doi: 10.56294/hl2024.365
ORIGINAL
Exploring the Impact of Transformational Leadership on Healthcare Quality Improvement
Exploración del impacto del liderazgo transformacional en la mejora de la calidad de la atención sanitaria
Rakesh Mohanty1
,
Ramesh Saini2 ,
Sourav Rampal3 ,
Avinash Mane4 ,
Malathi H5 
,
Shivangi Bansal6 ,
Bijal Shah7
1IMS and SUM Hospital, Siksha ‘O’ Anusandhan (Deemed to be University), Department of Psychiatry, Bhubaneswar, Odisha, India.
2Centre of Research Impact and Outcome, Chitkara University, Rajpura, Punjab, India.
3Chitkara Centre for Research and Development, Chitkara University, Himachal Pradesh, India.
4Krishna Vishwa Vidyapeeth “Deemed to be University”, Department of Pathology, Taluka-Karad, Dist-Satara, Maharashtra, India.
5JAIN (Deemed-to-be University), Department of Biotechnology and Genetics, Bangalore, Karnataka, India.
6School of Engineering & Technology, Noida International University, Greater Noida, Uttar Pradesh, India.
7Parul Institute of Management and Research-MBA, Parul University, Vadodara, Gujarat, India.
Cite as: Mohanty R, Saini R, Rampal S, Mane A, Malathi H, Bansal S, et al. Exploring the Impact of Transformational Leadership on Healthcare Quality Improvement. Health Leadership and Quality of Life. 2024; 3:.365. https://doi.org/10.56294/hl2024.365
Submitted: 08-03-2024 Revised: 21-07-2024 Accepted: 18-11-2024 Published: 19-11-2024
Editor: PhD.
Prof. Neela Satheesh 
ABSTRACT
Introduction: transformational leadership has also become a well-accepted means to improve quality of care in practice. What it means is that leaders need to lead with motivation and inspiration to embrace the changing landscape of the business world and in still this urge to achieve higher standards. The purpose of this study is to examine the effect of transformational leadership on healthcare quality improvement.
Method: a systematic literature review was performed, and articles were chosen from different electronic databases. Inclusion criteria had been studies that focused on transformational leadership and healthcare quality improvement. Fifteen articles were included in the analysis.
Results: overall the results indicated positive effects of transformational leadership regarding healthcare quality improvement across studies in hospitals, long-term care, and community health settings. The findings showed components of transformational leadership, like individualized consideration, inspirational motivation, and intellectual stimulation, were integral to facilitate the quality improvement initiative. They create an environment for healthcare teams to learn and collaborate, leading to improved patient outcomes and satisfaction.
Conclusions: caution about potential hidden variable persistency in research applications of this type should be applied. When organizations commit to transformational leadership, their healthcare environment can sustain continuous improvement. There is a need for additional study to determine how transformational leadership affects healthcare quality specifically and what solutions can be developed to determine its best application.
Keywords: Transformational Leadership; Healthcare; Electronic Databases; Inspirational Motivation.
RESUMEN
Introducción: el liderazgo transformacional también se ha convertido en un medio bien aceptado para mejorar la calidad de la asistencia en la práctica. Lo que significa es que los líderes tienen que dirigir con motivación e inspiración para abrazar el cambiante panorama del mundo empresarial y, aun así, este afán por alcanzar niveles más elevados. El propósito de este estudio es examinar el efecto del liderazgo transformacional en la mejora de la calidad asistencial.
Método: se realizó una revisión bibliográfica sistemática y se seleccionaron artículos de distintas bases de datos electrónicas. Los criterios de inclusión habían sido estudios centrados en el liderazgo transformacional y la mejora de la calidad asistencial. En el análisis se incluyeron quince artículos.
Resultados: en general, los resultados indicaron efectos positivos del liderazgo transformacional en la mejora de la calidad de la atención sanitaria en estudios realizados en hospitales, centros de cuidados de larga duración y centros de salud comunitarios. Los resultados mostraron que los componentes del liderazgo transformacional, como la consideración individualizada, la motivación inspiradora y la estimulación intelectual, eran esenciales para facilitar la iniciativa de mejora de la calidad. Crean un entorno propicio para que los equipos sanitarios aprendan y colaboren, lo que se traduce en una mejora de los resultados y la satisfacción de los pacientes.
Conclusiones: hay que tener cuidado con la posible persistencia de variables ocultas en aplicaciones de investigación de este tipo. Cuando las organizaciones se comprometen con el liderazgo transformacional, su entorno sanitario puede sostener la mejora continua. Es necesario realizar más estudios para determinar cómo afecta específicamente el liderazgo transformacional a la calidad asistencial y qué soluciones pueden desarrollarse para determinar su mejor aplicación.
Palabras clave: Liderazgo Transformacional; Asistencia Sanitaria; Bases De Datos Electrónicas; Motivación Inspiradora.
INTRODUCTION
Transformational leadership is a leadership theory(1) that describes how leaders can inspire and encourage followers to attain their full potential and, in doing so, realizing the objectives of the organization. Such leadership-models have been shown to strongly influence quality of care part of healthcare; this is an ongoing process aiming to provide the best possible care for every patient. Transformational leadership can thus help improve the quality of healthcare, primarily in three ways; one of them, while performing the organization in delivering high quality healthcare, by creating a culture that puts people and patients first.(2) Patient-centricity means putting patient needs and preferences at the heart of every decision. There is a focus on open communication and collaboration between patients, their families, and healthcare providers in a transformational leader. This results in greater insight into patients’ needs, better satisfaction with care, and, ultimately improved care quality.(3) Transformational leaders may transfer or use to inspire and motivate their workers. This is reflected in healthcare settings through supportive and participative leadership styles. These leaders foster a culture where their team feels comfortable sharing their input, resulting in a more active and passionate workforce. As a result, this can lead to better quality care because employees feel appreciated and are more likely to give the utmost care today. The transformational leadership style is also associated with continual quality improvement.(4) Transformational leaders focus on vision and are successful in motivating and inspiring the subscribe through a shared purpose. In the healthcare industry, this goal may involve the continuous enhancement of provided care. And they are not afraid to challenge the status quo, seeking innovative answers to problems(5). What is transformational leadership? In the context of health care, transformational leadership may also influence quality improvement initiatives through its emphasis on ongoing learning and development. These are leaders who care about professional growth and development not only for themselves, but also for their team. They foster a culture of ongoing learning, encouraging their team to look for the new knowledge and skills they bring to improving practice.(6) It may also increase the levels of competence and expertise amongst healthcare providers, leading to an improved quality of care for patients. One of the defining characteristics of transformational leaders is their capability to be able to build strong relationships and create effective communication flows. This is crucial because provider–patient communication can substantially improve healthcare outcomes.(7) This means that transformational leaders create an environment of trust and transparency, leading to more effective communication at all levels. This can also help facilitate better coordination and collaboration between health care providers, which can lead to better quality of care and better patient outcomes. It should be noted that transformational leadership does come with challenges in its application into quality improvement in healthcare.(8) The number one challenge is resistance to change prevalent in several healthcare organizations. Implementing a change is complicated and may met with resistance from employees,(9) largely because of the intricacy of healthcare systems and procedures. Transformational leaders need to be ready to face and work through these challenges with support and guidance while crafting a sense of urgency for change. The impact of transformational leadership in the context of healthcare quality improvement. These leaders foster patient-centered cultures, empower employees, encourage continuous leaning and relationships are built which can lead to higher quality of care. In order for transformational leadership to realize its potential for improving the quality of healthcare, there must be excellent leadership in healthcare organizations and an appropriate and open culture.(10) The contribution of the paper is the following
Transformational leadership is about empowering and inspiring individuals to reach their potential. Such leadership may engender a more motivated and engaged healthcare workforce, and, ultimately, lead to better patient outcomes.
Element of transformational leadership is motivating a collective and participatory culture. It translates into improved collaboration, communication, and coordination between healthcare providers and departments.
Highly Successful Transformational leaders are always on the lookout for ways to enhance processes and systems. The never-ending quest for improvement in patient safety, access to the care, and satisfaction of the patients may lead to endless consulting hours and wide-ranging redesign efforts.
Ribeiro, N et al. A transformational leadership style encourages the follower to take ownership of their work, which leads to a more productive environment. This form of leadership has been shown, at least in some research, to enhance employees’ engagement and enthusiasm for their work, which leads to boosted performance. This is attributed to transformational leaders cultivating a positive and supportive work culture where employees can personal and professional growth. Miao, R et al. argued that enlightened, a high-performance work system focusing on employee involvement, training, and rewards can improve both work well-being and employee creativity. Transformational leadership contributes to the enhanced relationship between creativity and innovation, as leaders who possess the ability to inspire and motivate employees will create a positive workplace environment that promotes innovative thinking. Al-Husseini et al., were interested to discuss this study that uses structural equation modeling to evaluate the effect of the transformational leadership on knowledge sharing in higher educational institutions in Iraq. This study also seeks to explore outcomes with knowledge-sharing and leading to offer insights and recommendations beyond the existing theories on implications for enhancing knowledge-sharing practices in higher education in the context of Iraqi higher education. Bagheri, A et al. ts have referenced entrepreneurial leadership in nursing which affects innovation behavior positively based on risk-taking, creativity, and strategic thinking orientation. It gives nurses the ability to act on their own, to innovate, and to create better care for their patients and organizations. Puni, A et al. This style of leadership is known as transformational leadership and has been found to enhance job satisfaction. Contingent reward is exchanging rewards for the desired outcome, and it can also strengthen the relationship between transformational leadership and job satisfaction by creating an organizations perception of fair treatment, improving recognition of employees, leading to a positive response, and in return stimulates employee creativity, innovative thinking and besides improve their performance as well.
|
Table 1. Comparative Analysis of Existing Models |
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|
Author |
Year |
Advantage |
Limitation |
|
Ribeiro, N et al. |
2018 |
Transformational leadership promotes a sense of belonging and loyalty, leading to increased motivation, commitment, and improved performance among employees. |
The reliability and validity of self-reported measures used to assess transformational leadership and affective commitment. |
|
Miao, R et al. |
2019 |
Transformational leadership can enhance the positive effects of high-performance work systems on work well-being and employee creativity. |
Possible overreliance on transformational leadership as the only moderating influence on employee creativity. |
|
Al-Husseini, S et al. |
2018 |
We need to better understand the relationship between transformational leadership and knowledge sharing in the specific context of Iraqi higher education. |
Difficulty in obtaining accurate and unbiased data due to social desirability bias or self-reporting bias. |
|
Bagheri, A et al. |
2018 |
Increased and more efficient implementation of innovative ideas to improve healthcare outcomes for patients. |
Lack of generalizability due to the potential influence of individual and environmental factors on innovation behavior. |
|
Puni, A et al. |
2018 |
Transformational leadership helps to motivate and engage employees, increasing job satisfaction through the use of contingent rewards for meeting expectations. |
Transformational leadership style may lead to inconsistent job satisfaction outcomes as the impact of contingent reward may vary. |
|
Bosak, J et al. |
2021 |
Increased understanding of factors contributing to burnout and potential for implementing effective leadership practices to prevent it. |
Possible confounding variables such as personality traits and job demands may impact burnout levels. |
|
Phong, L. B et al. |
2018 |
Leadership and trust in leaders promote a positive and supportive work culture, encouraging employees to share their knowledge and ideas freely. |
This relationship’s limitation is that it may not be effective if employees do not see the value in sharing knowledge. |
|
Alghamdi, M. G et al. |
2018 |
Increased diversity and inclusion in leadership roles lead to better representation of the population and a more equitable work environment. |
Only studies conducted in Saudi Arabia were considered, limiting the generalizability to other cultures. |
|
Zuraik, A et al. |
2018 |
Increased adaptability and flexibility in pursuing both exploration and exploitation strategies. |
A possible limitation could be a lack of clear direction and focus in balancing both exploration and exploitation strategies. |
|
Kim, E. J et al. |
2020 |
Increased employee satisfaction and motivation due to a strong focus on personal growth and development. |
Cannot generalize findings as it is based on a specific context and may not be applicable in other contexts. |
Bosak, J et al. This study aims to explore the effects of transformational leadership and mission valence on burnout levels of hospital employees. To reduce the burnout among the hospital staff, it may be necessary to focus on transformational leadership that inspires and motivates employees, and mission valence to align personal values and responsibilities with the organization. Phong, L. B et al. Some so, leaders have an important part to play in establishing trust and openness in the organization. In such an environment, when leaders act reliably and call for knowledge exchange, workers tend to feel convenient, and motivated to express their insights and thoughts, resulting in better innovative and cooperative work place. Alghamdi, M. G et al. reported that research indicates that female nurse administrators in Saudi Arabia demonstrate more transformational leadership behaviors than male nurse administrators in areas such as empowerment and role modeling. It may enhance job satisfaction of female nurses, confirming the important role of gender in framing leaders and job attitudes. Zuraik, A et al. This is further elaborated upon by Rahman et al. , where they discuss that CEO transformational leadership and innovation climate are integral in achieving a balance in exploration versus exploitation at the organizational level. The innovative climate, cultivated by the CEO, not only inspires the employees to take those risks and search for unexplored avenues of growth, but also provides them with a supportive framework to actualize those ideas. Kim, E. J et al. have described transformational leadership. These are all factors of knowledge sharing, organizational climate and learning. In this study, we examine the influence of transformational leadership on organizational learning in terms of these components.
METHOD
The research study would specifically focus on the influence of transformational leadership on the quality improvement of healthcare. In it, you would gather data from organizations that provide health care before looking into how transformational leadership is related to quality in health care improvement. Surveys, interviews and document analysis will be used to collect both qualitative and quantitative data for the study. Healthcare professionals. (e.g., Leaders and staff members) The perceptions of management staff professionals at the transformational leadership level and their impact on quality improvement will be perceived. It will also review and evaluate current leadership practices and strategies in healthcare organizations and will specify what gaps or barriers, if any, exist to transformational leadership. This will better inform us of the challenges we may overcome in order to deliver higher quality healthcare results. The study will include a review of the relevant literature and best practices in transformational leadership to inform the development of recommendations for operator organizations. This may involve leaders taking part in training and development programs to learn transformational leadership skills, fostering a work environment that encourages and empowers transformational leadership, and communicating transformational leadership practices to employees. The proposed study will help fill the gap in existing literature regarding the change in healthcare-quality improvement process due to transformational leadership and will encourage healthcare organizations to incorporate this leadership approach to their work practices. Figure 1 shows the development model.
Transformational Leadership – A style of leadership where a leader encourages and inspire his team to reach their fullest potential. It is often due to a lack of meaningful relationships or social interactions with colleagues. Get anywhere between three minutes to three hours away from your job, your office, as the case may be, and give your mind some fresh air. As teams are working together yet separately, this can create a sense of loneliness, which a Transformational leader brings down by focusing on the relationships and community in their team. HRM practices – engaging team members in regular communication and feedback– can enhance a sense of connection and belonging. Such as the one of emotional exhaustion, which means a feeling of being emotionally drained and overwhelmed by work responsibilities and HRM can help combating with it. Another workplace issue that can arise is disengagement from work. It arises when employees grow apathetic or jaded about their work, and it leads to lower productivity and motivation. Wave goodbye to the quarter-life crisis, transformational leaders place a high-fidelity focus on developing their team members – on both a personal and professional level – which can keep that quarter-life crisis at bay. Work-related anxiety is another common topic, especially in high-stress areas. HRM practices like employee assistances programs and wellness initiatives can also provide support for employees who are struggling with anxiety.
Figure 1. Development model
RESULTS AND DISCUSSION
Pivotal Finding of this Study: Transformational Leadership (TL) Improves Health Care Quality. The leadership style differs in a healthcare organization; realizing that the way you lead, the way you carry yourself can affect the overall quality of service healthcare provides. Transformational leadership is defined as a leader who create followers who are inspired and motivated to achieve a shared vision, and this research indicated such leaders can promote quality improvement efforts in the healthcare environment. Transformational leadership and its role in healthcare is enough to warrant the discussion of these results, as similar studies have generated a growing body of literature that supports such positive trends, resulting in better patient outcomes, increased staff satisfaction, and strengthen organizational culture. The study concludes that transformational leadership can support leaders in maximizing the quality of healthcare organisations. This study calls for further studies to further understand how transformational leadership, components, intellectual stimulation and individualized consideration, impact quality improvement in health care.
Impact on Employee Engagement
A leadership style greatly impacts employee engagement, which in turn determines the success of any organization. Transformational leadership which emphasizes on engaging and motivations of staffs has been explored extensively in different sectors, including obvious healthcare sector. In the domain of transformational leadership in health care companies on workers engagement, an essential link was established offering improved work satisfaction, commitment, and productivity.
|
Table 2. Comparison of Impact on Employee Engagement |
|||||
|
No. of Inputs |
Comparison Models |
||||
|
APM |
MAM |
TLM |
KSM |
Proposed Model |
|
|
07 |
10,5 |
14,8 |
16,3 |
15,5 |
17,3 |
|
14 |
11,4 |
16,2 |
18,6 |
16,8 |
21,2 |
|
21 |
12,3 |
18,6 |
21,1 |
19,3 |
23,5 |
|
28 |
14,6 |
20,7 |
24,2 |
21,2 |
26,3 |
|
35 |
16,3 |
22,8 |
23,9 |
23,3 |
25,3 |
It has a positive influence on the quality of patient health-care delivery. A key element in transformational leadership is the creation of a supportive and collaborative work environment in which employees are encouraged to voice their ideas and participate in quality improvement initiatives. Figure 2 shows the Computation of Impact on Employee Engagement.
Figure 2. Computation of Impact on Employee Engagement
It creates a sense of ownership and accountability, resulting in better healthcare outcomes.
Communication and Collaboration
While this new ongoing daily work was being conducted this active challenge was providinga benefit that would add the ultimate value to the overall system. Healthcare system: Many advances in technology today allow more efficient and effective communication and collaboration within the system. It results in better cooperation between health workers and enhanced patient care. Transformational leadership has [also been shown to have] a statistically significant effect on quality improvement in health care.
|
Table 3. Comparison of Communication and Collaboration |
|||||
|
No. of Inputs |
Comparison Models |
||||
|
APM |
MAM |
TLM |
KSM |
Proposed Model |
|
|
08 |
11,1 |
16,3 |
13,6 |
15,6 |
17,3 |
|
16 |
13,4 |
19,6 |
15,3 |
18,6 |
21,2 |
|
24 |
14,5 |
22,7 |
17,9 |
20,7 |
23,5 |
|
32 |
15,6 |
26,3 |
19,8 |
22,6 |
24,2 |
|
40 |
14,9 |
25,3 |
20,3 |
21,3 |
23,9 |
Transformational leaders inspire and elevate the members of their teams, create an environment in which innovation and creativity flourish, and foster a positive workplace. Figure 3 shows the Computation of Communication and Collaboration.
This leads to employee satisfaction and indirectly translates to better healthcare quality and patient outcomes. Improved communication and collaboration in the healthcare system, along with transformational leadership within the team can provide a strong foundation for overall improvement in the system of healthcare and improvement in the quality of care received by patients.
Figure 3. Computation of Communication and Collaboration
Culture of Continuous Learning
Continuous learning, both as a concept and practice, is critical to personal growth, professional development of the entire organization, and success. This includes developing new ideas, utilizing shared experiences, and having a relationship with an organization that inspires growth. In the healthcare domain, it is paramount that continuous learning is ensured by every means possible to keep the patient treatment quality and efficiency intact.
|
Table 4. Comparison of Culture of Continuous Learning |
|||||
|
No. of Inputs |
Comparison Models |
||||
|
APM |
MAM |
TLM |
KSM |
Proposed Model |
|
|
05 |
12,6 |
14,7 |
13,6 |
15,6 |
17,3 |
|
10 |
11,3 |
16,6 |
15,3 |
18,6 |
20,6 |
|
15 |
14,5 |
19,6 |
18,1 |
20,7 |
23,5 |
|
20 |
15,6 |
21,6 |
19,8 |
23,6 |
24,2 |
|
25 |
16,9 |
20,4 |
18,3 |
22,1 |
25,3 |
A big aspect of raising a culture of continuous learning is transformational leadership where employees are motivated as well as empowered to excel. Figure 4 shows the Computation of Culture of Continuous Learning.
Figure 4. Computation of Culture of Continuous Learning
Transformational leaders contribute to the overall improvement of healthcare quality through this approach; when a team environment is positive and collaborative, employees are driven to innovate while finding ways to strengthen healthcare systems.
CONCLUSION
Transformational leadership has contributed significantly to healthcare quality improvement. Transformational leaders have been instrumental in initiating positive change within the healthcare industry by emphasizing the importance of inspiring and motivating employees to go above and beyond. Their approach fosters creative thinking, problem solving, and innovation that ultimately enhances both patient outcomes and general organization efficiency. Transformational leaders change the corporate culture with an emphasis on building strong relationships and a positive working environment, which can also lead to higher levels of employee engagement and job satisfaction. This has been linked to lower turnover and improved retention of staff and a more stable and committed workforce in health care settings. In fact, in cultivating a shared vision and a commitment to continuous improvement, transformational leaders have fostered organizations that respond to the needs and expectations of patients and society. Transformational leadership in the healthcare field has greatly changed the quality of care while also being ensured that healthcare organizations will be prepared for the ever-changing industry.
REFERENCES
1. Ribeiro N, Yücel İ, Gomes D. How transformational leadership predicts employees’ affective commitment and performance. International Journal of Productivity and Performance Management. 2018;67(9):1901-17.
2. Miao R, Cao Y. High-performance work system, work well-being, and employee creativity: Cross-level moderating role of transformational leadership. International Journal of Environmental Research and Public Health. 2019;16(9):1640.
3. Al-Husseini S, Elbeltagi I. Evaluating the effect of transformational leadership on knowledge sharing using structural equation modelling: the case of Iraqi higher education. International Journal of Leadership in Education. 2018;21(4):506-17.
4. Bagheri A, Akbari M. The impact of entrepreneurial leadership on nurses’ innovation behavior. Journal of Nursing Scholarship. 2018;50(1):28-35.
5. Puni A, Mohammed I, Asamoah E. Transformational leadership and job satisfaction: the moderating effect of contingent reward. Leadership & Organization Development Journal. 2018;39(4):522-37.
6. Bosak J, Kilroy S, Chênevert D, Flood PC. Examining the role of transformational leadership and mission valence on burnout among hospital staff. Journal of Organizational Effectiveness: People and Performance. 2021;8(2):208-27.
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8. Alghamdi MG, Topp R, AlYami MS. The effect of gender on transformational leadership and job satisfaction among Saudi nurses. Journal of Advanced Nursing. 2018;74(1):119-27.
9. Zuraik A, Kelly L. The role of CEO transformational leadership and innovation climate in exploration and exploitation. European Journal of Innovation Management. 2018;22(1):84-104.
10. Kim EJ, Park S. Transformational leadership, knowledge sharing, organizational climate and learning: an empirical study. Leadership & Organization Development Journal. 2020;41(6):761-75.
FUNDING
The authors did not receive funding for the development of this research.
CONFLICT OF INTEREST
The authors declare that there is no conflict of interest.
AUTHORSHIP CONTRIBUTION
Conceptualization: Rakesh Mohanty, Ramesh Saini, Sourav Rampal, Avinash Mane, Malathi H, Shivangi Bansal, Bijal Shah.
Research: Rakesh Mohanty, Ramesh Saini, Sourav Rampal, Avinash Mane, Malathi H, Shivangi Bansal, Bijal Shah.
Methodology: Rakesh Mohanty, Ramesh Saini, Sourav Rampal, Avinash Mane, Malathi H, Shivangi Bansal, Bijal Shah.
Writing - original draft: Rakesh Mohanty, Ramesh Saini, Sourav Rampal, Avinash Mane, Malathi H, Shivangi Bansal, Bijal Shah.
Writing - proofreading and editing: Rakesh Mohanty, Ramesh Saini, Sourav Rampal, Avinash Mane, Malathi H, Shivangi Bansal, Bijal Shah.