Article: “Leadership Styles and leadership outcomes in nursing homes: a cross-sectional analysis”

This article is based on a cross-sectional study conducted in 6 Belgian nursing homes and on the influence of head nurses and directors of nursing regarding leadership. There were 302 staff members within the nursing home who collaborated as sample subjects, using a multifactor leadership questionnaire (measuring extra effort, effectiveness, and satisfaction) that visualized transformational, transactional, and passive-avoidant leadership styles.

The researchers found that head nurses and directors of nursing were reluctant to use a transformational or transactional leadership style. On the contrary, the passive-avoidant style scored higher in the questionnaire, showing a predominance of this style.

The environment in residential care facilities – also called nursing homes – is complex because most patients would prefer to be in their own home but difficulties in obtaining optimal medical care create the need for a 24/7 specialized treatment. Furthermore, staff tend to suffer from work overload, time-pressure, low wages and job satisfaction, high employee turnover, and poor management, which naturally results in low quality of service provided and reduced safety for the patients.

This is increasingly related to the leadership style adopted (depending on leader’s behaviour) which vary if it is:

a)       Transformational style

               Leaders motivates the team to do more than expected by increasing morale and commitment by:

•         Idealized influence attributed and behaviour: working on trusting relationships an acting with integrity in a common mission.
•          Individualized consideration: supporting and coaching group members.
•          Inspirational motivation: motivating the team with an inspiring vision.
•          Intellectual stimulation: trust in the abilities of the team to identify problems and solve them.

b)      Transactional style

                Leaders focus on the “exchange” between themselves and the team. The main components are:

•          Contingent reward: the leader clarifies roles and tasks, rewarding according to task completion.
•          Active management by exception: monitoring work to take corrective action in case of error.

c)       Passive-avoidant leadership.

•          Passive management-by-exception: avoidance of leadership.
•          Laissez-faire: absence of leadership

However, expectations can be different from perceptions of leadership that change depending on various factors (e.g., educational level) Despite the predominant results of the passive-avoidant style – probably used as a survival strategy due to the excess of work and scarce resources – the recommendation was to try to follow transformational leadership (relation-oriented) due to substantial deficiencies found in systematic reviews of previous studies.

It makes sense to think about using the passive-avoidant leadership style as a survival strategy, consciously or unconsciously, by management positions in nursing homes as a result of work overload and scarcity of resources. After all, we are all human. But, although it may seem like a logical response in front of a negative stimulus (similar to procrastination) it is not appropriate to use it at all, especially if medical care is compromised; patients at nursing homes are in a vulnerable position and need special care in a proper way, without being neglected. It is a major problem that needs a systematic approach to solve, which could include government policies to encourage people to pursue careers in health care and efforts to increase salaries, just to name a few.

Article:

Poels, J., Verschueren, M., Milisen, K. et al. Leadership styles and leadership outcomes in nursing homes: a cross-sectional analysis. BMC Health Serv Res 20, 1009 (2020). https://doi.org/10.1186/s12913-020-05854-7