pakistan. The findings indicated that authentic leadership was positively correlated with communal employee relationships. In addition, both affective- and cognitive-based trust were found to have a positive mediating effect on the relationship between authentic leadership and communal employee relationships. The practical implications, limitations and suggestions for future research are discussed.

Authentic leadership in healthcare organizations: A study of 14 chief executive officers and 70 direct reports

There is limited research on authentic leadership in senior leaders of healthcare organizations. The purpose of this study was to investigate authentic leadership from the perspectives of 14 healthcare Chief Executive Officers (CEOs) and 70 senior-level direct reports using the validated Authentic Leadership Questionnaire (ALQ) and one-on-one interviews. CEOs also completed a 20-hour leadership curriculum focusing on authentic leadership. Although CEOs rated themselves higher than their direct reports on the total ALQ, it only approached significance (P = .060). Ratings on the four component parts of the ALQ were also higher, but only one was significant (P = .025) with a trend toward significance on another (P = .61). The CEOs' scores were slightly higher after their self-directed study but only one component was significant (P = .040). Interviews with the CEOs and direct reports underscore how healthcare leadership and authentic leadership specifically is viewed depending on organizational roles.

Relationships among authentic leadership, manager incivility and trust in the manager

Purpose

This study aims to examine the relationships among authentic leadership of managers and new graduate nurses’ (NGNs) experience of manager incivility and their degree of trust in their managers.

Design/methodology/approach

A secondary analysis of data using a non-experimental, correlational design was undertaken. From 2012 to 2013, 3,743 surveys were mailed to NGNs eligible for the study, and 1,020 returned completed questionnaires for a response rate of 27.3 per cent. The hypotheses were tested using hierarchical multiple linear regression.

Findings

Authentic leadership had a negative relationship with manager incivility, which in turn was negatively related to trust in the manager, and overall the model accounted for 59.9 per cent of the variance in trust. Authentic leadership was positively associated with trust in the manager.

Originality/value

Findings supported that authentic leadership may be an effective approach to enhance manager–nurse interactions because authentic managers are less likely to display uncivil behavior, which diminishes trust. Findings may be useful to inform the development of positive and respectful work environments and the everyday practice of nurse managers.

Reframing commitment in authentic leadership: Untangling relationship–outcome processes

Affective organizational commitment is theorized and empirically tested as a key mediator between authentic leadership and desirable employee outcomes. The results of a two-wave survey of 830 business people in Australia support a serial mediation model of authentic leadership efficacy. Followers' perceptions of authentic leadership behavior influence their personal identification and affect-based trust in the leader, which in turn are mediated by affective organizational commitment to positively influence their work engagement and job satisfaction. These findings reinforce previous work that positions personal identification and affect-based trust as the two primary mediating mechanisms of authentic leadership. This paper extends prior research by demonstrating the important role of followers' affective bonds with their organization in the operation of authentic leadership, moving beyond the dyad in our understanding of follower outcomes.

The relationship between nurse managers' leadership style and patients' perception of the quality of the care provided by nurses: Cross sectional survey

BACKGROUND

In healthcare systems, human resources play a strategic role that has a significant impact on the whole caring process. When the wellbeing of professionals is low their performance decreases, counterproductive work behaviours may became more likely, and as a result the quality of care is compromised. Studies have shown that leadership style is particularly relevant in relation to the quality of work environments in healthcare organizations.

OBJECTIVE

The main purpose of this study is to test a model that investigates the relationships between nurse managers' leadership style and patients' perception of the quality of the care provided by the nurses, through the mediation of the quality of the working environment (in terms of burnout, interpersonal strain and counterproductive work behaviour).

DESIGN

A multi-centre cross-sectional study was conducted.

SETTING

The study was conducted in five hospitals located two in the north, two in the centre and one in the south of Italy.

PARTICIPANTS

Participants were 479 registered nurses (working as staff nurses, while head nurses and nurse managers were excluded) and 829 patients aged 18 years or older, able to read and write Italian and hospitalized for at least 3 days. Severely ill or mentally disabled patients who were not able to fill in the questionnaire were excluded.

METHODS

The data were collected through two different questionnaires, one for the nurses and one for the patients. A multilevel analysis was conducted to examine the hypothesized model.

RESULTS

Results confirmed the hypothesis that, when nurses were satisfied with leadership, they felt less burned-out and strained in interpersonal relationships, they engaged less in misbehaviour, and, in turn, patients were more satisfied with the quality of the care provided by the nurses.

CONCLUSIONS

The results of this study showed that the characteristics of the organizational context, the leadership, and the behaviours of nurses, influenced patients' perceptions of nurses' care. Therefore, managers of healthcare services should take these results into account seriously in order to improve the quality of care provided to patients.

Healthcare middle managers' experiences of developing capacity and capability: a systematic review and meta-synthesis

BACKGROUND

Healthcare middle managers play a central role in reducing harm, improving patient safety, and strengthening the quality of healthcare. The aim of this systematic review was to identify the present knowledge and critically discuss how healthcare middle managers experienced to develop the capacity and capability for leadership in a healthcare system characterized by high complexity.

METHODS

This comprehensive systematic review provided evidence of healthcare middle managers' experiences in developing the capacity and capability for leadership in public healthcare. The three-step literature search was based on six databases and led by a PICo question. The review had a critical hermeneutic perspective and was based on an a priori published, protocol. The methods were inspired by the Joanna Briggs Institute and techniques from Kvale and Brinkmann. The results were illustrated by effect size, inspired by Sandelowski and Barroso.

RESULTS

Twenty-three studies from four continents and multiple contexts (hospitals and municipal healthcare) published from January 2005-February 2019 were included. Based on experiences from 482 healthcare middle managers, 2 main themes, each with 2 subthemes, were identified, and from these, a meta-synthesis was developed: Healthcare middle managers develop capacity and capability through personal development processes empowered by context. The main themes included the following: 1. personal development of capacity and capability and 2. a need for contextual support. From a critical hermeneutic perspective, contrasts were revealed between how healthcare middle managers experienced the development of their capacity and capability and what they experienced as their typical work situation.

CONCLUSIONS

This review provides evidence of the need for a changed approach in healthcare in relation to criticisms of present organizational structures and management methods and suggestions for how to strengthen healthcare middle managers' capacity and capability for leadership in a healthcare system characterized by high complexity. Evidence of how leadership development affected the clinical context and, thus, the quality of healthcare was found to be a field requiring further research.

PROSPERO REGISTRATION NUMBER

CRD42018084670.

Authentic Leadership Theory and Practical Applications in Nuclear Medicine

As the field of nuclear medicine continues to evolve, a need for new leaders will emerge and leadership development will become critical. "Authentic leadership" is an emerging leadership style rooted in humanism that can be used in conjunction with other leadership styles. Authentic leadership has positive implications for health-care settings, including improved patient care, job satisfaction, motivation, collaboration, and knowledge sharing. This article reviews the philosophic foundations of authentic leadership theory and key characteristics of an authentic leader in the context of nuclear medicine.

Cultivating employees' communal relationship and organizational citizenship behavior through authentic leadership: studying the influence of procedural justice

Background

Leaders play vital role in organization to accomplish organizational goals and establish healthy working environment. This study addresses the effect of authentic leadership on employees’ communal relationship and organizational citizenship behavior (OCB). In addition, this research also examines how procedural justice augments the effect of authentic leadership on both aforementioned employees’ behavioral outcomes.

Materials and methods

Using a cross-sectional design, data were collected from 425 employees working in banking sector of Pakistan. It was hypothesized that authentic leadership would positively predict employees’ communal relationship and OCB. Furthermore, we also assumed that procedural justice will strengthen the relationship between authentic leadership, both behavioral outcomes, that is, employees’ communal relationship and OCB.

Results

Analyses reveal that authentic leadership positively predicts employees’ communal relationship and OCB. In addition, procedural justice was found to positively moderate the effect of authentic leadership on employees’ communal relationship and OCB.

Conclusion

To our knowledge, this is the first study to investigate the relationships among authentic leadership, procedural justice, communal relationship, and OCBs in the South Asian context. This is the first study to report the moderating role of procedural justice in the relationship between authentic leadership and communal relationship and OCB. The practical implications of study findings and direction for future research are discussed.

Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review

BACKGROUND

Leadership is critical in building quality work environments, implementing new models of care, and bringing health and wellbeing to a strained nursing workforce. However, the nature of leadership style, how leadership should be enacted, and its associated outcomes requires further research and understanding. We aimed to examine the relationships between various styles of leadership and outcomes for the nursing workforce and their work environments.

METHODS

The search strategy of this systematic review included 10 electronic databases. Published, quantitative studies that examined the correlations between leadership behaviours and nursing outcomes were included. Quality assessments, data extractions and analysis were completed on all included studies by independent reviewers.

RESULTS

A total of 50,941 titles and abstracts were screened resulting in 129 included studies. Using content analysis, 121 outcomes were grouped into six categories: 1) staff satisfaction with job factors, 2) staff relationships with work, 3) staff health & wellbeing, 4) relations among staff, 5) organizational environment factors and 6) productivity & effectiveness. Our analysis illuminated patterns between relational and task focused leadership styles and their outcomes for nurses and nursing work environments. For example, 52 studies reported that relational leadership styles were associated with higher nurse job satisfaction, whereas 16 studies found that task-focused leadership styles were associated with lower nurse job satisfaction. Similar trends were found for each category of outcomes.

CONCLUSIONS

The findings of this systematic review provide strong support for the employment of relational leadership styles to promote positive nursing workforce outcomes and related organizational outcomes. Leadership focused solely on task completion is insufficient to achieve optimum outcomes for the nursing workforce. Relational leadership practices need to be encouraged and supported by individuals and organizations to enhance nursing job satisfaction, retention, work environment factors and individual productivity within healthcare settings.

Impact of Empowering Leadership on Antimicrobial Stewardship: A Single Center Study in a Neonatal and Pediatric Intensive Care Unit and a Literature Review

Background: Antimicrobial stewardship (AMS) is an important strategy of quality improvement for every hospital. Leadership is an important factor for implementation of quality improvement and AMS programs. Recent publications show successful AMS programs in children's hospitals, but successful implementation is often difficult to achieve and literature of AMS in neonatal and pediatric intensive care units (NICU/PICU) is scarce. Lack of resources and prescriber opposition are reported barriers. A leadership style focusing on empowering frontline staff to take responsibility is one approach to implement changes in health care institutions. Aim: Literature review regarding empowering leadership and AMS in health care and assessment of the impact of such a leadership style on AMS in a NICU/PICU over 3 years. Methods: Assessment of the impact of a leadership change September 1, 2015 from control-driven to an empowering leadership style on antibiotic use and hospital acquired infections. Prospective analysis and annual comparison of antibiotic use, rate of suspected and confirmed ventilator-associated pneumonia (VAP) and central-line associated blood stream infection (CLABSI) including antibiotic use overall, antibiotic therapy for culture-negative and culture-proven infections including correct initial choice and streamlining of antibiotics in the NICU/PICU of the Children's Hospital of Lucerne between January 1, 2015 and December 31, 2017. Results: Five articles were included in the literature review. All five studies concluded that an empowering leadership style may lead to a higher engagement of physicians. Three out of five studies reported improved AMS as reduced rate in hospital-acquired infections and improved prevention of MRSA infections. From 2015 to 2017, antibiotic days overall and antibiotic days for culture-negative situations (suspected infections and prophylaxis) per 1000 patient days declined significantly from 474.1 to 403.9 and from 418.2 to 309.4 days, respectively. Similar, the use of meropenem and vancomycin declined significantly. Over the 3 years, suspected and proven VAP- and CLABSI-episodes decreased with no confirmed episodes in 2017. Conclusion: An empowering leadership style which focuses on enabling frontline physicians to take direct responsibilities for their patients may be a successful strategy of antimicrobial stewardship allowing to overcome reported barriers of AMS implementation.