 Transformational Leadership on Job Satisfaction and Patient Safety Outcomes in Health Sector of Pakistan
Received Date: Mar 07, 2018 / Accepted Date: Mar 25, 2018 / Published Date: Apr 03, 2018
Abstract
Background: To improve the patient safety among health care sector and organizations need effective and efficient leadership at all stages.
Purpose: The aim of this research was to examine the impact of nurse’s manager transformational leadership performance on job contentment and also towards patient safety outcomes.
Methods: Random sampling of critical care nurses (N=358) was carried out through cross sectional survey in Lahore, Rawalpindi and Islamabad hospitals of Pakistan. By using structural equation model technique hypothesized model was verified.
Discussion: Data acceptability fit in the hypothesized model. Results highlighted that transformational leadership had solid positive impact on workstation empowerment, which resultantly enhances nurse’s job satisfaction and reduces adverse patient outcomes frequency. Consequently, job satisfaction was interrelated towards lower adverse measures.
Conclusion: Findings of this research provides support for manager’s to adopt transformational leadership conduct as a beneficial strategy to create office environments which encourage better safety results for patients as well as nurses.
Keywords: Transformational leadership; Patient safety; Job satisfaction; Empowerment; Work environment
Introduction
Worldwide patient safety and care quality are acknowledged as a priority for all organizations dealing health care. Though, large researches across Europe and North America have highlighted that health care organizations are liable to mistakes and the hazard of adversarial happenings is substantial [1,2].
Adversarial patient outcomes or happenings are described as unintentional injuries or problems affected by management of health care rather than original patient’s ailment process, causing extended stay in hospital, disability or expiry [3]. According to landmark report of Institute of Medicine (IOM), every year in the United States due to human errors estimated 98,000 patients expire and due to avoidable medical mistakes approximately one million are injured [2]. Similarly, according to report of Canadian Institute for Health Information (CIHI) in Canada during 2014 and 2015 in more than 138,000 estimated hospitalizations, around 30,000- or one among every 18th patient underwent avoidable injury that conceded their care [4]. Research has highlighted that economic expenses of adverse events are also noteworthy and the load on developed countries rests high. For example, in 2009 and 2010 price of adverse happenings towards health care system of Canada was estimated around $1.1 billion [5]. In United States also similar expenditures have been stated. After IOM report and past 18 years progress, patient safety remains a significant challenge in public health sector [6]. Previous researches highlighted that disturbingly in hospitals adverse events high rates are outcome of avoidable incidents, few of which are probably due to nursing associated issues [7]. Scholars have associated outcomes of patient safety with quality of nursing working environment and nonexistence of effective and efficient leadership [7]. In organizational literature, transformational leadership style has been linked with reduction in adverse patient results [8]. However, few researches have explored the mechanisms by which leadership affects employee performance which subsequently influence outcomes of patient’s safety [9]. In the background of previous research work, one of the major knowledge gaps is how leadership in nursing trade and workplace features effect safety outcomes and quality of health care. Therefore, aim of this research was to examine a model connecting structural empowerment and transformational leadership towards nurse’s job gratification and frequency of adverse happenings in severe care situations. In this research, it has been examined how transformational leadership impact towards job satisfaction and outcome of patient’s safety and, structural empowerment as mediator.
Transformational leadership is performance based approach with aim to achieve performance beyond basic employee’s potential and to struggle for brilliance [10]. Researches have highlighted that transformational leadership is vital in building helpful working environment for nurses in whom they are organizationally empowered for provision of optimum patient care [11].
Numerous authors [12] have recommended that style of transformational leadership appears to be predominantly relevant in existing turbulent and nerve-wracking health care work atmospheres. Relating transformational leadership concept to this matter may offer awareness into the methods by which leadership can affect patient outcomes.
Theoretical framework and relevant research
This research integrates ideas from Bass theory of transformational leadership [13] and structural empowerment theory by Kanter [14] to study how workplace features effect job satisfaction and outcomes towards patient safety. Theoretical foundations of the thoughts in the suggested model are described in following paragraphs.
Transformational leadership
One of relational leadership style is transformational leadership in which employers have faith and admiration for their leadership and they are motivated for doing more than what is officially expected from them to attain organizational objectives [13].
Transformational leadership entails four basic dimensions: (1) Idealized inspiration (traits and actions) defines a manager for followers as an example or role model, establishes high conduct standards and he has capability to communicate organizational vision in struggle to win employees trust. (2) Inspirational enthusiasm reveals leader’s clear expression of a convincing visualization through arguments, cryptograms, and descriptions [13] to inspire employees for their performance. (3) Intellectual inspiration, reflects the degree to which leader implores workers perspective on issues and took into consideration a diverse variety of ideas during decision making [13]. (4) Transformational leadership reflects leaders which involve themselves in individualized consideration; address individual variances employee’s needs and pursue to counsel them in a struggle to assist them in reaching their full capabilities and potential [15].
Transformational leadership style has steadily been connected to employee behaviors, conduct and attitudes in both nursing and management backgrounds. Researchers are of the view that four ways of transformational leadership may help as experience in making working environment organizationally empower. For example, through intellectual inspiration, transformational leaders inspire employees to contribute in the process of decision making, which nurtures skills improvement, knowledge and critical thinking. Such leadership generates authorizing and empowering environments for nurses by affecting support quality, availability of resources at place of work and information. Behavior of transformational leaders is normally related with greater levels of workers satisfaction [16], performance of organization, work commitment of the followers [17], and workers enthusiasm to perform beyond than he was required for achieving assigned goal. In a research carried out on almost 700 nurses working in seven Canadian critical care hospitals, from Squires et al. [18] established significant association between job satisfaction and transformational leadership conduct of nurse working as managers. In recent times, [19] established that leaders with transformational can enhance patient care quality by ensuring citizenship behaviors at organizational level and caring practice environment. These researches elaborated the significance of transformational leadership style in generating work atmospheres that augments professional practices by nurse’s practice which resultantly encourage improved results for nurses and patients. Transformational leaders after developing positive interactions and relationship obtain followers trust faith and forestall their requirements by giving accessibility to structural authorizing factors (i.e., support, information, resources) essential for workers to complete their work in a better way.
Structural empowerment
Structural empowerment theory by Kanter [14] enlightens the ways by adopting which leaders can have impact on workers regarding completion their assigned task successfully by ensuring access to four structures of organization: resources, information, opportunities support, Informational access is regarding to have organizational objectives knowledge, technical as well as policies knowledge and proficiency required for effectiveness at job. Support access comprises of supervision and response delivered by subordinates, peers and supervisors. It also includes emotional and social support from associates. Resources access refers having supplies, materials, time, equipment and money required to accomplish assigned task. Lastly, opportunities access refers to growth, mobility and involves challenge’s access, competence recognition, rewards for skills, increased status and professional growth prospects that enhances one’s skills and information [14,20].
Various researches have been carried out to examine the theory of structural empowerment by Kanter in a diversity of nursing settings and populations. Structural authorization has been linked with hospital management features, for example greater stages of nurse independence and healthier relationships with physicians [21]. While working in empowering atmospheres, nurses have mutual support and sufficient resources needed for higher quality patient care [21]. Structural empowerment has emerged as an important predictor for greater job satisfaction in nursing profession [22,23].
Work commitment [24] organizational faith and obligation [25] turnover intents [26] and improvement in quality care [27].
Researchers recommended that nurses having transformational leadership traits may have increased organizational empowerment which lead towards improvement in working environments and outcomes of high-quality [28,29].
Adverse patient outcomes
The main worry of any health care delivery method, and in principle nursing, is in achieving best patient results [30]. Researches related to patient outcome has endorsed that most adverse patient results to issues in work atmosphere [31] and deficiency in visible, efficient and effective leadership [2].
Aiken et al. [32] established that poor working environments and insufficient nursing staff were adverse patient results predictors, for example pneumonia, medication mistakes, pressure ulcers, rescue failure and humanity. In succeeding sub investigation of Canadian statistics from this research, similar outcomes were stated [28]. In this research, nurse evaluated adverse patient results or happenings comprises medication mistakes, patient drops, infections developed from hospital, pressure ulcers, and /or family complaints as perceived by nurses not from supervisory or administrative databank sources. Nurse care quality ratings offer related yet different patient outcomes information because nurses are almost involved at all patient care points, which create their viewpoint a valued informational source. In a research of 396 U.S. hospitals of 16,000 nurses [33] Established that nurse evaluated pat [26] care quality was related with indicators of objective hospital excellence, such as patient contentment, rescue failure and rates of mortality advising that real and nurse professed patient outcomes evaluation are intertwined.
Job satisfaction
One of vital nursing outcome is job satisfaction, which is pretentious by work atmosphere quality. Even