A Multidisciplinary Intervention to Reduce Post-Craniotomy Surgical Site Infection Rates
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Running head: TRANSFORMATIONAL AND SHARED LEADERSHIP 1
Transformational and Shared Leadership Theories: Comparison and
Application During a Surgical Department’s Cultural Change
Traci McGee
University of Charleston, School of Business
Doctor of Executive Leadership Program
TRANSFORMATIONAL AND SHARED LEADERSHIP 2
Abstract
This document contains the results of a literature review of
transformational and shared leadership theories through the lens
of a nursing leader in a perioperative setting, using theory
context and application. Transformational leadership is the
preferred form of leadership for nursing. The author selects
and defends transformational leadership with strong emphasis on
shared leadership, as the best and most effective leadership
style to use when enacting change in a hostile nursing
environment where there is overt resistance to change.
Involving followers and converting them into leaders of change
is an effective and powerful way to evoke follower support and
sustainability of changes in nursing practice and adoption of
best practices.
TRANSFORMATIONAL AND SHARED LEADERSHIP 3
Transformational and Shared Leadership Theories: Comparison and
Application During a Surgical Department’s Cultural Change
The purpose of this document is to compare and contrast the
leadership theories of transformational leadership and shared
leadership; and, the context is presented through the lens and
perspective of a nursing leader in a perioperative setting. The
lens of the nursing leader includes a brief introduction in to
the American Nurses Credentialing Center and the magnet model,
which supports transformational leadership as their chosen and
preferred nursing leadership style. Main themes and highlights
from a scholarly literature inquiry are presented, for both
leadership styles. Similarities and differences in
transformational leadership and shared leadership will be
discussed. The writer will select and defend the theory most
significant to my personal practice—leading and navigating a
group of novice surgical charge nurses through the cultural
change of a toxic work environment, where there is a long-
TRANSFORMATIONAL AND SHARED LEADERSHIP 4
standing culture of lateral violence, low employee morale, and
employee disengagement. Finally, lessons learned will be
summarized; and, gaps in research and future research needs will
be outlined.
Magnet Hospitals
Margaret Sovie, a nursing pioneer, was a member of the
American Academy of Nursing Task Force, in 1981. The task force
mission was to identify the qualities and common threads of
hospitals that shaped nursing excellence. Sovie is credited
with creating the term ‘Magnet Hospital’ to describe hospitals
that attract and retain the best nurses. This term later
evolved, and was accepted by the American Nurses Credentialing
Center as the Magnet Recognition Program—a program that is still
popular and in use today. During a nursing shortage in the
1980s, McClure et al. (1983), began two decades of research on
the characteristics of magnet hospitals, and the relationship to
nurse and patient outcomes.
TRANSFORMATIONAL AND SHARED LEADERSHIP 5
The Magnet model endorses transformational leadership, where
leaders embody vision and influence. Transformational leaders
exhibit and model strong clinical and professional practice, and
they are proactive and inspiring in meeting challenges.
Transformational leadership “has been shown to be particularly
effective in turbulent and uncertain environments” (Messmer &
Turkel, 2011, p. 239). A trusting work environment of magnet
hospitals was identified as a common thread among magnet
hospitals. McClure found that facilitation of trust by nursing
leadership, and strong clinical competence among nurses, was key
in achieving a trusting work environment in nursing units.
Transformational Leadership
Leaders, practicing transformational leadership, excite and
motivate their team through charismatic influence, and by
communicating a vision that inspires and connects to individual
values. The leader stimulates their followers to work towards
the accomplishment of goals. The followers accomplish their
TRANSFORMATIONAL AND SHARED LEADERSHIP 6
work, and will actually perform beyond what is necessary when
inspired by a transformational leader. Bacha and Walker (2013)
suggest that there are four dimensions of leader behavior with
regard to transformational leadership theory. The four areas
involve ways in which the leader’s behavior causes the follower
to pursue the mission, aligning with the desires of the leader.
According to Bacha and Walker, the transformational leader
exemplifies and role models the following four dimensions of
behaviors to inspire followers:
Transformational Leadership:
Four Dimensions of Leader Behavior
Individualized consideration Degree to which the leaders attends to each follower’s needs
Intellectual stimulation Degree to which the leader challenges assumptions, takes risks and solicits followers’ ideas
Inspirational motivation Degree to which the leader
TRANSFORMATIONAL AND SHARED LEADERSHIP 7
articulates a vision that is appealing and inspiring to followers
Idealized influence Highest level of transformational leadership—behavior of leaders that results in there being role models for their followers.
Trust
Many organizations accomplish projects and daily work
through teams. Therefore, it is imperative that transformational
leaders be able to influence and inspire groups of people as
well as individuals (Chen, Kirkman, Kanfer, Allen, & Rosen,
2007). In 2011, Lord and Dinh, found that transformational
leadership has the greatest influence over group motivation as
opposed to individual motivation. Schaubroeck et al. (2011)
identified a link between team perception of a transformational
leader’s trustworthiness and team performance. Mayer et al.
TRANSFORMATIONAL AND SHARED LEADERSHIP 8
(1995) wrote that the competency areas of benevolence, ability,
and integrity enhance leader trustworthiness.
Intragroup Trust. There is a lag in research examining the
existence of trust between team members—and the impact of
trusting and distrusting relationships between team members and
the impact upon group productivity (Lau & Liden, 2008). As a
nursing leader, this author has personally observed obstacles in
productivity when individual members of a charge nurse team have
had varying degrees of trust between members. The deficit or
varying degrees of trust between individual team members creates
Leader
Trustworthi
Benevolenc
Integrity
Ability(Mayer et al.,
TRANSFORMATIONAL AND SHARED LEADERSHIP 9
a dysfunctional and broken circle of trust among the
perioperative nursing leadership team. It is the author’s
opinion that building trust within a department begins with the
leadership team, and that there is a trickle down effect with
the staff members.
Work Performance. When intragroup trust exists—trust among
team members and trust of the leader, work performance and job
satisfaction shift in a positive direction. There is a
correlation between job performance and trust. Both the
individual trust in their leader and group trust, enhance
individual and group job performance, respectively (Braun, Peus,
Weisweiler, & Frey, 2013). The team and front-line leaders are
more apt to be inspired, and to embrace the influence of the
transformational leader with trusting relationships have been
established.
Competence. A component of building trust is the
establishment of leadership competence. Trust can be viewed as a
TRANSFORMATIONAL AND SHARED LEADERSHIP 10
two-way street. Leader trust in the abilities of employees to
perform their job depends upon belief that the individual has
the competence and decision making capabilities required to
complete assigned work. Leader interactions with the employee
are to a great degree dictated by the employee’s degree of
competence. On the flip-side, employee perception of a leader’s
overall competence is based upon the leader’s “ability,
benevolence, and expertise (Page, 2004, p. 117). Trust is in
part, built upon the group or individual employees’ perception
of leader competence.
Fairness. Scholarly research on leadership focuses upon the
behaviors and actions of leaders. An important factor in
transformational leadership behavior is the existence and
perception of leader fairness towards followers. Fairness is an
essential element in having the follower act upon the directive,
influence, and desire of the leader. Bacha and Walker found a
correlation between follower perception of fairness of the
TRANSFORMATIONAL AND SHARED LEADERSHIP 11
leaders actions, and employee engagement and satisfaction,
confidence in the leader, and job performance. Followers
respond well to leaders who treat all individuals with respect
and fairness. Overall performance is improved, when followers
believe that their leader respects their individual needs and
opinion.
Engagement
Followers value clear, timely, and truthful communication,
as well as the opportunity to be involved in decision-making
(Parry and Proctor-Thomson 2002; Bacha and Walker, 2013).
Transformational leaders show support and cooperation towards
individuals and groups, both privately and publicly, which helps
to gain the support and engagement of followers. Another way to
gain engagement of followers is through intellectual stimulation
—where the leader inspires and encourages followers to examine
current work methods. Transformational leaders encourage
innovation among followers—producing new ideas and fresh
TRANSFORMATIONAL AND SHARED LEADERSHIP 12
approaches. Transformational leadership theory places high
value upon integrity, ethical behavior, and where leaders place
others’ needs ahead of their own (Parry, Proctor-Thomson, &
Parry, 2002). Key to determination of leadership success is the
degree in which change is completed and follower needs and
desires are fulfilled (Page, 2004).
Shared Leadership
Shared leadership consists of two or more members of a team
participating in the leadership of a group. Leaders efforts are
typically focused on capitalizing productivity and effectiveness
of the team. Shared leadership this through participation of
all members of the team, and empowers the group in
accomplishment of work, and decision-making. The skills that
the group leaders and members hold collectively would be
difficult for a single leader to match. Shared leadership holds
that overall team effectiveness and performance may depend on
its ability to draw on the leadership skills of its members
TRANSFORMATIONAL AND SHARED LEADERSHIP 13
(Bergman, Rentsch, Small, Davenport, & Bergman, 2012). Yukl
(2010) classified shared leadership into wide classes of
behavior: task-oriented, relations-oriented, and change-
oriented. A fourth class of spanning was recently added. All
are crucial in team leadership situations, whether the goal is
oriented to task, relations, change, or organizational context:
Initiating structure behaviors are task-oriented
Consideration behaviors are relations-oriented
Envisioning behaviors are oriented toward change
Spanning behaviors are operational within organizational
context
Trust
Trust influences performance in shared leadership. Enhanced
trust within the team means better group performance (Drescher,
Korsgaard, Welpe, Picot, & Wigand, 2014). A certain degree of
trust among team members is exhibited by their sheer agreement
TRANSFORMATIONAL AND SHARED LEADERSHIP 14
to take part in shared leadership, which is the first step in
establishing intragroup trust. Members render themselves
vulnerable by taking the risk of taking part in shared
leadership and through the acceptance of influence by other team
members (Engel Small & Rentsch, 2010). Over time, trust within
the group, as well as individual roles will change with the
desired team outcome being communicating, influencing, making
suggestions, and holding people accountable (Drescher et al.,
2014).
Enhanced Team Function. Intragroup conflict causes decreased
productivity, difficulty in reaching consensus, and laborious
decision-making. Teams practicing shared leadership experience
less socio-emotional conflict; thereby increasing consensus
building, intragroup trust, team cohesion, and job satisfaction.
Teams practicing shared leadership theory reach consensus
quicker than teams who do not share leadership. Team member
TRANSFORMATIONAL AND SHARED LEADERSHIP 15
performance and satisfaction is higher, as more members have an
opportunity to participate in leadership. Accountability and
commitment grow, with more positive team functioning and
outcomes than non-shared leadership models (Drescher, et als.).
Competence. Research supports the finding that perceptions
within shared leadership teams include a sense of shared respect
for each other’s competence (Simons & Peterson, 2000). A study
by Bertman et al. in 2012 revealed the following survey
responses from members of shared leadership teams: “We
absolutely respect each other’s competence,” and “We are all
certain that we can fully trust each other.” Sharing leadership
functions accelerates trust between team members, and trust is
higher than in teams with no shared leadership (Drescher,
Korsgaard, Welpe, Picot, & Wigand, 2014).
Empowerment
Team empowerment is a motivational and inspirational concept.
Group empowerment in shared leadership elevates engagement of
TRANSFORMATIONAL AND SHARED LEADERSHIP 16
the team members, to complete tasks in meaningful and
constructive ways (Kirkman & Rosen, 1997). The team’s level of
empowerment is dependent upon the team’s maturity and
development, and the empowerment level is constantly evolving
(cf. Marks, Mathieu, & Zaccaro, 2001). Attention must be given
to the influence of external leaders upon shared leadership, as
they may inhibit the empowerment of the team. In shared
leadership, empowerment requires that all team members be
willing to offer leadership, rely on leadership by multiple team
members, and to have a voice.
Common Threads and Contrasts
In contrasting transformational and shared leadership, it
is important to note that shared leadership is actually a
component of transformational leadership. Trust is important in
the success of both transformational and shared leadership.
Trust positively influences transformational leaders’ ability to
motivate and inspire individuals and groups. In shared
TRANSFORMATIONAL AND SHARED LEADERSHIP 17
leadership, trust influences effectiveness of the group in
accomplishing shared goals and objectives. In both types of
leadership, trust between team members and the leader are
important in the success of leadership and team success.
Without trust, neither style of leadership would be successful
in moving forward to achieve desired work.
Work performance and job satisfaction are influenced by
trust and cohesion in both leadership styles. Trust in the
leader and group trust augment team inspiration and influence by
the transformational leader. Shared leadership teams who
possess functional, trusting relationships, are able participate
in leadership and to achieve a higher degree of accountability
and commitment.
Competence is an essential element in building trust, and
in achieving the capacity or aptitude needed to fulfill work
tasks. In transformational leadership, followers need to feel
confident in the leaders level of competence as a leader, with
TRANSFORMATIONAL AND SHARED LEADERSHIP 18
competence in their area of expertise. In turn, leaders must be
comfortable with the level of competence, both collectively and
individually, of shared leadership teams. In addition to trust,
mutual respect between members enhances work relationships and
the achievement of work.
In both transformational and shared leadership, followers
have the chance to be involved in decision-making. Engaging the
team, and empowering them gives followers an opportunity to add
value and to contribute input into how work is accomplished.
Both theories involve the engagement of followers.
Transformational leaders inspire and motivate followers. In
contrast, shared leadership allows the leader to inspire and
motivate through teams of followers, who represent and influence
the work group.
Preferred Leadership Style and Application
There is considerable change currently underway in
healthcare organizations. Hospitals and other healthcare
TRANSFORMATIONAL AND SHARED LEADERSHIP 19
organizations are challenged today to provide more patient care
services and improved patient outcomes, while utilizing fewer
resources. To achieve this, healthcare organizations are
rapidly seeking innovative changes that will challenge the old
ways of accomplishing work tasks and patient care. The
innovative process of assessment and process improvement will
include adopting best practices. Many procedures and practices
were established decades ago, without consideration of patient
outcomes and quality indicators. Healthcare in the United
States will morph and change significantly over then next
decade, as reimbursement dollars shrink, and the number of baby
boomers needing healthcare peeks.
In order to meet these challenges, nursing leaders must help
nurses and other healthcare practitioners embrace the need for
change, and to adapt and incorporate best practices into their
patient care delivery. I believe that transformational
leadership theory is the best choice in applying theory into the
TRANSFORMATIONAL AND SHARED LEADERSHIP 20
practice of change management in healthcare. The nursing
profession in the United States has recognized transformational
leadership as the leadership theory and style of choice.
When tasked with changing a negative work culture, the
author prefers transformational leadership with an emphasis on
shared leadership. Shared leadership is actually a component of
the transformational leadership model. Shared leadership is a
valuable tool in transforming healthcare, as this style involves
and gains the buy-in of followers. By emphasizing the shared
leadership component, leaders enable followers to be inspired to
act and to become leaders of change (Bennis & Nanus, 1985).
Members of shared leadership teams have the opportunity to
become role models for professional and organizational values
(Kouzes & Posner 2003). Transformational leaders persuade
individuals to rise above their own biases and desires; and
multiple leaders within the shared leadership team can provide
the same persuasion to their peers (Hutchinson & Jackson, 2013).
TRANSFORMATIONAL AND SHARED LEADERSHIP 21
The author is leading change within a hostile and toxic work
environment, where there exists fear and negative push back from
informal leaders of cliques who resist change, and who actively
lead and seek to protect the status quo. Values within a
workplace create the culture or work environment. Employee
behavior is a primary influence on culture (Marinova, Dyne, &
Moon, 2015). When a new leader challenges status quo this can
be perceived as a threat to the informal leaders of a
dysfunctional work group (Morrison & Phelps, 1999; Marinova et
al., 2015).
Nursing leaders have the role of motivator and generator of
inspiration, while also having accountability for patient care
standards. Some decisions will be unpopular. Relationships
with followers can be built and maintained through fair and
consistent leadership. Rolfe (2011) recommends treating
pessimists with respect and compassion, while moving forward
with the majority to accomplish traction with work and
TRANSFORMATIONAL AND SHARED LEADERSHIP 22
attainment of vision. “The naysayers can stagnate without input
into their future, or they can join forces, making the group
even more powerful as they move toward the vision” (Rolfe, 2011,
p. 55). Morale in the work environment can improve when there
is no blame, and followers can express their
concerns and desires. Follower collaboration and involvement in
implementing improvements can increase morale. Transformational
leadership and evidence-based management to improve patient
safety can be accomplished in ways that satisfy follower’s
values (Page, 2004).
The writer believes that transformational leaders should
emphasize and deploy shared leadership when working as a change
agent in a challenging environment—and where the change is vital
to obtain safe and optimal patient care. In complex teams, such
as the charge nurse team in the writer’s surgical department, it
is difficult for one leader to implement all of the necessary
functions. By involving and including the charge nurse team in
TRANSFORMATIONAL AND SHARED LEADERSHIP 23
a shared leadership model, the author will be able to
successfully accomplish change, for a number of reasons.
First, by using the shared leadership model, trust in the
leader and ownership of the initiative would be obtained from
charge nurses and followers. The charge nurses possess
historical data relevant to the organization and the individuals
within the department, making it easier to maneuver the
political landscape. Second, this would allow an opportunity
for the charge nurses to grow and develop—both individually and
as a team. Possible improvements include building a
relationship of trust between the leader and the charge nurses,
from charge nurses to the leader, with improved teamwork and
trust between charge nurses. The relationship of trust between
followers and the leader would be enhanced, as well as improve
the professional perception and respect of the charge nurses by
staff (Carson, Tesluk, & Marrone, 2007, p. 1217).
TRANSFORMATIONAL AND SHARED LEADERSHIP 24
The author is developing a model that visually expresses the
desired changes and characteristics brought about by
transformational leadership with strong utilization of shared
leadership means such as: shared leadership teams, nursing
practice councils, and shared governance. At the focal point of
all actions and initiatives, is patient-focused care. The
opposing force is lead by dysfunctional or weak nursing leaders,
where informal leaders and cliques manipulate and manage the
operations of the nursing unit. This group of opposition
includes disengaged and toxic employees, who focus upon their
own individuals versus the needs of the patient. These
individuals cause loss to the organization in terms of lost
revenue, waste, property damage, horizontal violence, patient
errors, safety violations, billing errors, and recruitment costs
of nurses related to high turnover in a toxic environment.
TRANSFORMATIONAL AND SHARED LEADERSHIP 25
Traci McGee, 2015
Conclusion
Endorsements for the transformational leadership style
include the American Nurses Credentialing Center and the magnet
model, as well as the Registered Nurses Association of Ontario’.
TRANSFORMATIONAL AND SHARED LEADERSHIP 26
In today’s environment of rapid change in healthcare delivery,
well-skilled nursing leaders are vital (MacPhee & Bouthillette,
2008). Transformational leadership and shared leadership both
involve teamwork and collaborative exploration and implement of
strategies that can address followers’ issues. Morale will
increase, when followers feel empowered by seeing their ideas
transformed into reality.
While transformational leadership has been widely adopted in
nursing, evidence of effectiveness related to clinical outcomes
and quality of working environment are lacking (Hutchinson &
Jackson, 2013). Attention and research is needed in order to
gain understanding of the follower’s role in the effectiveness
of leaders. In the author’s opinion, this gap in research and
understanding is emphasized in the nursing sector, where ‘nurses
eat their young’ (Hutchinson & Jackson, 2013). Nurses and
informal leaders of cliques working on a nursing unit will
defend the status quo by safeguarding formal and informal
TRANSFORMATIONAL AND SHARED LEADERSHIP 27
organizational procedures; and they perceive the leader’s change
management as a lack of relational concern. The informal
nursing leaders’ motives are in conflict with the leader’s
goals, and they will demonstrate their loyalty and support of
the group and personal objectives versus accepting the leader’s
desired changes (Marinova et al., 2015).
Today many organizations are adapting to change by
increasing the use of team based structures (Hoch, Pearce, &
Welzel, 2010). Transformational leadership and evidence-based
management help nurses make practice changes related to patient
safety (Page, 2004). A patient-centered culture improves the
quality of patient care as well as the nurses’ work environment
(Hutchinson & Jackson, 2013).
Future Research
A great deal of research exists on the topic of
transformational leadership. However, a gap exists in the study
of transformational leadership and leader fairness to followers
TRANSFORMATIONAL AND SHARED LEADERSHIP 28
(Bacha & Walker, 2013). Nursing teams in the surgical setting
are very task oriented, and more research on efficacy of shared
leadership on this specific group would be very enlightening
(Künzle et al., 2010). There has been little research on the
foundations of shared leadership (Carson et al., 2007). More
research is needed to examine impact of team factors in shared
leadership, such as task complexity, team size, team maturity,
demographic diversity, team member desire to lead, and
leadership self-efficacy (Bergman et al., 2012). Trust is a
critical element in predicting performance in both leadership
styles, yet available scholarly research is limited. In the
expansive globalization of the economy, research to compare the
impact of shared leadership on teams in various cultural setting
would be useful (Hoch et al., 2010).
TRANSFORMATIONAL AND SHARED LEADERSHIP 29
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