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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 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-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.

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 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 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.


(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 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

Leader

Trustworthiness

Benevolence

Integrity

Ability

(Mayer et al., 1995)


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 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 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 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 (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 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 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 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

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 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 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 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).

When author is leading change within a hostile and toxic work environment, often fear

and negative push back exists. This resistance is generated by informal leaders of cliques 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 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 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).

The author is developing the transformational empowerment model of leadership in

healthcare that visually expresses the desired changes and characteristics brought about by

transformational leadership with strong utilization of shared leadership and empowerment. 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.


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’. 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 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 (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).


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