Transformational Theory of Leadership

Transformational Theory of Leadership


Leadership in health care organizations is critical in improving the quality of care accorded to patients. Health care organizations are currently facing immense challenges ranging from shortage of medical personnel, high number of patients, increasingly diverse demographics, and fewer resources to support service provision. With regard to this, health care practitioners need to employ innovative strategies in order to enhance quality service delivery to patients. One of the ways that leaders in health care organizations can improve management practices is by deploying an effective health care administration leadership theory. Clinical leaders are essential in improving the quality of health care organizations and helping them overcome the modern-day challenges. The transformational theory of leadership can significantly help in improving management practices in health care organizations through inspiring and motivating employees. The purpose of this paper is to expand our current knowledge and understanding on the role of transformational theory of leadership in improving patient safety through service delivery across health care organizations.


The transformational theory of leadership asserts that leadership is all about inspiring employees to become self-directed (Jones, 2007). The theory contradicts motivational theories, which partly assert that leaders should motivate employees to work hard to external rewards such as higher pay. Transformational leaders inspire employees to work hard not for external rewards or exchanges, but for self-actualization. Transformational leaders establish mutual relationships with their followers; they establish motives among their followers, engage them, and evaluate their higher needs with an aim of meeting these needs. The mutual relationship that results transforms followers to mortal leaders in their respective fields. The transformational leader must have a strong self-esteem that leads to feelings of self-worth and adequacy. In transformational leadership, employees are able to contribute towards decision making in the organization. As a result, it is possible to identify the hidden talents of the employees.

Revised Literature Review and Problem Statement

Vast volumes of literature exist on the role of transformational leadership in health care administration. This section analyzes extant literature on this subject, drawing from peer-reviewed articles and other academic literature.

The effectiveness of nurse leaders significantly determines the ability of the health care organization to achieve optimal care outcomes, including patient safety. Huston (2008) examines the role of nurse executives in strategic management in health organizations. The study identifies eight core competencies that nurse leaders must gain in the modern world. Key among these competencies is developing collaborative skills, which are essential in team building. Capuano, Bokovoy, Hitchings, and Houser (2005) employ a structural model to examine the impact of work environment, resources, staff expertise, work environment, and leadership on patient outcomes. The findings indicate that transformational leadership approach is positively associated with staff expertise, which invariably contributes to improved patient outcomes. Some studies have examined the efficacy of the transformational leadership style when applied in the emergency department. By employing a multifactor leadership questionnaire, Raup (2008) notes that there is reduced turnover rate among nurses in health organizations practicing transformational leadership.

Gregory (2006) conducts a survey in an effort to examine the relationship between transactional and transformational leadership and the attitude of various service providers. This study hypothesizes that transformational leadership contributes to the development of positive attitudes with regard to implementation of evidence-based practices. The study included 322 participants, majority of whom were employees in a medical health organization. The study indicates that transformational leadership had a significantly higher impact on the attitudes of employees in implementing evidence-based practices compared to transactional leadership. Julie (2013) conducts a literature review to evaluate the efficacy of transformational leadership in health care. The findings indicate that transformational leadership is key in improving the performance, motivation and moral of health workers. This contributes to patient safety. These findings echo those by Robin (2016) on transformational leadership, which indicates that this form of leadership significantly improves the performance of health workers.

An important concern in the health sector regards patient safety. Some studies have focused on the role of transformational leadership in enhancing patient safety. McFadden, Henagan, and Gowen (2009) examine the impact of transformational leadership style to patient safety. The trio conducted an empirical review drawing data from 626 US hospitals. The findings indicate that there is a strong correlation between transformational leadership and patient safety culture in the organizations surveyed. Some scholars have explored the efficacy of the Multifactor Leadership Theory in the management of health care organizations. This theory recommends the application of three different leadership styles: transformational, transactional, and laissez-faire type of leadership (Kanste, Miettunen, & Kynqas, 2007). According to this theory, application of the three styles of leadership can significantly improve patient outcomes in health care settings.

A number of researchers have focused on the role played by transformational leadership in enhancing the safety performance of employees. There are concerns that majority of health organizations are yet to achieve high levels of safety despite the tremendous changes in health systems over the years. Inness, Barling, Turner, and Stride (2010) examine the role of transformational leadership to safety performance of the employees. The study utilizes an empirical analysis using a sample of 159 respondents. Data was obtained through self-reporting of the respondents. Structural models are used to test the hypothesis in the study. The findings indicate that transformational leadership is key in enhancing the safety performance of employees. Transformational leadership enhances the development of a learning culture, which is critical in ensuring patient safety.

Wong, Cummings, and Ducharme (2013) conduct a meta-analysis of existing literature with an aim of identifying the relationship between nursing leadership practices and patient outcomes. The three examined 20 studies that analyze nursing leadership. The study finds a positive correlation between relational leadership and lower medication errors and improved patient outcomes. This study identifies a gap in available literature that supports specific leadership styles in improving patient outcomes. As such, there is need for robust studies that examine the efficacy of various leadership styles in health care settings. Little is known about the relationship between nursing leadership styles and patient outcomes.

Some studies aim at investigating the efficacy of different leadership styles in improving patient safety and quality of care. Verschueren, Kips, and Euwema (2013) conduct a meta-analysis of existing literature from 200 to 2011. The meta-analysis of literature indicated that transformational leadership style was the most effective in improving patient outcomes in health care organizations. Transformational leadership is associated with improved organizational citizenship behaviors among employees. Humphrey (2012) defines the organizational citizenship behaviors as those activities that employees engage in during the course of their job but are not formally recognized in their job specifications. Organizational citizenship behaviors are important in helping develop a positive image of the organization. This study employs a survey methodology using a sample of 128 participants. The findings indicate that transformational leadership greatly improves the organizational citizenship behavior of employees.

Some studies have raised concern over the overall impact of the leadership style employed in a particular organization. The major issue of concern concerns whether one type of leadership is context-specific or whether it exhibits characteristics of context-spillover. Ritter and Lord (2007) examine this issue with positive results. The duo concludes that experiences obtained by employees in one context are likely to be transferred to another job or different context. For instance, employees who experience high job motivation may continue to feel so even when they move to new organizations. Moreover, a single employee may hold more than one job. Evidence of context specific transference is also available. Transformational leadership can at times influence employees at a particular context without the occurrence of a transference. For instance, context-specific effect of this style of leadership is evident among employees who are able to distinguish the experiences of one leader from that of a different leader.

The quality of care provided to patients partly depends on how the nurses receive training and their willingness to observe all medical procedures. One of nurses’ key role is providing medication, which also greatly reflects on the quality of care at the organization. Vaismoradi, Griffiths, Turunen, and Jordan examine the role of transformational leadership in enhancing medication safety education among nurses. The major role of this study is to examine how transformational leadership reduces cases of adverse drug events in health care organizations. The results indicate that transformational leadership plays a significant role in teaching medication safety among nurses. The study notes that for this style of leadership to be effective, there should be mutual relationship between the policy makers, managers and the educators concerned.

Application of appropriate leadership styles in health care organizations is essential in promoting job satisfaction among nurses. A study conducted by Armstrong, Laschinger, and Wong (2009) indicates that transformational leadership is critical in promoting a healthy nursing environment. Transformational leadership also improves patient safety in health care organizations. This study included a sample of 300 participants from different Canadian hospitals. The study supports the results of other researches, which indicate that the transformational leadership style is the most effective leadership style in health care organizations. Although errors may naturally occur in the field of nursing, the style of leadership determines the frequency and severity of the errors. According to Katz-Navon and Stern (2005), few medical errors are reported in hospitals that have instituted a culture of safety. Fewer errors are reported in hospitals that have redesigned their workplace environment or those that have modified their systems.

Fischer (2016) conducts a conceptual analysis on transformational leadership in health care settings using a meta-analytical approach. The aim of the study is to gain a deeper understanding of the role of transformational leadership in the field of nursing. The findings support the conclusions made by previous studies concerning the efficacy of the transformational leadership concept. The study concludes that transformational leadership contributes to high performance of health care workers and consequently, improved patient care. The study notes that the concept of transformational leadership can be put in the category of teachable competencies. This means that nurse leaders can learn the concept of transformational leadership in training situations and apply these concepts effectively in the hospital environments. Fischer (2016) employs the Multifactor Leadership Questionnaire (MLQ) to measure the efficacy of transformational leadership in health care organizations. This questionnaire has been widely used in measuring the effectiveness of various leadership models.

An eminent gap within the existing literature regards the identification of the actual mechanisms or ways by which the transformational theory of leadership affects patient outcomes. The specific mechanisms through which transformational leadership style in organizations influences various measures of outcomes such as patient safety and the quality of care remains unclear. There is also a gap in existing literature regarding the comparison of the transformational theory of leadership with other leadership theories in health care settings. Few studies exist comparing transformational leadership style with other forms of leadership, and providing support for the most robust theory of leadership. The empirical references by which the theory is hedged on are also weak. More researches are necessary in order to support the current empirical references. For instance, some critics argue that the inherent processes of the transformational theory of leadership are not clear.

Personal Health Care Administration Leadership Theory

My personal health care administration leadership theory involves the transformational theory of leadership. Transformational theory helps health care organizations to clarify vision. The theory of leadership is important in empowering employees by increasing their self-confidence in making critical decisions within the organization. The theory helps in developing alternative solutions to problems that arise in the workplace (Fischer, 2016). Another key aspect of the theory is that it helps in inspiring employees. This increases the productivity of an organization that employs this theory in management. The foundations of transformational theory lie on developing personal interpersonal relationships that transcends the hierarchical levels in the organization. Communication is another key aspect of the theory. The leadership approach requires that employees maintain open communication irrespective of their position. Transformational leadership instills confidence and innovativeness among employees to handle day-to-day challenges that may arise (Fischer, 2016). This is critical in improving patient outcomes.

Transformational leadership has a number of defining attributes (Fischer, 2016). The first attribute is idealized influence. This involves the leader acting as a role model in the organization. The leader behaves in an ethical manner and is responsible for making tough decisions when the need arises. The second attribute is inspirational motivation, which involves inspiring employees to commit towards achieving organizational goals. Leaders must communicate expectations to employees and challenge them to achieve the organizational goals (Armstrong, Laschinger, & Wong, 2009). Intellectual stimulation is the third attribute. This attribute emphasizes on the ability of the employees to evaluate the current assumptions held in the organization as well as develop creativity in solving problems. This attribute encourages employees to become innovative in handling various challenges in the organization. The last attribute is individualized consideration, which involves examining the specific manner in which a leader interacts with employees (Fischer, 2016). This helps in the development of a supportive culture.

An example of transformational leadership in health organizations is where the leader demonstrates a caring attitude towards workers and is passionate concerning the team’s mission. The transformational leader should make the followers experience warmth and security while relating to him or her (Armstrong, Laschinger, & Wong, 2009). This is based on the idealized influence attribute. The leader should develop trusting relationships with the employees. Another key aspect is demonstration of ethical behavior. A transformational leader should follow the ethical guidelines established by the organization (Fischer, 2016). This helps in making tough decisions and avoiding legal issues that may arise out of making the wrong decisions. The leaders should exhibit honesty and integrity in dealing with other people. The transformational leader should be keen to put forward his/her personal career growth and that of the employees. Transformational leaders are known to make value-based decisions that inspire motivation among the followers.

Transformational theory of leadership holds that in order for the leader to inspire followers, he must modify behavior in ways that allow him to accommodate the behavior of others. This is similar with the assertion of the congruent leadership model (Fischer, 2016). Transformational leadership is preventive or proactive in nature. This is contrary with the assertions of the transactional model, which calls for reactive type of behaviors in organizations. The proactive attribute encourages leaders to identify potential problems in the environment before they lead to damages. Contingent rewards are given to followers who achieve specific goals in order to keep them motivated. Transformational leadership is recognized as one of the leadership styles that can help in transforming the organizational culture and process (Armstrong, Laschinger, & Wong, 2009). This is achieved through inspiring, motivating, and engaging employees to adapt new behaviors.

Revised Visual Representation of your Health Care Administration Leadership Theory

The transformational theory of leadership in health care administration is key in achieving positive outcomes. Nurse leaders can apply the transformational model in health care settings to achieve positive outcomes among patients. However, there is a lack of extant literature on the role of nurse managers with regard to the transformational theory of leadership. Existing literature fails to provide details concerning how the nurse leaders may involve nurse managers in order to help in transforming the health care organization. It is worth noting that the nurse manager has a more formal role in the health care setting compared to the nurse leader. Nurse managers are expected to fulfill certain duties in the health care organization. The major concern is how the nurse leader can build mutual relationship with the nurse manager in order to bring change to the organization. Nurse leaders cannot work alone to bring change in the organization, but they need help from other key stakeholders in the organization to bring change.

The management is concerned with designing, developing, maintaining, and implementing various tasks and processes. Most often, these kind of competencies cannot surface to support the entire strategies and visions identified by the organization. As such, there is need for other forms of leadership that can help in bringing change in the organization. The nurse leader is different from the nurse manager. The nurse manager is concerned with coordinating resources in the organization (financial and human resources), setting goals and objectives, ensuring ethical guidelines are followed, and other managerial roles. It is difficult to teach the competencies of the transformational leader to others in the organization, including the nurse manager. Organizations wishing to teach the competencies of the transformational leader can begin by first examining the characteristics associated with the transformational leadership. Some of these characteristics are honesty, effective communication skills, accountability, listening skills, and others.

The four dimensions of transformational leadership

The transformational leader is involved in motivating and increasing the morale of the employees. This can be achieved through a number of ways, which include leading by example, coaching & empowerment, inspiring employees to reach new heights, and encouraging growth and learning. The transformational leader acts as the role model so that followers can get inspiration. The inspirational leader must also challenge followers to go beyond working for external rewards. Employees are more productive when they value their work not for external rewards but for its intrinsic value. It is also important for the leader to take into consideration the strengths or weaknesses of the workers. This enables the leader to align followers with jobs or tasks that match their abilities.

Systems thinking in health care settings refer to an approach that defines and takes into consideration the various aspects of complex adaptive systems. Complex adaptive systems are dynamic social systems that keep on changing depending on various factors (Swanson et al., 2012). The various components of complex adaptive systems include patients, health care providers, communities, policy makers, citizens, and other stakeholders. These components are dynamic due to the changes in the environment. Health organizations, which are part of the adaptive systems, have certain characteristics such as constant changes, time differences in inputs and outcomes, self-organization characteristics, and feedback loops. Systems thinking take into consideration the impacts of complex adaptive systems and in doing so attempts to achieve maximum positive effects. Systems thinking hold great potential in addressing the challenges that the public health sector is currently facing.

Under the concept of systems thinking, three major themes are evident. These include collaboration across disciplines and organizations, ongoing learning, and transformational leadership (Swanson et al., 2012). In the application of systems thinking, a number of tools and strategies are applied. Organizations that utilize systems thinking often develop a common vision or purpose that guides employees. These organizations may also put into use a number of system thinking tools such as concept mapping, systems dynamics modelling, social network analysis, knowledge synthesis, and program budgeting. Organizations utilizing the concept of systems thinking may evaluate their health programs on regular basis with the aim of enhancing capacity. These organizations may also spend a great deal of time and resources in capacity development and implementing transformational leadership. Systems thinking is also characterized by the application of feedback loops, careful monitoring of processes, and transparent use of information.

Empirical Evaluation Plan for a Health Care Administration Leadership Theory

It is important to examine the efficacy of the transformational theory of leadership in improving patient safety outcomes. Patient safety is a significant area that health care organizations cannot choose to ignore. Patient safety outcomes reflect the overall effectiveness of service delivery at any health facility. In order to examine patient safety, it is important to establish applicable patient safety indicators. Patient safety indicators are the adverse events encountered by patients during their stay at the health facility. The patient safety indicators under consideration in this study are as follows:

  • Accidental punctures and laceration.
  • Specific hospital acquired infections.
  • Incidences of foreign body left at the area of operation.
  • Transfusion reaction.
  • Complications involving anesthesia.
  • Incidences involving administration of wrong drugs or injections to patients.

All patient safety indicators are preventable. It is worth noting that the lower the case of these patient safety indicators the safer the health facility is considered to be. Lack of adherence to safety standards or protocol touches on the patient safety indicators mentioned above. The consequences resulting from this can be referred to as hospital-acquired conditions (HAC), which is the adverse effect as it manifests itself on the patient. Process Quality Scores (PQSs) will be used as a measure of the hospital’s ability to provide care to a given set of patients with particular needs.


This study will employ a survey methodology. The study will use health care facilities as the unit of the analysis. The first part of the study entails developing an initial questionnaire that is sent to various hospital directors countrywide. This will be a pilot survey meant to obtain response from the hospitals about their willingness to participate in the study. Telephone interviews will be employed during the initial phase to reduce any ambiguities that could be there. If hospital directors are not available, the researchers will contact patient safety director, risk management director, quality director, or even the chief quality officer. This will also be a good opportunity for the team of researchers to convince the hospital management of the need to participate in the study. The inclusion criteria recommend that the study utilize only the hospital based organizations with a bed capacity of 50 beds and more. This means that mammography centers, clinics, and other small private facilities will face exclusion from the study.

From the list of all eligible hospitals that make a response, the researchers will email surveys bearing appropriate questions. The focus of the research questions will be on quality, patient safety, medical errors, and leadership style exhibited by the management. It is imperative to identify the leadership style exhibited in each of the hospitals involved in the survey. With this regard, the researchers will provide a list of leadership characteristics whereby the respondents will pick the best match or one that fits their organization. This list will detail characteristics of various leadership styles such as transformational leadership, transactional leadership, democratic leadership, authoritarian leadership, and laissez-faire leadership. Respondents will use the four categories to detail the kind of leadership style in their respective organizations.

Data Collection

Data concerning patient safety indicators will be obtained from relevant government websites such as and These websites contains information about all hospitals in the U.S. They also provide detailed comparisons of various patient care indicators in different hospitals. The aim is to provide consumers with detailed information about where they can obtained quality health services. Data for all hospitals will be collected from the same period or year. This will help in avoiding bias. In addition, hospitals will be at liberty to make a choice on whether to submit data concerning the patient safety indicators. This data is available in all hospitals and is similar to that contained in the government-run websites. Hospitals must report data concerning the leadership style applied since this data is not available anywhere else.

It is important that the data submitted by the respondents concerning patient safety indicators should match to that obtained from the websites. This will be a way of ensuring that the respondents submit accurate and reliable data. Transformational leadership will be measured using a questionnaire having 8 items. The items will prompt respondents to list the frequency with which the top leadership applied the specific item. The other leadership styles will be analyzed using questionnaires having 5 items. Measures of skewness and kurtosis will be used to measure whether the data obtained deviates from the norm. Statistical modeling will be used to analyze data obtained from the survey. This will provide an accurate report of the efficacy of the transformational leadership model in health care organizations.


The transformational theory of leadership is effective in improving patient outcomes in hospitals. The model of leadership is associated with positive impacts on patient safety culture within the hospital, patient safety initiatives by nurses, and improvement in overall patient safety outcomes. The literature review indicates that majority of studies support relational models of leadership in health care organizations. Transformational leadership improves almost every aspect of healthcare organizations – from effectiveness of emergency departments, general staff expertise, staff motivation, development of positive attitudes, patient safety, and in among other areas. Today’s health care leaders cannot afford to ignore the benefits of transformational theory of leadership in helping transform their organizations positively and in improving patient outcomes. Patient safety is one of the most important considerations in health care organizations. Since the transformational model helps improve patient safety, it is important that health care organizations should consider it imperative to adopt and implement the model in practice.

Some studies have investigated the efficacy of different leadership styles in improving patient safety and quality of care. These studies conclude that transformational leadership style is the most effective in improving patient outcomes in health care organizations. Transformational leadership is associated with improved organizational citizenship behaviors among employees.. The findings also indicate that transformational leadership greatly improves the organizational citizenship behavior of employees. This is significant in improving the overall performance of the organization. Application of appropriate leadership styles in health care organizations is essential in promoting job satisfaction among nurses. Transformational leadership is critical in promoting a healthy nursing environment. Transformational leadership also improves patient safety in health care organizations. Although errors may naturally occur in the field of nursing, the style of leadership determines the frequency and severity of the errors. Few medical errors are reported in hospitals that employ transformational leadership model.


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