Transformational Versus Transactional Leadership

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Transformational, transactional and laissez-faire leadership among physician executives Sudha Xirasagar
Arnold School of Public Health, Department of Health Services Policy & Management, University of South Carolina, Columbia, South Carolina, USA Abstract
Purpose – The purpose of this paper is to examine the empirical validity of transformational, transactional and laissez-faire leadership and their sub-scales among physician managers. Design/methodology/approach – A nation-wide, anonymous mail survey was carried out in the United States, requesting community health center executive directors to provide ratings of their medical director’s leadership behaviors (34 items) and effectiveness (nine items), using the Multifactor Leadership Questionnaire 5X-Short, on a five-point Likert scale. The survey response rate was 40.9 percent, for a total 269 responses. Exploratory factor analysis was done, using principal factor extraction, followed by promax rotation). Findings – The data yielded a three-factor structure, generally aligned with Bass and Avolio’s constructs of transformational, transactional and laissez-faire leadership. Data do not support the factorial independence of their subscales (idealized influence, inspirational motivation, individualized consideration, and intellectual stimulation under transformational leadership; contingent reward, management-by-exception active, and management-by-exception passive under transactional leadership). Two contingent reward items loaded on transformational leadership, and all items of management-by-exception passive loaded on laissez-faire. Research limitations/implications – A key limitation is that supervisors were surveyed for ratings of the medical directors’ leadership style. Although past research in other fields has shown that supervisor ratings are strongly correlated with subordinate ratings, further research is needed to validate the findings by surveying physician and other clinical subordinates. Such research will also help to develop appropriate content of leadership training for clinical leaders. Originality/value – This study represents an important step towards establishing the empirical evidence for the full range of leadership constructs among physician leaders. Keywords Transformational leadership, Transactional leadership, Clinical governance, United States of America Paper type Research paper

Leadership among physician executives 599

The Department of Health Services Policy and Management, University of South Carolina, Arnold School of Public Health, provided financial support for data collection expenses and conducting the study. The author gratefully acknowledges the professional contribution and support of Michael E. Samuels, DrPH, Distinguished Scholar in Rural Health Policy and Professor of Family Practice and Community Medicine, University of Kentucky School of Medicine, in planning the study and facilitating the conduct of the survey. The author is also grateful to Thomas F. Curtin, MD, Chief Medical Officer, National Association of Community Health Centers for helpful comments in adapting the survey instrument for the healthcare setting, and Jong-Deuk Baek, PhD, Research Assistant, University of South Carolina, Department of Health Services Policy and Management for helpful comments and suggestions to present the factor analysis findings.

Journal of Health Organization and Management Vol. 22 No. 6, 2008 pp. 599-613 q Emerald Group Publishing Limited 1477-7266 DOI 10.1108/14777260810916579

JHOM 22,6

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Study purpose and background This paper documents the factor structure of a survey that measured perceived leadership styles and effectiveness of medical directors of the federally-funded community health centers (CHC) in the United States. Although transformational and transactional leadership are widely validated in business and...
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