Abstract

The health care industry is continuously developing, and constant leadership must maintain high-quality care to patients. Applying certain leadership styles is critical in developing, aligning and fabricating a pathway to effective and reliable care. Leaders can improve their subordinates’ performance, work behavior, and communication of their subordinates through the application of different styles of leadership. The two styles of leadership under investigation in this paper are transformational leadership and laissez-faire leadership.

In health care organizations, transformational leadership improves the quality and safety of patient care. Furthermore, transformation enhances staff commitment to organizational goals. In contrast, Laissez-faire leadership is not an ideal style in health care facilities. Laissez-faire leadership increases stress levels, anxiety, and staff turnover rates. As a result, the higher level of stress among staff leads to medical errors, a higher rate of staff turnovers, and suboptimal care to care for patients. Each leadership style has its strengths and weaknesses; leaders need to apply the appropriate leadership style to improve health care quality, patient safety, teamwork, and increase staff motivation and commitment to reduce adverse events in health care facilities.

Introduction

Impacts of Transformational and Laissez -faire Leadership in Health :

Leadership is a process with multiple dimensions; in this process, appointed individuals guide people to obtain desired goals. Leadership in the health care industry is recognized as an essential tool to enhance the quality, integration, and efficacy of health care delivery to patients (Danae et al., 2017).

Human involvement is the core component of delivering health care to patients in the health care system. Human-related factors such as poor communication among staff could contribute to medical errors (Umberfiel et al., 2019). Therefore, effective Leadership styles should align with organizational goals and positively influence human factors to deliver high quality and effective care to patients (Pelletier & Beaudin, 2018). The purpose of this paper is to review the literature relevant to support for either the Transformational leadership (TL) style or laissez-faire leadership (LF) style. The intent is to support which leadership style effectively delivers high-quality, safe healthcare to the patients.

Literature Searching Strategies

Databases that are used: PubMed, UpToDate, and STAT! Ref.

Keywords for search: “transformational leader and patient safety”; “transformational leadership and drug safety”; “laissez-faire leadership and anxiety”; “laissez-faire leadership and staff motivation”; and “laissez-faire leadership and patient safety”.

Filtering approach Boolean logic:“Transformational leadership AND patient safety”; “laissez-faire leadership AND patient safety OR health care quality”; “transformational leadership AND laissez-faire leadership AND patient safety”; and “transformational leadership AND laissez-faire leadership AND staff turnover”.

Inclusion criteria: peer-reviewed articles; articles published in academic journals; articles from 2015-2020; Articles written in English; and articles that included cross-sectional studies and surveys

Exclusion criteria: articles published before 2015, and articles not published in academic journals.

Reliability of the source: used the CRAAP test for the reliability of sources. Only articles obtaining a score of 50/50 are included in this review.

TL: Patient Safety and Quality of Care

Transformational leadership (TL) is a process to reshape people’s attitudes and commitments. TL aligns more readily to people’s emotions, values, and long-term goals. In addition, the application of TL creates and enhances a culture of safety, increases patient satisfaction, and decreases adverse events(Wagner et al., 2018).

Patient safety

Merril (2015) carried out a descriptive correlational study in 9 adult in-patient wards from a convenience sample of hospitals in one state in the United States of America. The study's main focus was to evaluate the relationship of specific leadership approaches and patient safety and explore the extent to which leadership enhances patient safety (Merril, 2015).

Merril (2015) sent a survey link using Survey Monkey through e-mail to 1579 registered nurses at the target hospital who perform duties on nine selected wards. Responses were received from 466 nurses (29.5%). The study's principal subjects were female nurses with associate degrees (n = 367; 79%) working full time (Merril, 2015). In the bivariate analysis, the study showed an essential relationship between the TL style and elements of safe environment, including manager support, socialization, safety emphasis, blameless system, worker safety, pharmacist support, and use of safety data. The study indicated a significant positive correlation between TL and patient safety (Merril, 2015).

Medication Safety

Adverse events from medication administration threaten patient safety in in-patient settings. Medication adverse events cause patient harm and delay on-time discharges while also decreasing patient satisfaction (Nash & Joshi, 2019).

Human related factors and ineffective systems contribute to medication errors. Nurses' engagement, motivation, and commitment to learning about medication can be a significant step in decreasing medication errors (Pelletier & Beaudin, 2018), and can be directly influenced by leadership style.

Lappalainen et al. (2020) designed a cross-sectional study at three central hospitals in eastern Finland. The focus of the study was to test the relationship between transformational leadership and medication safety. The study indicated a statistically significant relationship between transformational leadership and total drug safety (r = 0.541, p < 0.001).The subscale that showed the critical correlation with drug safety included the elements of supervision workflow, which was strongly associated with positive working conditions (Lappalainen et al., 2020). TL is an essential step for fostering workflow where the staff is engaged and innovative in providing adequate care to patients (Gemeda & Lee, 2020). It can be assumed then that with improved workflow, medication errors would be reduced.

TL: Job Satisfaction and Patient Outcomes :

Boamah et al. (2018) used a cross-sectional survey to test the hypothesis that well-structured staff involvement would increase job satisfaction. High job satisfaction reduces adverse patient outcomes (Boamah et al,. 2018).

Findings by Boamah et al. (2018) indicated that leaders with a transformational approach enhance patient care quality by designing a working condition that allows nurses to feel confident to deliver effective and safe care to patients. Furthermore, the authors indicated that positive leadership approaches, including TL, lead to better outcomes and reduced complications (Boamah et al,. 2018).

LF Effects on Staff mood and Motivation :

In health care facilities, specific tasks require mood stability to be performed meticulously and adequately. Positive leadership styles are essential maintaining subordinates' mood stability. Cross-sectional research shows that staff domination with authoritative leadership styles, or, in this case, passive leadership styles such as LF, can result in disruptive behaviors leading to higher staff anxiety levels. (Pyc et al., 2017). Additionally, ineffective leadership styles, such as LF, can foster negative working relationships and poor task performance through weak communication (Gemeda & Lee, 2020).

LF Effects on Job satisfaction :

Every industry is interested in retaining talented staff in the workforce. Organizations invest vast resources to safely and efficiently train individuals to perform the required routine patient care tasks. A leader-subordinate relationship is a mutual contract, and leaders' behavior and leadership styles shape subordinates' motivation, commitment, and teamwork in health care settings (Asiri et al., 2016).

Musinguzi et al. (2018) designed a cross-sectional study to test the relationship between leadership styles and elements affecting staff retention. The authors collected data from health care workers utilizing self-administered questionnaires that encompassed four elements including leadership style, job satisfaction, motivation, and teamwork (Musinguzi et al., 2018). The study results indicated leaders with LF styles had less motivated, satisfied, and team-oriented subordinates than the behaviors and outcomes of subordinates of TL styles (Musinguzi et al., 2018).

LF Effects on Job Stress:

The health industry is currently a complex and multidisciplinary system that requires proper leadership style to influence subordinates to deliver effective and high-quality care to patients (Lotfi et al., 2018). Pishgooie et al. (2019) conducted a cross-sectional study to hypothesizing that laissez-faire leadership cause’s job stress. Pishgooie et al. (2019) indicated that LF behaviors are correlated with subordinates' job stress and turnover rate versus the other types of leadership studied, such as TL style (Pishgooie et al., 2019).

Discussion

Leadership is considered the most critical health care delivery step to provide safe and effective care to patients in an environment where the potential for human error exists. Not only do individual leadership styles affect patient outcomes, they also affect staff satisfaction and retention. Several studies have shown that leadership style is vital to staff work outcomes including job satisfaction, performance, and motivation (Pourbarkhardari et al., 2016). As a result of this review transformational leadership is found to improve patient and medication safety, whereas laissez-faire leadership has indicated undesirable impacts on the patient safety environment (Lappalainen et al., 2020; Merril, 2015; Musing Uzi et al., 2018). In healthcare, retention of qualified staff is essential for sustainability and patient care quality. TL increases job satisfaction, staff retention, and reduces job stress compared to LF (Bo amah et al., 2018; Musing Uzi et al., 2018). Laissez-faire leadership increases emotional stress, turbulent behaviours, and fatigue, reducing staff performance and retaining of qualified staff (Pishgooie et al., 2019). On the other hand, transformational leaders increase staff motivation and emotional stability, which are influential factors for retaining qualified staff and reducing medical errors (Bo amah et al., 2018; Beau din & Pelletier, 2018).

Summary and Recommendation for practice:

Studies reviewed in these articles have shown the impact of specific leadership styles on patient care delivery, improvement of patient outcomes, and improved job satisfaction with retention of qualified staff. Some of the studies were based on cross-sectional data, which makes it difficult to generalize results to other populations. Upon the review of the included articles, one can conclude that a specific leadership style impacts patient outcomes either in positive or negative ways. As summarized above, TL has positive effects on multiple elements in healthcare. However, some the studies reviewed were based on small samples, which may not be generalized to larger populations with different cultural backgrounds and educational levels, and from different parts of the world, to discover which leadership style is the most optimal for inclusion in health care industry. The discovery of effective leadership styles with various populations can assist in application in healthcare, to improve patient safety, enhance staff commitment to organizational goals, improve retention of qualified staff, enhance organizational vision, teamwork, and quality of care.

Conclusion

Even with the application of advanced technology in the diagnosis and treatment of patients, there is still a human component involved in day-to-day healthcare services delivery. Human beings have emotions and feelings that can easily be influenced by their superiors' behavior or leadership styles. The LF leadership style can lead to increased job stress and anxiety, affecting work performance, retention, and increasing medical errors posing ongoing challenges to an organization’s quality of health care and goals. TL leadership style can improve healthcare quality and patient safety. Future research needs to focus on applying TL in different cultures and populations with different backgrounds, to note the most effective style of leadership to improve patient outcomes.

Acknowledgement :

I want to thank my parents for encouraging me to pursue my education at the Doctorate level. I want to thank my friends for supporting me in writing this Brief Review to help a healthcare professional. I want to thank my professor, who taught me well and provided me with great feedback while working on my review. Finally, I would like to thank my wife who supported me and took care of the kids while I was working on this paper.

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