Transformational leadership moderates the relationship between emotional exhaustion and turnover intention among community mental health providers

Characteristics of transformational leadership development programs: A scoping review

The effectiveness of transformational leadership (TFL) on various outcomes is well known. Accordingly, researchers have developed training programs to enhance TFL behaviours of leaders. Yet, no reviews summarizing the characteristics of TFL training programs exist. The purpose of this review was to examine the characteristics, reporting, and application of TFL-informed programs. A search of six databases yielded 4032 articles, 31 of which met the inclusion criteria. Program characteristics were analyzed using the Template for Intervention Description and Replication (TIDieR) checklist tool, while outcomes were analyzed according to the Kirkpatrick model of evaluation. The most common context for TFL program implementation was healthcare (n = 9). Programs were tailored and often delivered using group workshops and individual feedback. Studies reported variation in the dose of programs, rarely evaluated outcomes multiple times post-baseline, and typically employed Level 3a (subjective ratings of behaviour) evaluation measures. Reporting on program location, modifications, and fidelity was poor. Varying conceptualizations of TFL in different contexts lead to disparities in programs and protocols. Evaluation specialists should consider using tools like the TIDiER checklist to ensure that program characteristics are reported appropriately. Program planners should develop common approaches for planning and evaluating TFL programs to improve transparency and replicability of programs.

Supporting Emotionally Exhausted Community Mental Health Therapists in Appropriately Adapting EBPs for Children and Adolescents

Evidence-based practices (EBPs) are often adapted during community implementation to improve EBP fit for clients and the service context. Augmenting EBPs with additional dosing and content may improve fit. However, reducing EBP content can reduce EBP effectiveness. Using multilevel regression models, this study examined whether supportive program climate and program-furnished EBP-specific implementation strategies (e.g., materials, ongoing training, in-house experts) are associated with augmenting and reducing adaptations, and whether therapist emotional exhaustion moderated these associations. Data were collected from surveys completed by 439 therapists from 102 programs 9 years after a system-driven EBP implementation initiative. Supportive program climate was associated with more augmenting adaptations. Emotional exhaustion was a significant moderator. When organizations used more EBP-specific implementation strategies, more emotionally exhausted therapists reduced EBPs less and less emotionally exhausted therapists augmented EBPs more. Findings provide guidance on how organizations can support appropriate EBP adaptations in spite of therapist emotional exhaustion.

Physician Burnout-Evidence That Leadership Behaviors Make a Difference: A Cross-Sectional Survey of an Academic Medical Center

INTRODUCTION

High rates of physician burnout are well documented in the USA. Identifying beneficial leadership behaviors as an organizational approach to mitigating burnout can lead to improved wellness in the physicians that they lead; however, few studies have examined which leadership behaviors are beneficial and which may be detrimental.

MATERIALS AND METHODS

This survey study of academic medical center physicians and their physician leaders assessed the correlation between burnout and leadership behaviors. Data were analyzed for the strength of correlation between scores for leadership behaviors and self-reported physician burnout with analysis of variance by sex, time from training, specialty, and age.

RESULTS

Of 1,145 physicians surveyed, 305 returned surveys. Among the respondents, 45% were female, 25% were 56 years or older, and 57% self-identified as practitioners of medicine or medicine subspecialties. Two transformational leadership categories of behaviors (idealized influence behaviors and individualized consideration) and one transactional leadership behavior category (contingent reward) correlated favorably with all domains of burnout (P < .0001). Conversely, two transactional leadership categories of burnout (management by exception passive and laissez-faire) correlated unfavorably with all burnout domains.

CONCLUSIONS

Organizational interventions are needed to improve burnout in physicians. Adopting favorable leadership behaviors while avoiding unfavorable leadership behaviors can improve burnout in those physicians being led. These findings could inform the conceptual basis of future physician leadership training programs as transactional leadership behaviors also have an impact on physician wellness.

The mediating effect of job satisfaction and emotional exhaustion on the relationship between psychological empowerment and turnover intention among Chinese nurses during the COVID-19 pandemic: a cross-sectional study

BACKGROUND

Turnover intention occurs frequently in nurses and psychological empowerment has been shown to be major factors that influence turnover intention. However, little is known about the driving force behind turnover intention among nurses in China during the COVID-19 pandemic.

OBJECTIVES

To investigate the mediating role of job satisfaction and emotional exhaustion on the association between psychological empowerment and turnover intention among Chinese nurses during the COVID-19 pandemic.

METHODS

A cross-sectional design was conducted in China. A total of 507 nurses completed scales of psychological empowerment, job satisfaction, emotional exhaustion and turnover intention anonymously. Descriptive analysis, Pearson's correlation analysis in SPSS 23.0 and structural equation modeling (SEM) by Mplus 7.4 RESULTS: Psychological empowerment had a significantly effect on turnover intention through three significantly indirect pathways: (1) through job satisfaction (B = -0.14, SE = .03, 95% CI = [-.19, -.09]). (2) through emotional exhaustion (B = -0.07, SE = .02, 95% CI = [-.11, -.03]). (3) through the chain mediating effect of "job satisfaction → emotional exhaustion" (B = -0.12, SE = .02, 95% CI = [-.16, -.09]).

CONCLUSIONS

Intervention measures to reduce the incidence of turnover intention of nurses should include the evaluations of work demands and emotional exhaustion of nurses and organization's management strategies to promote their psychological empowerment and job satisfaction.

Work-family conflict and withdrawal behavior among mainland China's IT employees: the mediating role of emotional exhaustion and moderating role of job autonomy

Since the turn of the millennium, the information technology (IT) industry has been growing rapidly in mainland China. One of the significant characteristics of IT employees in mainland China during the past decades was that they tended to work more overtime, which might result in more work-family conflicts and higher turnover rates. Our study tested the mechanism of work-family conflict and work withdrawal behaviors using data from 389 IT employees in mainland China. Using the job demands-resources model and the conservation of resources theory, we examined the mediating effect of emotional exhaustion and the moderating effect of job autonomy. The results indicated that work-to-family conflict was negatively related with work withdrawal behaviors, whereas family-to-work conflict was positively related with work withdrawal behaviors. Moreover, we found the opposite moderating role of job autonomy, which enhanced the relationships between emotional exhaustion and work withdrawal behaviors. That is, the relationship was stronger among employees with higher job autonomy than among those with lower job autonomy. These findings indicate that work-family conflict relates to employees' psychological well-being and behavior, and that job autonomy might play a special role between work-family conflict and work withdrawal behaviors.

Building capacity to create community change (BC4): A model to support successful program planning and implementation

Community-based interventions (CBIs) are increasingly used to address health problems and are usually implemented by organizations outside and/or inside the community. CBIs are complex and organizations need to have, or be able to build the capacity needed to implement CBIs effectively. The importance of organizational capacity building is well established in the literature, but less attention is focused on how to build capacity, particularly for prevention-focused and mental health CBIs. As part of the longitudinal process evaluation of a national initiative to promote the mental health and wellbeing of men and boys in the United States, this study developed a capacity-building model to identify areas and associated factors that were integral to grantee organizations' ability to build capacity to create change in their communities. The findings identified five domains used to comprise the Building Capacity to Create Community Change model, which contributed to organizational capacity building and as a result, implementation progress: Administrative Support, Leadership, Vision and Mission, Partnership Development, and Community Engagement. Strength in each domain increased grantees' capacity to impact the lives of participants and progress towards the goal of creating community change.

Emotional Exhaustion and Turnover Intentions among Counselors in Rural Substance Use Disorder Treatment Programs

Counselor turnover is a serious problem for substance use disorder (SUD) treatment programs, especially in rural areas. This study examined the relationship between workload, workplace environment, and emotional exhaustion on turnover intentions among SUD treatment counselors in rural Pennsylvania. An online, anonymous survey was administered to rural SUD treatment counselors in Pennsylvania between October and December 2020. Completed surveys from 206 counselors were used for analysis. Variables included multi-dimensional measures of emotional exhaustion, intention to quit, workload, and workplace environment. Results showed age, perceptions of distributive justice, and management communication to be inversely related to emotional exhaustion and intention to quit. A subsequent analysis showed that the direct effects of these variables on intention to quit were reduced with the inclusion of emotional exhaustion in modeling, suggesting a potential mediation effect. Findings indicated that higher levels of emotional exhaustion were directly related to a greater intention to quit. A statistically significant indirect relationship was also found for distributive justice on intention to quit through emotional exhaustion, indicating a significant mediating effect. While counseling is a stressful occupation with high potential for burnout, these results show that organizations can adopt practices that help lower emotional exhaustion and turnover intentions for their counselors which could improve retention in the SUD treatment field. This is especially important for rural areas, where there is a high demand for SUD services and not enough treatment workers to meet that demand.

A scoping review of the literature pertaining to burnout and leadership in mental health clinicians

PURPOSE

This paper aims to explore what is known in the literature about leadership and burnout within mental health clinicians (MHC).

DESIGN/METHODOLOGY/APPROACH

The Arksey and O'Malley (2005) framework was used to conduct a systematised scoping review of three databases: PsycInfo, PubMed and CINAHL. To ensure a broad scope of the literature, Google, Google Scholar and three sources of grey literature were also searched.

FINDINGS

In total 1,087 articles were identified and 36 were included in the final review, 23 of which were cross-sectional and correlational studies. There is a lack of experimental studies, longitudinal research and qualitative approaches. The literature repeatedly demonstrated an association between leadership and burnout; transformational-leadership style, good quality supervision, supportive relationships, positive communication and fostering autonomy are areas of interest.

RESEARCH LIMITATIONS/IMPLICATIONS

Future research activity should aim to follow the recommendations made in the literature; more experimental and longitudinal approaches are needed to support practical application of the findings.

ORIGINALITY/VALUE

To the best of the author's knowledge there is no other review which maps out the research pertaining to leadership and burnout among MHC. These findings can be used to guide future research to ensure that efforts are directed toward original, meaningful and practical ventures that will add to the evidence base and benefit clinical practice.

Lived Experience as a Protective Factor for Mental Health Workers

OBJECTIVE

When clients do not seem to be improving, mental health workers have more negative job attitudes, experience higher levels of client-related burnout, and are more interested in leaving the field. Nonetheless, it is unclear whether all mental health workers are equally susceptible to burnout caused by feelings that their clients are not improving. Specifically, people with lived experience of mental illness are intimately familiar with their own recovery challenges and thus may be less susceptible to this source of burnout.

METHODS

To test this possibility, mental health providers (N=179) from a nongovernmental community mental health organization in Australia completed a survey assessing their perceptions of client improvement from treatment, their feelings of client-related burnout, and a range of organizational outcomes (job satisfaction, job engagement, workplace well-being, and intentions to resign).

RESULTS

Moderated mediation analyses revealed that although mental health providers who felt that their clients were not improving experienced client-related burnout, lived experience served as a buffer. Staff with lived experience were less susceptible to burnout associated with perceptions that their clients were not improving from treatment. Mental health providers with lived experience also reported more positive job attitudes compared with providers without lived experience.

CONCLUSIONS

Given the high rates of burnout in the mental health profession, future research should examine why lived experience appears to buffer staff from burnout when they believe that their clients are not improving. This knowledge could aid in the development of interventions to boost resilience, engagement, and longevity in the field.

Using readiness to understand implementation challenges in school mental health research

Schools and research partners are increasingly implementing complex, multicomponent interventions and school-wide frameworks to better meet students' social, emotional, behavioral, and academic needs; however, in the research and real-world contexts, implementation is often fraught with many challenges and barriers to success. This study explores implementation barriers encountered during a randomized controlled trial testing effects of one complex intervention strategy-the Interconnected Systems Framework-from the lens of a practical model for conceptualizing organizational readiness-the Interactive Systems Framework for Dissemination and Implementation. Implementation of the Interconnected Systems Framework was explored via focus group and key informant interviews with school and mental health professionals, and research team members responsible for implementing the intervention in randomly assigned study schools. Results from inductive thematic analysis of verbatim transcripts identified three primary implementation challenges: staff turnover, inadequate leadership buy-in, and insufficient time for training/planning. Each challenge is explored from interview participants' perspectives and the extant literature, then connected to recommendations from implementation science to help others avoid similar challenges in their well-intentioned efforts to address the mounting concern for students' wellbeing.

Strengths-Based Leadership and Turnover Intention: The Roles of Felt Obligation for Constructive Change and Job Control

This study draws on the substitutes for leadership theory to investigate the association of strengths-based leadership with employee turnover intention and the mediating role of felt obligation for constructive change and the moderating role of job control in the linkage. Data were collected using a three-wave survey from a sample of 317 employees working in a variety of enterprises in China. The multiple regression analyses with bootstrapping procedure were utilized to examine the proposed hypotheses. The results indicate that strengths-based leadership negatively relates to turnover intention and felt obligation for constructive change partially mediates the relationship between strengths-based leadership and turnover intention. Furthermore, job control, acting as a substitute for strengths-based leadership, negatively moderates the indirect relationship between strengths-based leadership and turnover intention via felt obligation for constructive change. This study contributes to the literature of strengths-based leadership and the substitutes for leadership theory by enhancing our understanding of the effect of job control.

Supervisors' transformational leadership style and residents' job crafting in surgical training: the residents' views

OBJECTIVES

This study aims to explore the effects of three supervisors' leadership styles (transformational, transactional, and laissez-faire) on residents' job crafting.

METHODS

Sequential explanatory mixed-methods. First, a purposive sample of residents rated the leadership style of their supervisors and their own job crafting on the Multifactor Leadership Questionnaire and the Dutch Job Crafting Scale. The effects were tested through linear mixed effects regression analysis. Thereafter we conducted semi-structured interviews with residents and conducted a thematic analysis.

RESULTS

A total of 116 residents participated. A transformational style had a positive effect on residents' job crafting (b = .19, t₍₁₁₂₎ =3.76, p=. 009), whereas the transactional and laissez-faire styles did not. This could be explained by the fact that residents felt a positive influence of the supervisors with such style on the atmosphere for training, on the job resources available to them, and on their modelling function for how to handle the demands of the environment.

CONCLUSIONS

A transformational style of the supervisor has a positive effect on residents' job crafting. Future research should explore the supervisors' perspective, as well as the effectiveness of leadership training for supervisors with a focus on resident outcomes, such as job crafting.

“When” and “why” employees resort to remain silent at work? A moderated mediation model of social undermining

Purpose

To date, few empirical studies have explored the boundary conditions under which employees may choose to observe silence at work. Drawing on the conservation of resource (COR) theory, the present study bridges this gap by examining the interaction effect of leader-member exchange (LMX) on the relationship between social undermining and employee silence while considering the mediating role of emotional exhaustion.

Design/methodology/approach

Data were collected from 327 employees working in Pakistan's service sector through the purposive sampling technique and analyzed using PLS path modeling.

Findings

The findings support the authors’ projections such that social undermining, i.e., supervisor undermining, coworker undermining and customer undermining, are positively related to emotional exhaustion. Besides, emotional exhaustion partially mediates the associations between supervisor undermining and employee silence, coworker undermining and employee silence, and customer undermining and employee silence. Further, the results confirm the interaction effect of LMX. The harmful impact of social undermining is exacerbated in high-quality LMX relationships compared to those at low LMX relationships.

Originality/value

This study is one of the few efforts to understand the conditions under which employee silence is more likely or less likely to occur. The authors’ findings draw the attention of researchers and practitioners to understand the uniqueness of this linkage such that variations in leaders' behavior are more detrimental for “in-group” members than their counterparts (i.e. “out-group” members).

A stepped-wedge randomized trial investigating the effect of the Leadership and Organizational Change for Implementation (LOCI) intervention on implementation and transformational leadership, and implementation climate

BACKGROUND

This study evaluates the Leadership and Organizational Change for Implementation (LOCI) strategy and its effect on implementation leadership, transformational leadership, and implementation climate.

METHODS

A stepped wedge cluster randomized study design enrolling 47 first-level leaders from child- and adult-specialized mental health clinics within Norwegian health trusts across three cohorts. All therapists (n = 790) received training in screening of trauma exposure and posttraumatic stress, and a subgroup of therapists (n = 248) received training in evidence-based treatment methods for posttraumatic stress disorder (PTSD). First-level leaders and therapists completed surveys at baseline, 4, 8-, 12-, 16-, and 20-months assessing leadership and implementation climate. General linear mixed-effects models were used to investigate whether the LOCI strategy would lead to greater therapist-rated scores on implementation leadership, transformational leadership, and implementation climate.

RESULTS

After introducing the LOCI strategy, there was a significant increase in therapist-rated implementation and transformational leadership and implementation climate. The increase was sustained at all measurement time points compared to non-LOCI conditions, which demonstrated a steady decrease in scores before LOCI.

CONCLUSIONS

The LOCI strategy can develop better transformational and implementation leadership skills and contribute to a more positive implementation climate, which may enhance successful EBP implementation. Thus, LOCI can help leaders create an organizational context conducive for effective EBP implementation.

TRIAL REGISTRATION

Retrospectively registered: ClinicalTrials NCT03719651 , 25th of October 2018. The trial protocol can be accessed from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6417075/ .

Validation and Use of the Measure of Effective Attributes of Trainers in School-Based Implementation of Proactive Classroom Management Strategies

In-service training is a critical and frequently utilized implementation strategy to support the adoption and delivery of evidence-based practice (EBP) across service settings, but is characteristically ineffective in producing provider behavior changes, particularly when delivered in single exposure didactic events. EBP trainers are in a strategic position to leverage their trainee-perceived characteristics to influence trainees' attitudes, motivation, and intentions to implement, and ultimately increase the likelihood of successful uptake of skills. The purpose of this study was to extend research on the measure of effective attributes of trainers (MEAT) by examining its underlying factor structure and reliability in the context of in-service EBP training for teachers (i.e., structural validity). This study also examined the predictive validity of the MEAT by examining relationships with a measure of teacher intentions to implement EBPs following a standardized training experience (i.e., predictive validity). An exploratory factor analysis (EFA) was employed to determine the latent factors (i.e., subscales of characteristics) that underlie the data. Additionally, a forward selection, stepwise regression was conducted to determine the extent to which trainer attributes could explain variance in intentions to implement. Results indicated that the MEAT was a valid and reliable measure to examine trainer attributes in school settings. Moreover, findings suggested that trainer attributes, particularly those related to trainee perceptions of the trainers' welcoming disposition (i.e., related to trainers' warm, positive temperament and internal character traits), were significantly associated with trainees' intentions to implement the trained upon EBP.

The Effect of Burnout and Its Dimensions on Turnover Intention Among Nurses: A Meta-Analytic Review

AIM

The objective of this study is elaborating on the relationship between burnout and turnover intention.

BACKGROUND

Burnout and its dimensions have a significant effect on turnover intention.

EVALUATION

Meta-analysis technique is used. 44 studies were brought together to form four data sets. These data sets were heterogeneous and they did not include publication bias. The effect sizes of burnout, emotional exhaustion, depersonalization, and professional efficacy on turnover intention among nurses were computed.

KEY ISSUES

Random effects model was used. The groups including 2 or more studies were added into moderator analysis.

CONCLUSIONS

The effect size of the relationship between professional efficacy and turnover intention was small, and the effect size of the other surveyed reationships were medium among both nurses and other health employees. The moderator analysis results suggested that the effect size of the relationship between professional efficacy and turnover intention among nurses is significantly different from the other health employees.

CONCLUSION

Being a nurse was determined as a significant moderator for the relationship between professional inefficacy and turnover intention and it weakened this relationship.

IMPLICATIONS FOR NURSING MANAGEMENT

The findings of this study can be used by health managers as burnout and turnover intention are important to determine organizational policies.

Youth Mental Health First Aid: Examining the Influence of Pre-Existing Attitudes and Knowledge on Training Effectiveness

Youth Mental Health First Aid (YMHFA) is a gatekeeper training designed to assist professionals in their identification and response to youth mental illness. Despite widespread implementation, few studies have examined how individual-level trainee characteristics may impact the effectiveness of this training. In this study, we examined how pre-existing knowledge and attitudes about youth mental illness (measured prior to participation in the program) influenced training outcomes. We used a sample of 987 child-serving professionals who completed the YMHFA training program to identify demographic and work-related factors that predicted pre-existing attitudes and knowledge. The sample was then divided into two groups based on pre-existing attitudes and knowledge. We examined training effectiveness across four constructs: knowledge, confidence, intentions to intervene, and stigma. Findings indicate that gender and work-related characteristics were associated with pre-existing knowledge and attitudes about youth mental illness. The magnitude of training effectiveness varied across pre-existing attitudes and knowledge. Those participants with above average attitudes and knowledge benefited little from the program, suggesting that universal implementation of YMHFA may not be an efficient use of resources. Suggestions for a tiered implementation plan that prioritizes professionals most in need of the training are discussed.

Burnout and Leadership Style in Behavioral Health Care: a Literature Review

Burnout among behavioral health care providers and employees is associated with poor patient and provider outcomes. Leadership style has generally been identified as a means of reducing burnout, yet it is unclear whether some leadership styles are more effective than others at mitigating burnout. Additionally, behavioral health care is provided in a variety of contexts and a leadership style employed in one context may not be effective in another. The purpose of this paper was to review the literature on leadership style and burnout in behavioral health care contexts to identify the different leadership styles and contexts in which the relationship between the two constructs was studied. Studies were categorized based on the leadership style, study design, research methods, and study context. Findings of this review provide insights into potential approaches to prevent employee burnout and its attending costs, as well as ways to improve future research in this critical area.

Workplace bullying and turnover intentions of nurses: the multi-theoretic perspective of underlying mechanisms in higher-order moderated-serial-mediation model

PURPOSE

This study examines the relationship between workplace bullying (WPB) and the turnover intentions (TIs) of nurses, both directly and indirectly, i.e. through serial mediation of psychological contract violation (PCV) and poor employee wellbeing (EWB). And that with the moderating effect of servant leadership (SL) on its final path to TIs of nurses.

DESIGN/METHODOLOGY/APPROACH

A total of 285 nurses voluntarily participated in the survey through convenient sampling from 13 different district hospitals. The authors performed partial least squares structural equation modeling (PLS-SEM) to test the study's measurement and structural models.

FINDINGS

Overall, results indicated 62% prevalence rate of WPB and TIs of nurses had 67% variance explained by the exogenous factors. Workplace bullying was found to have direct as well as indirect relationship with TIs of nurses. For the latter, PCV and poor EWB were found to have partially mediated, both singly and serially. The moderating effect of SL on the serial mediation pathway was negative and significant.

ORIGINALITY/VALUE

Drawing on a tripartite theoretical perspective, this study illuminates the mechanism underlying WPB-TIs relationship with an advanced multivariate statistical technique in the nursing work setting in a developing country.

Transformational Leadership and Turnover Intentions: The Mediating Role of Employee Performance during the COVID-19 Pandemic

The purpose of this research paper is to explain the impact of transformational leadership on employees’ turnover intentions in light of the mediating role of their individual performance. More precisely, we attempt to explain (a) how TL connects to employees’ turnover intentions, (b) how TL connects to employee performance, (c) how employee performance connects to turnover intentions, and (d) how employee performance mediates the connection between intentions and TL. Four hundred and seventy-eight Turkish healthcare professionals participated in this research. The results revealed that employee performance mediates the connection between turnover intentions and TL. In other words, transformational leaders encourage employee performance, which in turn decreases their turnover intentions. This research has important implications for reducing turnover in workplaces and increasing employee performance by facilitating a setting for high performance, since employees who are supported by their leaders are generally more committed to their organizations and exhibit better performance. This research answers calls to study the mediating function of the TL procedure, since the mediation clarifies the circumstances under which TL relates to the favorable results.

Influencing Mechanism of Green Human Resource Management and Corporate Social Responsibility on Organizational Sustainable Performance

Sustainable organizational achievement of firms is the dominant approach in today’s world, with an inclination on improving profitability, social condition, and a healthy environment. Based on ability, motivation, opportunity (AMO), and stakeholder theories, this study explored the green human resource management (GHRM) and corporate social responsibility (CSR) mechanism towards sustainable performance achievement. A structured questionnaire survey from 305 samples was appropriate for the quantitative study on this research. Moreover, widely used structural equation modeling and analysis of moment structures (AMOS) was used to analyze the proposed structural model of the study. Findings from the study added significance to all posited hypotheses and validated the study model. The current study added literature to the body of knowledge on green human resource management practices and corporate social responsibility in the pursuit of improved performance towards society, the environment, and sustainability of construction firms. For future studies, the inclusion of industries such as transportation-based industries and manufacturing companies that contribute to development should be considered for broad learning.

Perception of Recovery Orientation as a Predictor of Clinician Turnover in Community Mental Health Clinics

Turnover in community mental health clinics threaten the delivery of quality behavioral health services; recovery orientation has been shown to be associated with lower levels of burnout but its relationship with actual turnover has not yet been examined. This study aimed to examine the relationship between provider perceptions of recovery orientation and 12-month turnover status among community mental health providers. Secondary data analyses were conducted with data collected from 224 community mental health providers from ten organizations across 14 clinic sites participating in a larger effectiveness-implementation trial. Chi square analyses were used to examine between-site variation in 1-year turnover rates among the ten organizations. Logistic regression was used to examine effects of perceptions of recovery orientation along with known predictors of turnover among community mental health providers. Results revealed no between-site variation in organizational turnover rates. The logistic regression model was statistically significant, χ²(17) = 47.64, p < .0001 and explaining 30% (Nagelkerke R²) of within-site variance and correctly classifying 79% of cases. Perceptions of recovery orientation emerged as the sole significant predictor of 12-month turnover status, with higher levels of recovery orientation significantly associated with lower odds of turnover at 12 months [B = .90, p = .008, OR 2.47 (95% CI 1.23, 4.82)]. Perceptions of recovery orientation was protective against 12-month turnover status suggesting that a more person-centered and empowering approach to care may improve the provider experience. More research is needed to further understand how recovery orientation can contribute to workforce stability.

Leader–member exchange and organizational climate effects on clinician turnover intentions

Purpose

Clinician turnover in mental health settings impacts service quality, including availability and delivery of evidence-based practices. Leadership is associated with organizational climate, team functioning and clinician turnover intentions (TI). This study examines leader–member exchange (LMX), reflecting the relationship between a supervisor and each supervisee, using mean team LMX, dispersion of individual clinician ratings compared to team members (i.e. relative LMX) and team level variability (i.e. LMX differentiation), in relation to organizational climate and clinician TI.

Design/methodology/approach

Survey data were collected from 363 clinicians, nested in children's mental health agency workgroups, providing county-contracted outpatient services to youth and families. A moderated mediation path analysis examined cross-level associations of leader–member exchange with organizational climate and turnover intentions.

Findings

Lower relative LMX and greater LMX differentiation were associated with higher clinician TI. Higher team-level demoralizing climate also predicted higher TI. These findings indicate that poorer LMX and more variability in LMX at the team level are related to clinician TI.

Originality/value

This study describes both team- and clinician-level factors on clinician TI. Few studies have examined LMX in mental health, and fewer still have examined relative LMX and LMX differentiation associations with organizational climate and TI. These findings highlight the importance of leader–follower relationships and organizational climate and their associations with clinician TIs. Mental health service systems and organizations can address these issues through fostering more positive supervisor–supervisee relationships.

Transformational Leadership and Turnover Intention in Child Welfare: A Serial Mediation Model

PURPOSE

This study examined a serial mediation model testing the effects of STS on turnover intention through executive leaders' use of transformational leadership as perceived by child welfare workers and then organizational commitment while controlling for age, gender, and social work degrees.

METHOD

Survey data were collected from 264 child welfare workers at one Midwestern state.

RESULTS

The results supported the serial mediation model, corroborated by the finding that the impact of STS on turnover intention has disappeared as a result of transformational leadership and organizational commitment between the two variables.

DISCUSSION

The findings of the study provide practical implications for training transformational leadership styles to leaders training at the middle manager and executive leadership levels in child welfare agencies.

Leadership that promotes successful implementation of community-based mental health interventions

Community-based interventions (CBIs) have become an effective approach to promote mental well-being. To increase organizational capacity and effectively deliver CBIs, leadership is crucial. The current study aims to identify leadership qualities that are facilitators of CBI implementation. This paper presents evaluation findings from a national effort emphasizing CBIs for improving the mental well-being of men and boys in 16 local communities. The study utilized a mixed-method design, including both examining each grantee as a case study and conducting a cross-site evaluation. Findings revealed five leadership qualities that contributed to CBIs' success: personal vision, value-based leadership, relationship-oriented leadership, task-oriented leadership, and leadership development. The results outline strategies for strengthening organizational capacity through these leadership qualities. This study adds to the limited literature on leadership qualities that strengthen organizational capacity to successfully implement CBIs and can serve as a guide for funders, program planners, and evaluators.

Do Social Workers Lead Differently? Examining Associations with Leadership Style and Organizational Factors

What training leaders need to successfully shepherd high quality human service delivery remains less understood. This study aims to evaluate associations between social work training, leadership style, and organizational factors. Participants included leaders (N=49) and employees (N=224) working in 10 behavioral health organizations who completed a survey. Hierarchical linear models were used to analyze multilevel associations. Analyses indicated that leaders with social work training were rated higher in transformational leadership and organizational factors (e.g., lesser stress) on average within both samples. Findings begin an empirical argument for the value of social work leaders for the success of human service organizations.

Impact of Supervisory Support on Turnover Intention: The Mediating Role of Burnout and Job Satisfaction in a Longitudinal Study

High rates of provider turnover are problematic for our mental health system. Research indicates that supervisory support could alleviate some turnover intention by decreasing emotional exhaustion (a key component of burnout) as well as by increasing job satisfaction. However, the potential mediation mechanisms have not been rigorously tested. Longitudinal data collected from 195 direct clinical care providers at two community mental health centers identified positive effects of supervisory support on reduced turnover intention through reduced emotional exhaustion. Job satisfaction was not a significant mediator. Supervisory support may help mitigate turnover intention through work-related stress reduction.

Occupational burnout in nurses: a concept analysis†

Objective

This paper aims to clarify the concept of occupational burnout (OB) as well as develop appropriate methods to relieve or prevent OB in the nursing profession.

Methods

Walker and Avant’s eight-step approach of concept analysis was applied.

Results

OB was defined as a chronic form of work-related stress. Accurately, it was characterized by emotional exhaustion, depersonalization/cynicism, and reduced personal accomplishment/inefficacy. Antecedents of burnout included (a) demographic characteristics; (b) chronic exposure to work-related stressors; (c) quantitative and qualitative job demands; (d) lack of job resources; and (e) personality traits. Consequences involved (a) individual’s unfavorable quality of life; (b) negative impact on the organization; and (c) poor services quality. Although the Maslach Burnout Inventory (MBI) is perceived as an ideal tool to measure burnout and hence, it is used worldwide, whether this instrument fits to measure this concept for nurses has still not yet been verified and thus further research is needed.

Conclusions

By proposing a comprehensive definition of the concept, this analysis contributes to recognition of the process of OB of nurses. All nurses are vulnerable to OB. Hence, burnout in nursing needs to be recognized as a critical factor in the delivery of safe patient care. It proposes that the prevention of OB would be achieved through team communication training, mindfulness group, education, etc.

Relationship between employability and turnover intention: The moderating effects of organizational support and career orientation

This study examines the impact of employability on turnover intention by differentiating internal and external employability, and considering the possible moderating roles of perceived organizational support (POS) and career orientation. Using a sample of 411 responses to a two-wave questionnaire survey generated from six cities in China, we find that external employability positively influenced turnover intention, but internal employability negatively influenced turnover intention. The results also indicate that POS had a positive moderating effect only on the relationship between external employability and turnover intention. Furthermore, for employees with disengaged career orientation, external employability exerts a strong impact on turnover intention. This study adds to the limited research empirically linking employability and turnover intention, whereas the findings can be used by HRM practitioners to factor in organizational support and career orientation initiatives that improve the retention of employees with high external employability.

Community Mental Health Professionals' Perceptions About Engaging Underserved Populations

This study explored mental health professionals' perceptions about barriers and facilitators to engaging underserved populations. Responses were coded using an iterative thematic analysis based on grounded theory. Results revealed that many professionals endorsed barriers to engaging ethnic minorities and families receiving social services. Client-provider racial and linguistic matching, therapy processes and procedures (e.g., nonjudgmental stance), and implementation supports (e.g., supervision) were commonly nominated as engagement facilitators. Many professionals felt that an organizational culture focused on productivity is detrimental to client engagement. Findings shed light on professionals' perceived barriers to delivering high-quality care to underserved communities and illuminate potential engagement strategies.

Significance of Leaders for Sustained Use of Evidence-Based Practices: A Qualitative Focus-Group Study with Mental Health Practitioners

Evidence-based practices that are implemented in mental health services are often challenging to sustain. In this focus-group study, 26 mental health practitioners with high fidelity scores were interviewed regarding their experiences with implementing the illness management and recovery, an evidence-based practice for people with severe mental disorders, in their services and how this could influence further use. Findings indicate that high fidelity is not equivalent to successful implementation. Rather, to sustain the practice in services, the practitioners emphasized the importance of their leaders being positive and engaged in the intervention, and hold clear goals and visions for the intervention in the clinic. In addition, the practitioners' understanding of outcome monitoring as a resource for practice improvement must be improved to avoid random patient experiences becoming the decisive factor in determining further use.Trial registration: ClinicalTrials.gov NCT02077829. Registered 25 February 2014.

Perceived inability to help is associated with client-related burnout and negative work outcomes among community mental health workers

Community mental health is a vital service, but it faces ongoing challenges from its high staff-turnover rates. The current study provides a preliminary test of a novel explanation for employee disengagement in community mental health. It is proposed that providing assistance to clients, while simultaneously feeling that only limited progress is being made, is associated with client-related burnout among community mental health providers, leading to negative work outcomes. Employees (N = 349) from three non-governmental community mental health organisations in Australia completed a survey assessing their perceptions of client improvement from treatment, client-related burnout and a range of organisational outcomes. Analyses revealed that perceptions that clients are not improving was associated with burnout, which in turn is related to lower job satisfaction, decreased job engagement, poorer workplace well-being, and increased turnover intentions. These findings suggest that interventions that highlight positive changes among clients could reinforce the important service provided by community mental health employees and may minimise burnout and negative work outcomes.

Predicting Turnover: The Moderating Effect of Functional Climates on Emotional Exhaustion and Work Attitudes

High levels of emotional exhaustion are frequently reported among clinicians working in community mental health settings. This study draws on social exchange theory and examines the relationships between emotional exhaustion and mental health provider work attitudes and turnover, and the moderating effect of functional psychological climates. Data were analyzed using multilevel structural equation modeling in a sample of 311 mental health providers from 49 community mental health programs. Results revealed that emotional exhaustion was negatively related to work attitudes, and the relationship was moderated by functional climates characterized by high levels of cooperation, growth and advancement opportunities, and role clarity. Specifically, the relationship between emotional exhaustion and work attitudes was attenuated for providers working in programs with a more functional psychological climate. Lower work attitudes significantly predicted higher clinician turnover. Results are discussed as they relate to improving climates and enhancing mental health provider and organizational well-being.

Agreement and Discrepancy Between Supervisor and Clinician Alliance: Associations with Clinicians' Perceptions of Psychological Climate and Emotional Exhaustion

Despite increasing interest in supervision as a leverage point for bolstering public mental health services, the potential influence of supervisory alliance on organizations and direct service providers remains understudied, particularly in the context of supporting evidence-based treatment (EBT) use. This study examined agreement and discrepancy between supervisor and clinician ratings of alliance associated with clinicians' perceptions of psychological climate and emotional exhaustion. Results indicated that discrepancies in alliance ratings were common and associated with clinicians' perceptions of psychological climate. These findings have important implications for collaboration among supervisors and clinicians within a community mental health organizational context and the provision of EBTs.

Integrating Self-Determination and Job Demands-Resources Theory in Predicting Mental Health Provider Burnout

Limited progress has been made in reducing burnout in mental health professionals. Accordingly, we identified factors that might protect against burnout and could be productive focal areas for future interventions. Guided by self-determination theory, we examined whether supervisor autonomy support, self-efficacy, and staff cohesion predict provider burnout. 358 staff from 13 agencies completed surveys. Higher levels of supervisor autonomy support, self-efficacy, and staff cohesion were predictive of lower burnout, even after accounting for job demands. Although administrators may be limited in their ability to reduce job demands, our findings suggest that increasing core job resources may be a viable alternative.

Relationships between burnout, turnover intention, job satisfaction, job demands and job resources for mental health personnel in an Australian mental health service

BACKGROUND

Burnout and employee turnover in mental health services are costly and can have a negative impact on service user outcomes. Using the Job Demands-Resources model as a foundation, the aim of this study was to explore the relationships between burnout, turnover intention and job satisfaction in relation to specific job demands and job resources present in the workplace in the context of one Australian mental health service with approximately 1100 clinical staff.

METHODS

The study took a cross-sectional survey approach. The survey included demographic questions, measures of burnout, turnover intention, job satisfaction, job demands and job resources.

RESULTS

A total of 277 mental health personnel participated. Job satisfaction, turnover intention and burnout were all strongly inter-correlated. The job resources of rewards and recognition, job control, feedback and participation were associated with burnout, turnover intention and job satisfaction. Additionally, the job demands of emotional demands, shiftwork and work-home interference were associated with the exhaustion component of burnout.

CONCLUSION

This study is the largest of its kind to be completed with Australian mental health personnel. Results can be used as a foundation for the development of strategies designed to reduce burnout and turnover intention and enhance job satisfaction.

Burnout in mental health professionals: A systematic review and meta-analysis of prevalence and determinants

This study aimed to estimate the level of burnout in mental health professionals and to identify specific determinants of burnout in this population. A systematic search of MEDLINE/PubMed, PsychINFO/Ovid, Embase, CINAHL/EBSCO and Web of Science was conducted for original research published between 1997 and 2017. Sixty-two studies were identified as meeting the study criteria for the systematic review. Data on the means, standard deviations, and prevalence of the dimensions of burnout were extracted from 33 studies and included in the meta-analysis (n = 9409). The overall estimated pooled prevalence for emotional exhaustion was 40% (CI 31%-48%) for depersonalisation was 22% (CI 15%-29%) and for low levels of personal accomplishment was 19% (CI 13%-25%). The random effects estimate of the mean scores on the Maslach Burnout Inventory indicate that the average mental health professional has high levels of emotional exhaustion [mean 21.11 (95% CI 19.98, 22.24)], moderate levels of depersonalisation [mean 6.76 (95% CI 6.11, 7.42)] but retains reasonable levels of personal accomplishment [mean 34.60 (95% CI 32.99, 36.21)]. Increasing age was found to be associated with an increased risk of depersonalisation but also a heightened sense of personal accomplishment. Work-related factors such as workload and relationships at work, are key determinants for burnout, while role clarity, a sense of professional autonomy, a sense of being fairly treated, and access to regular clinical supervision appear to be protective. Staff working in community mental health teams may be more vulnerable to burnout than those working in some specialist community teams, e.g., assertive outreach, crisis teams.

Turnover intention and related factors among general practitioners in Hubei, China: a cross-sectional study

Background

High turnover among general practitioners (GPs) is a significant challenge in China’s efforts to build a sustainable, effective primary care system, but little data is available to help understand and address this issue. The study was aiming at assessing the intention to leave their posts among a sample of GPs and investigating associated factors.

Methods

A cross-sectional survey was conducted between December 12, 2014 and March 10, 2015 in Hubei Province, Central China. A total of 1016 GPs (response rate, 85.67%) were investigated by using a structured self-administered questionnaire. A generalized linear regression model was used to identify the associated factors with turnover intention among GPs.

Results

Based on a full score of 24, the average score for GPs’ turnover intention was 15.40 (SD = 3.43). 78.35% of the GPs had a moderate or higher level of turnover intention. Six hundred and thirty one (62.37%) GPs had ever been exposed to abuse of any kind (physical assault, 18.92%; verbal abuse, 54.38%; threat, 33.79%; verbal sexual harassment, 22.66%; and physical sexual harassment, 7.59%). Generalized linear regression analysis indicated that GPs who were male; who had a vocational school or higher; who had a temporary work contract; who were with lower level of job satisfaction; who reported higher scores on emotional exhaustion; who had been exposed to higher frequency of workplace violence were expressed higher intention to leave their present positions.

Conclusion

This study shows that GP’s intention to leave general practices is high in Hubei, China. In addition, the prevalence of workplace violence is high among GPs, particularly in the verbal abuse and threat. Measures such as offering permanent contract status, increasing overall job satisfaction, and improving doctor-patient relationship, are needed to moderate GP’s turnover intention in order to maintain the foundation of China’s three-tier health system.

Electronic supplementary material

The online version of this article (10.1186/s12875-018-0752-3) contains supplementary material, which is available to authorized users.

Employer branding and talent retention: perceptions of employees in higher education institutions in Uganda

Purpose

The purpose of this paper is to examine, empirically the relationship between employer branding attributes of reward strategy, people orientedness and; leadership and development on talent retention in institutions of higher learning in Uganda.

Design/methodology/approach

In a cross-sectional study, data were obtained form 218 respondents from two public universities. Confirmatory factor analysis (CFA) and structural equation modeling were employed to analyze the data.

Findings

The paper has two major findings: first, CFA maintained three dimensions of employer branding, namely; reward strategy, people orientedness and; leadership and development; and second, only reward strategy and people orientedness emerged as significant predictors of talent retention.

Originality/value

The results suggest that institutions of higher learning that embrace reward people orientedness strategies as measures for employer branding succeed in retaining their employees for longer.

An Exploration of the Perspectives of Associate Nurse Unit Managers Regarding the Implementation of Smoke-free Policies in Adult Mental Health Inpatient Units

CONTEXT

In Adult Mental Health Inpatient Units, it is not unexpected that leadership of Associate Nurse Unit Managers contributes to successful implementation of smoke-free policies.

AIM

In light of challenges facing mental health nursing, and limited research describing their leadership and the role it plays in addressing smoke-free policy implementation, the aim of this study is to explore Associate Nurse Unit Managers perspectives' regarding the implementation of smoke-free policies, which were introduced on 1 July, 2015.

DESIGN, SETTING, PARTICIPANTS

Individual in-depth semi-structured interviews were undertaken six months post the implementation of smoke-free policies. In this qualitative descriptive study, six Associate Nurse Unit Managers working in a Victorian public Adult Mental Health Inpatient Unit, were asked eight questions which targeted leadership and the implementation and enforcement of smoke-free policies. Associate Nurse Unit Managers provide leadership and role modeling for staff and they are responsible for setting the standards that govern the behavior of nurses within their team. All participants interviewed believed that they were leaders in the workplace.

MAIN OUTCOMES

Education and consistency were identified as crucial for smoke-free policies to be successful. Participants acknowledged that the availability of therapeutic interventions, staff resources and the accessibility of nicotine replacement therapy were crucial to assist consumers to remain smoke-free while on the unit.

CONCLUSION

The findings from this research may help to improve the understanding of the practical challenges that Associate Nurse Unit Manager's face in the implementation of smoke-free policies with implications for policies, nursing practice, education and research.

Contradictory results on the mediating roles of two dimensions of trust between transformational leadership and employee outcomes

Purpose

The purpose of this paper is to examine the mediating roles of cognitive and affective trusts between the transformational leadership (TL) and employee outcomes (task performance (TP), organizational commitment (OC), and employee turnover intention (ET)).

Design/methodology/approach

This study samples 384 bank employees and records their self-reported responses for closed-ended items in the survey. SmartPLS 3.0 is used for the analysis.

Findings

The results indicate that affective trust (AT) and cognitive trust (CT) mediate between the transformation leadership and OC positively. Moreover, AT and CT both mediate negatively between TL and TP. Finally, both dimensions of trust as second-order constructs mediate positively between the TL and ET. The results related to the ET and TP are highly intriguing and in conflict with the simple and non-contextual statement of the social exchange theory.

Practical implications

TL, AT, and CT have greater importance for the managers to increase the positive work-related outcomes of employees. Moreover, the results related to TP and ETs are highly applicable to the managers and business.

Originality/value

The originality of the study lies in use of the SmartPLS 3.0 for analysis as it offers unique and precise measures of the measurement model like HTMT ratio and does not rely on the co-variance. Moreover, mediating roles of AT and CT have never been tested before in the given settings. Finally, results defy the simple statements of the theory and call for the context-based theorized empirical studies. In doing so, it calls for the post-modernist stage (case-by-case contextual treatment of theory) of HR and management literature.

Leadership style of nurse managers as perceived by registered nurses: A cross-sectional survey

Given rapid changes in the health care landscape, nurse leaders need to be equipped with effective leadership skills. Those who are aware of their styles of working and its impact on their employees could adopt a better leadership style. The study aim was to assess the leadership styles of nurse leaders, as perceived by their employees. The secondary objectives were to explore differences between self-ratings and others’ ratings of leadership styles, as well as correlation between perceived leadership styles and organisational outcomes. A cross-sectional survey was conducted among registered nurses from four inpatient wards in an acute tertiary hospital in Singapore. Respondents were asked to complete a questionnaire that consisted of demographic questions, the Multifactor Leadership Questionnaire and the Organizational Commitment Questionnaire, as well as a Three-index item Questionnaire, to elicit turnover intention. A total of 111 completed surveys (37% response) were received. Overall, registered nurses reported that their nurse leaders exhibited both transformational and transactional leadership behaviours and, to a lesser extent, laissez-faire. Of interest was the finding that nurse leaders in this study tend to rate themselves higher than others rate them. The results implied a need to incorporate self-awareness elements in nursing leadership development programmes.

Transformational leadership and turnover

Purpose

The purpose of this paper is to report the findings of a study which examines the relationship between transformational leadership and intention to leave through the mediating role of employee engagement, employer branding, and psychological attachment.

Design/methodology/approach

Transformational leadership, employee engagement, employer branding, and psychological attachment were assessed in an empirical study based on a sample of 405 full-time employees working in information technology (IT) organizations in India. The data which were obtained using Google doc and a printed questionnaire was analyzed through structural and measurement model.

Findings

The results reveal that transformational leadership style directly influences employee intention to leave. Transformational leadership and employer branding is mediated by employee engagement. The leadership relation with psychological attachment is mediated by employer branding.

Practical implications

The implications of the study are of utmost importance for Indian IT industries facing high voluntary turnover in recent times. Transformational leaders in teams contribute to develop employee engagement, employer branding, and psychological attachment. Imparting transformational leadership training to team leaders can help in generating psychological attachment with the employees which would go a long way.

Originality/value

This study explores the relationship among transformational leadership style, employee engagement, employer branding, and psychological attachment which has not been explored theoretically and tested empirically in an Indian context.