The relationship between leadership style and health worker motivation, job satisfaction and teamwork in Uganda.
ABSTRACT: Leadership is key to strengthening performance of Health Systems. Leadership styles are important organizational antecedents, especially in influencing employee's motivation, job satisfaction, and teamwork. There is limited research exploring this relationship among health workers in resource-limited settings such as Uganda. The aim of this study was to examine the relationship between transformational, transactional, and laissez-faire leadership styles and motivation, job satisfaction, and teamwork of health workers in Uganda.We conducted a cross-sectional study in 3 geographic regions of Uganda in November 2015, using self-administered questionnaires with 564 health workers from 228 health facilities. Data were collected on health workers' perception of leadership styles displayed by their facility leaders, their level of motivation, job satisfaction, and team work. Using Pearson correlation, relationships among variables were identified and associations of the components of leadership styles with motivation, job satisfaction, and teamwork was found using multivariable logistic regression.Health workers in Uganda preferred leaders who were transformational (62%) compared with being transactional (42%) or laissez-faire (14%). Transformational leadership was positively correlated with motivation (r=0.32), job satisfaction (r=0.38), and team work (r=0.48), while transactional leadership was positively correlated with job satisfaction (r=0.21) and teamwork (r=0.18). Motivation was positively associated with leaders who displayed idealized influence-behavior (odds ratio [OR]=3.7; 95% CI, 1.33-10.48) and intellectual stimulation (OR=2.4; 95% CI, 1.13-5.15) but negatively associated with management by exception (OR=0.4; 95% CI, 0.19-0.82). Job satisfaction was positively associated with intellectual stimulation (OR=5.7; 95% CI, 1.83-17.79). Teamwork was positively associated with idealized influence-behavior (OR=1.07-8.57), idealized influence-attributed (OR=3.9; 95% CI, 1.24-12.36), and contingent reward (OR=5.6; 95% CI, 1.87-17.01).Transformational styles had a positive impact on stimulating motivation, assuring job satisfaction, and consolidating teamwork among health workers compared with those who demonstrated transactional skills or laissez-faire styles.Supporting transformational leadership skills development in health facility leaders could encourage health worker motivation, strengthen job satisfaction, and maintain cohesion among health workers for better service delivery.
Project description:In order to study the influence of different entrepreneurial psychological leadership styles on organizational learning ability and organizational performance and to provide theoretical basis for the improvement of organizational benefits of entrepreneurial enterprises in the future, 421 general managers, middle managers, and grassroots managers of 350 small- and medium-sized private enterprises in Beijing were surveyed by questionnaire in two forms: online and on-site. Then, a hypothesis model of the relationship between different entrepreneurial psychological leadership styles and organizational learning ability and organizational performance was constructed. The correlation between transformational, transactional, and laissez-faire psychological leadership styles and organizational performance and organizational learning ability was analyzed using multiple regression models. AMOS 7.0 software was used to simulate and verify the model. The results show that transformational psychological leadership style is positively correlated with organizational learning ability, financial performance, and growth performance; transactional psychological leadership style is positively correlated with organizational financial performance, growth performance, and organizational learning ability; there is no correlation between laissez-faire psychological leadership style and organizational financial performance and growth performance, but there is a significant positive correlation between laissez-faire psychological leadership style and organizational learning ability. The covariance between the error terms of the internal and external potential variables of the model is positive, and the factor load value of each potential variable and the observed variable is between 0.5 and 1, which shows that transformational and transactional psychological leadership styles have a more positive influence on organizational financial performance and learning ability than a laissez-faire psychological leadership style. The hypothesis model of the relationship between entrepreneurial psychological leadership styles and organizational learning ability and organizational performance conforms to the adaptation criteria and is feasible.
Project description:OBJECTIVES:This study aimed at opening the black box of the relationship between leadership and motivation of health workers by focusing on a high-performance hospital in Morocco. DESIGN:We adopted the realist evaluation approach and used the case study design to test the initial programme theory we formulated on the basis of a scoping review on complex leadership. We used the Intervention-Context-Actors-Mechanism-Outcome Configuration as a heuristic tool to identify plausible causal configurations. SETTINGS:Since 2000, the Ministry of Health in Morocco initiated many reforms in the frame of the governmental deconcentration process called 'advanced regionalisation'. The implementation of these reforms is hampered by inadequate human resource management capacities of local health system managers. Yet, the National 'Concours Qualité', a national quality assurance programme implemented since 2007, demonstrated that there are many islands of excellence. We explore how leadership may play a role in explaining these islands of excellence. PARTICIPANTS:We carried out a document review, 18 individual interviews and 3 group discussions (with doctors, administrators and nurses), and non-participant observations during a 2-week field visit in January-February 2018. RESULTS:We confirmed that effective leaders adopt an appropriate mix of transactional, transformational and distributed leadership styles that fits the mission, goals, organisational culture and nature of tasks of the organisation and the individual characteristics of the personnel when organisational culture is conducive. Leadership effectiveness is conditioned by the degree of responsiveness to the basic psychological needs of autonomy, competence and relatedness, perceived organisational support and perceived supervisor support. Transactional and overcontrolling leadership behaviour decreased the satisfaction of the need for autonomy and mutual respect. By distributing leadership responsibilities, complex leaders create an enabling environment for collective efficacy and creative problem solving. CONCLUSIONS:We found indications that in the Moroccan context, well-performing hospitals could be characterised by a good fit between leadership styles, organisational characteristics and individual staff attributes.
Project description:For the purpose of providing excellent patient care, residents need to be strong, effective leaders. The lack of clinical leadership is alarming given the detrimental effects on patient safety. The objective of the study was to assess whether a leadership training addressing transactional and transformational leadership enhances leadership skills in residents.A volunteer sample of 57 residents from postgraduate year one to four was recruited across a range of medical specialties. The residents took part in an interventional controlled trial. The four-week IMPACT leadership training provided specific strategies for leadership in the clinical environment, addressing transactional (e.g. active control, contingent reward) and transformational leadership skills (e.g. appreciation, inspirational motivation). Transactional and transformational leadership skill performance was rated (1) on the Performance Scale by an external evaluator blinded to the study design and (2) self-assessed transformational and transactional leadership skills. Both measures contained items of the Multifactor Leadership Questionnaire, with higher scores indicating greater leadership skills.Both scores were significantly different between the IMPACT group and the control group. In the IMPACT group, the Performance Scale increased 15% in transactional leadership skill performance (2.10 to 2.86) (intervention effect, 0.76; 95% CI, 0.40 to 1.13; p < .001, eta2 = 0.31) and 14% in transformational leadership skill performance (2.26 to 2.94) (intervention effect, 0.68; 95% CI, 0.27 to 1.09; p < .001, eta2 = 0.22). The self-assessed transactional skills revealed a 4% increase (3.83 to 4.03) (intervention effect, 0.20; 95% CI, 0.08 to 0.33; p < .001, eta2 = 0.18) and a 6% increase in transformational leadership skills (3.54 to 3.86) (intervention effect, 0.31; 95% CI, 0.02 to 0.40; p< .001, eta2 = 0.53).These findings support the use of the transactional and transformational leadership framework for graduate leadership training. Future studies should incorporate time-latent post-tests, evaluating the stability of the behavioral performance increase.
Project description:BACKGROUND:Motivation is critical to health worker performance and work quality. In Bihar, India, frontline health workers provide essential health services for the state's poorest citizens. Yet, there is a shortfall of motivated and skilled providers and a lack of coordination between two cadres of frontline health workers and their supervisors. CARE India developed an approach aimed at improving health workers' performance by shifting work culture and strengthening teamwork and motivation. The intervention-"Team-Based Goals and Incentives"-supported health workers to work as teams towards collective goals and rewarded success with public recognition and non-financial incentives. METHODS:Thirty months after initiating the intervention, 885 health workers and 98 supervisors completed an interviewer-administered questionnaire in 38 intervention and 38 control health sub-centers in one district. The questionnaire included measures of social cohesion, teamwork attitudes, self-efficacy, job satisfaction, teamwork behaviors, equitable service delivery, taking initiative, and supervisory support. We conducted bivariate analyses to examine the impact of the intervention on these psychosocial and behavioral outcomes. RESULTS:Results show statistically significant differences across several measures between intervention and control frontline health workers, including improved teamwork (mean = 8.8 vs. 7.3), empowerment (8.5 vs. 7.4), job satisfaction (7.1 vs. 5.99) and equitable service delivery (6.7 vs. 4.99). While fewer significant differences were found for supervisors, they reported improved teamwork (8.4 vs. 5.3), and frontline health workers reported improved fulfillment of supervisory duties by their supervisors (8.9 vs. 7.6). Both frontline health workers and supervisors found public recognition and enhanced teamwork more motivating than the non-financial incentives. CONCLUSIONS:The Team-Based Goals and Incentives model reinforces intrinsic motivation and supports improvements in the teamwork, motivation, and performance of health workers. It offers an approach to practitioners and governments for improving the work environment in a resource-constrained setting and where there are multiple cadres of health workers.
Project description:BackgroundNurses and midwives are a critical part of the healthcare team and make up the largest section of health professionals. Leadership styles are believed to be an important determinant of job satisfaction and retention making effective leadership within nursing and midwifery crucial to health systems success. In Rwanda, there are gaps in knowledge of managerial leadership styles of nurses and midwives and the influence of these styles on job satisfaction and retention for nurses and midwives who report to them, as well as their influence on the provision of health services. This study describes the managerial leadership styles adopted by nurses/midwives and examines the relationship between managerial leadership styles and job satisfaction, intention to stay, and service provision.MethodsThe Path-Goal Leadership questionnaire was adopted and used to collect data on leadership styles while other questionnaires with high validity and reliability were used to collect data on job satisfaction, intention to stay and service provision. The study involved 162 full-time nurses and midwives practicing in 5 selected hospitals with a minimum of 6 months of experience working with their current direct managers. Regression analysis was used to draw conclusions on relationships between variables.ResultsNurses and midwives managers were more inclined to the directive leadership style followed by a supportive leadership style, and the participative leadership style. The nurse and midwife’s managerial leadership styles together significantly explained 38, 10 and 23% of the variance in job satisfaction, intention to stay and service provision, respectively.ConclusionThe findings of this study indicate that managerial leadership styles play a substantial role in enhancing job satisfaction, intention to stay and service provision.The implication for nursing and midwifery managementThere is a need to develop a comprehensive formal professional continuous development course on leadership styles and ensure that all nurses and midwives managers benefit from this course prior to or immediately after being appointed as a manager. Having such a course may even prepare future leaders for their role early in their career. Effective leadership in nursing and midwifery should be enhanced at all levels to improve the job satisfaction of nurses and midwives, address the issue of retention in their respective health facilities and strengthen service provision.
Project description:OBJECTIVES:We aimed at exploring the underlying mechanisms and contextual conditions by which leadership may influence 'public service motivation' of health providers in Moroccan hospitals. DESIGN:We used the realist evaluation (RE) approach in the following steps: eliciting the initial programme theory, designing the study, carrying out the data collection, doing the data analysis and synthesis. In practice, we adopted a multiple embedded case study design. SETTINGS:We used purposive sampling to select hospitals representing extreme cases displaying contrasting leadership practices and organisational performance scores using data from the Ministry of Health quality assurance programmes from 2011 to 2016. PARTICIPANTS:We carried out, on average, 17 individual in-depth interviews in 4 hospitals as well as 7 focus group discussions and 8 group discussions with different cadres (administrators, nurses and doctors). We collected relevant documents (eg, performance audit, human resource availability) and carried out observations. RESULTS:Comparing the Intervention-Context-Actor-Mechanism-Outcome configurations across the hospitals allowed us to confirm and refine our following programme theory: "Complex leaders, applying an appropriate mix of transactional, transformational and distributed leadership styles that fit organisational and individuals characteristics [I] can increase public service motivation, organisational commitment and extra role behaviours [O] by increasing perceived supervisor support and perceived organizational support and satisfying staff basic psychological needs [M], if the organisational culture is conducive and in the absence of perceived organisational politics [C]". CONCLUSIONS:In hospitals, the archetype of complex professional bureaucracies, leaders need to be able to balance between different leadership styles according to the staff's profile, the nature of tasks and the organisational culture if they want to enhance public service motivation, intrinsic motivation and organisational commitment.
Project description:It is well documented that both work stress and work motivation are key determinants of job satisfaction. The aim of this study was to examine levels of work stress and motivation and their contribution to job satisfaction among community health workers in Heilongjiang Province, China.Cross-sectional survey.Heilongjiang Province, China.The participants were 930 community health workers from six cities in Heilongjiang Province.Multistage sampling procedures were used to measure socioeconomic and demographic status, work stress, work motivation and job satisfaction. Logistic regression analysis was performed to assess key determinants of job satisfaction.There were significant differences in some subscales of work stress and work motivation by some of the socioeconomic characteristics. Levels of overall stress perception and scores on all five work stress subscales were higher in dissatisfied workers relative to satisfied workers. However, levels of overall motivation perception and scores on the career development, responsibility and recognition motivation subscales were higher in satisfied respondents relative to dissatisfied respondents. The main determinants of job satisfaction were occupation; age; title; income; the career development, and wages and benefits subscales of work stress; and the recognition, responsibility and financial subscales of work motivation.The findings indicated considerable room for improvement in job satisfaction among community health workers in Heilongjiang Province in China. Healthcare managers and policymakers should take both work stress and motivation into consideration, as two subscales of work stress and one subscale of work motivation negatively influenced job satisfaction and two subscales of work motivation positively influenced job satisfaction.
Project description:Transformational leadership is a popular and well-researched leadership style. Although much is understood about its positive consequences, less research has focused on antecedents of transformational leadership. In this research we draw upon self-determination theory and incorporate a self-regulatory approach to investigate if and how leader mindfulness influences transformational leadership. The analyses show that autonomy, competence and relatedness need satisfaction mediate between mindfulness and transformational leadership, indicating that mindfulness is associated with psychological need satisfaction. Furthermore, the data show that neuroticism moderates the relationship between mindfulness and relatedness need satisfaction. Generally speaking, the association between mindfulness and relatedness need satisfaction is positive. When neuroticism is also high, mindfulness has the largest impact. Or conversely, when emotional stability is high, mindfulness has the smallest association with relatedness need satisfaction. This is in line with evidence suggesting that mindfulness may primarily exert its influence through emotional self-regulation. Furthermore, the moderated mediation model for relatedness need satisfaction is significant, indicating that neuroticism is a boundary condition for the indirect effect of mindfulness on transformational leadership through relatedness need satisfaction.
Project description:BACKGROUND: Motivation and job satisfaction have been identified as key factors for health worker retention and turnover in low- and middle-income countries. District health managers in decentralized health systems usually have a broadened 'decision space' that enables them to positively influence health worker motivation and job satisfaction, which in turn impacts on retention and performance at district-level. The study explored the effects of motivation and job satisfaction on turnover intention and how motivation and satisfaction can be improved by district health managers in order to increase retention of health workers. METHODS: We conducted a cross-sectional survey in three districts of the Eastern Region in Ghana and interviewed 256 health workers from several staff categories (doctors, nursing professionals, allied health workers and pharmacists) on their intentions to leave their current health facilities as well as their perceptions on various aspects of motivation and job satisfaction. The effects of motivation and job satisfaction on turnover intention were explored through logistic regression analysis. RESULTS: Overall, 69% of the respondents reported to have turnover intentions. Motivation (OR?=?0.74, 95% CI: 0.60 to 0.92) and job satisfaction (OR?=?0.74, 95% CI: 0.57 to 0.96) were significantly associated with turnover intention and higher levels of both reduced the risk of health workers having this intention. The dimensions of motivation and job satisfaction significantly associated with turnover intention included career development (OR?=?0.56, 95% CI: 0.36 to 0.86), workload (OR?=?0.58, 95% CI: 0.34 to 0.99), management (OR?=?0.51. 95% CI: 0.30 to 0.84), organizational commitment (OR?=?0.36, 95% CI: 0.19 to 0.66), and burnout (OR?=?0.59, 95% CI: 0.39 to 0.91). CONCLUSIONS: Our findings indicate that effective human resource management practices at district level influence health worker motivation and job satisfaction, thereby reducing the likelihood for turnover. Therefore, it is worth strengthening human resource management skills at district level and supporting district health managers to implement retention strategies.
Project description:It is widely acknowledged that women in science, technology, engineering, mathematics, and medicine (STEMM) fields are underrepresented in leadership globally. However, little is known about how leadership styles of women in STEMM relate to this underrepresentation. This article discusses findings from a survey examining how 61 women in STEMM define leadership and describe their own leadership styles. Using content analysis and drawing on Full Range Leadership Model factors, findings suggest that women define leadership and describe their own leadership styles using transformational factors. However, there was no consistency in how participants defined ideal leadership or how they defined their own leadership styles. This finding unsettles ideas of distinctly gendered leadership styles. We argue that expectations that leadership will be performed in distinctly gendered styles may be contributing to the underrepresentation of women in leadership roles in STEMM.