Problem analysis
Teams in health care face several challenges such as increasing complexity of health care provision; emphasis on efficiency and cost control; and focus on innovation, patient and person centred care delivery (IoM, 2001) (Kessel, Kratzer, & Schultz, 2012). Often high performing teams are seen as a panacea for the continuously challenging environment. Moreover, several studies have shown the link between high performing teams and performance in terms of patient safety (Carayon, et al., 2014; Baker, Salas, & Barach, 2003), quality of care (Carayon, et al., 2014; Gittel, et al., 2000), clinical performance (Baker, Salas, & Barach, 2003; Gittel, et al., 2000), individual well-being (Manser, 2009).
A 2016 longitudinal study by People Analytics Unit of Google found psychological safety to be the top characteristic of the high-performing teams (Newman, Donohueb, & Evab, 2017). Psychological safety describes the perception that an individual holds regarding the consequences of interpersonal risks in their working environment (Edmondson, 2004). In psychologically safe environments, followers are encouraged to seek help when they have doubts regarding tasks, to ask for feedback, to speak up on errors and concerns, to be comfortable with innovation and innovative behaviours, and to cooperate with other groups (Edmondson, 2004). Moreover, studies have emphasised psychological safety as vital in decreasing employees’ errors and in increasing safety, thus highly important for environments like health care provision (Newman, Donohueb, & Evab, 2017).
In reviewing the antecedents of psychological safety, Edmondson (2004) argues that the behaviours that position the leader as being approachable and available, inviting input, and modelling fairness and fallability is crucial for nurturing team psychological safety. Furthermore, studies also showed that leaders who encourage their members’ participation and exhibit orientation towards improvement manage to foster higher levels of psychological safety in their teams (Newman, Donohueb, & Evab, 2017).
Leadership taxonomy distinguishes between transformational and transactional leadership. Bass theorised that while the transformational leader is motivating the followers by inspiring them to reach their common goal together, the transactional leader is using what could be considered a give&take approach in order to determine the followers to move towards their common goal (Bass & Bass, The Bass Handbook of Leadership: Theory, Research, and Managerial Applications , 2009). While Bass’ model for conceptualising leadership is focusing on the leader’s persona, positioning the leader at the core of leadership, the Leader Member Exchange (LMX) theory focuses on the relationship implied by leadership (Glynn & DeJordy, 2010). This theory emphasises the importance of leader-member dyads. It argues that leadership is a continuous exchange between the leader and every follower rather than being just a one-way process from leader towards followers (Graen & Uhl-Bien, 1995).
Research has shown the potential positive effect of leadership style and LMX on performance. Transformational leadership was found to be associated with positive behaviours like learning (Raes, Lismont, Decupyer, & van den Bossche, 2013; Garcia-Morales, Jimenez-Barrionuevo, & Gutierrez-Gutierrez, 2012) and innovation (Garcia-Morales, Jimenez-Barrionuevo, & Gutierrez-Gutierrez, 2012; Gumusluoglu & Ilsev, 2009) but less is researched on transactional leadership’s impact. Moreover, LMX was shown to be a mediator in the relationship between transformational leadership and organisational citizenship behaviour (Wang, Law, Hackett, Wang, & Chen, 2005) but it is not clear whether a similar phenomenon is also valid for the transactional leadership.
Societal and Scientific value
Given the impact that psychological safety has on teams’ performance outcomes, it is undoubtedly crucial for health care. Thus, gaining insight into how leadership influences psychological safety is valuable. Being a transactional or a transformational leader is not a label that a leader is keeping regardless of situations and/or followers but rather a set of behaviours that are influenced by contextual factors and that build a relationship between leader and follower (Glynn & DeJordy, 2010). Therefore understanding how leader-member interactions nurtured by transformational, respectively transactional, leadership influence team psychological safety is resourceful. Not only will it increase the current knowledge on the relationship between leadership and team psychological safety, but it will also be helpful for informing strategies aimed at enhancing leaders’ practices for fostering psychological safety.
Objective and research questions
Aim of the research
The aim of this research is understanding whether being transactional or transformational leader has a different effect on the psychological safety due to the quality of the leader-member exchanges entailed by each of these leadership approaches.
Research questions
Main research question
What is the relationship between transformational, respectively transactional, leadership LMX and psychological safety?
Sub-questions:
1) What is the relationship between on the one hand transformational, respectively transactional, leadership and psychological safety on the other hand?
2) What is the relationship between on the one hand transformational, respectively transactional, leadership and LMX on the other hand?
3) To what extent does LMX mediate the relationship between transformational/transactional leadership and psychological safety?
Concepts
Psychological safety
In this study’s context, psychological safety describes the perception that an individual has regarding the consequences of interpersonal risks in their working environment. In other words, it consists of beliefs on how other people will react when an individual exposes himself by asking questions, reporting an error, asking for feedback or making a proposal of a new idea (Edmondson, 2004). At individual level, psychological safety is associated with knowledge sharing, employee engagement, and employee voice (Edmonson & Lei, Psychological Safety: The History, Renaissance, and Future of an Interpersonal Construct, 2014). At group level, Edmonson (2004; 1999) argues that by facilitating error reporting, help seeking, and feedback seeking, psychological safety mediates team learning behaviours.
Transformational leadership
Transformational leadership is centred on the leader increasing followers’ levels of motivation and performance (Bass B. M., 1985). It was suggested by Shamir et al. (1993) that charismatic–transformational leaders transform the self-concepts of their followers. These leaders bridge the social and personal identification of the followers with the goals of the organisation, this way enhancing followers’ feelings of involvement, cohesiveness, commitment, potency, and performance (Shamir, House, & Arthur, 1993).
Transactional leadership
Before the conceptualisation of the transformational leadership, transactional contingent reinforcement was considered the main component of effective leadership. This approach is characterised by a clear set of expectations whose achievement offers recognition. In this situation, followers agree with or accept the leader either in exchange of a praise or in order to avoid disciplinary action that could be taken against them (Bass B. M., 1985). When in its more corrective form, this approach is labelled as active management by exception; in this scenario, the leader is specifying not only what is considered effective performance but also what is considered ineffective performance and is monitoring for deviances or errors, correcting them if they happen (Bass, Jung, Avolio, & Berson, 2003).
Leader-Member Exchange
The leader-member exchange theory was developed in several phases, firstly relying on the notion of role making, then on those of social exchange, reciprocity, and equity (Deluga, 1994). This theory entails that leaders cast role expectations on their followers and provide tangible and intangible rewards if these expectations are met. Similarly, followers also hold expectations from their leaders regarding their treatment and the rewards given if leaders’ expectations are met (Wang, Law, Hackett, Wang, & Chen, 2005). Therefore, followers are not considered passive role holders but they accept or reject and renegotiate the role that the leaders prescribed. In other words, there is a reciprocal process, a dyadic exchange, in which each of the parties brings different resources to be exchanged. Over time, the quality of a dyadic exchange changes, calling for role negotiations (Wang, Law, Hackett, Wang, & Chen, 2005).
Previous empirical research & Study Hypotheses
Edmondson (2004) argues that leader’s behaviour is one of psychological safety’s antecedents, positing that leader behaviour is influencing team psychological safety by creating salient beliefs among followers regarding the way that the leader will use power and how this may affect a follower. As well, a meta-analytic review of psychological safety found leadership to influence the team psychological safety by shaping the work environment (Frazier, Fainshmidt, Klinger, Pezeshkan, & Vracheva, 2017).
In a cross-sectional study on 489 health care workers from 28 nursery teams, Raes et al. (2013) investigated how team learning behaviour is influenced by the transformational leadership and laissez-faire leadership. The results showed that team learning behaviour was better predicted by transformational leadership, due to transformational leadership being primarly related to psychological safety while it is not the case for laissez-faire leadership (Raes, Lismont, Decupyer, & van den Bossche, 2013). On the other hand, a study on organisational learning analysing teams 44 whtin community clinics in Israel concluded that transactional leadership is negatively associated with learning behaviours (Amitay, Popper, & Lipshitz, 2005). Even though the authors of the study do not link directly this correlation with the team psychological safety, they posit that obtaining valid information for learning requires psychologically safe environments that discourage the usage of defensive routines (Amitay, Popper, & Lipshitz, 2005).
H1: Transformational leadership is positively related to psychological safety.
H2: Transactional leadership is negatively related to psychological safety.
In a study analysing more than 160 leader-follower dyads, Wang et al. (2005) found evidence suggesting that LMX mediates the relationship between transformational leadership and performance (more specifically, task performance and organisational citizenship behaviour). The study concluded that the behaviours of the transformational leadership are a social currency that nourishes a high-quality leader-member exchange; that transformational leadership enhances followers’ receptivity for role expansion and extra-role actions via processes of social and/or personal identification; and that leader-member exchange gives leadership a more personal meaning (Wang, Law, Hackett, Wang, & Chen, 2005). In a case-based analysis, Roussin (2008) found that dyadic leadership discovery – “leader joining in honest, revealing, and (potentially) trust- building conversations with individual team members” – was more effective in increasing team psychological safety and team performance (Roussin, 2008). In a study aimed at understanding whether LMX mediates the relationship between Research&Development team leadership and employees’ organisational commitment, Lee (2005) found that transactional leadership had no associations or negative associations with different dimensions of LMX (Lee, 2005). A subsequent study of the author established that transactional leadership is negatively influencing innovativeness due to the leader-member exchanges that it encourages (Lee, 2008).
H3: LMX partially mediates the relationship between transformational, respectively transactional, leadership on the one hand and psychological safety on the other hand.
Conceptual framework
Strategy
Study Design
The research is a cross-sectional quantitative study. Data used for this study are part of an extended database; only part of the collected data is of interest for the present study. The study population is represented by employees of an academic hospital in the Netherlands. The respondents are leaders, respectively members, in teams at operational, tactical or strategical level.
The organisation and respondents
Data were collected from employees of a Dutch academic hospital having more than 1,000 beds and 10,000 employees. Respondents were either a team leader or member in a team whose leader was enrolled in the study. Data collected from leaders and team members at operational level are of interest for this study.
Data collection methods
Data were collected through a 111 item questionnaire which included both validated and non-validated scales. The questionnaire collected data on leadership styles, Leader-Member exchange, psychological safety, individual well-being, team reflexivity, team effectiveness, and respondents’ background. Of interest for this study are the questionnaire items on transactional leadership, transformational leadership, Leader-Member exchange, psychological safety, and respondents’ background. Except for respondents’ background, the answers were collected by the use of items extracted from validated scales; these answers were collected in form of 1 to 7 Likert scales (1 = “strongly agree”, 7 = “strongly disagree”). Data on respondents’ background were obtained using close-ended question or open-ended question framed to obtain answers represented by discrete values or 1 word.
Data on transactional leadership was collected using 5 items of Podsakoff, et al.’s (1990) scale. The items targeted behaviours such as providing feedback, acknowledging or not performance, and praising work that is better than the average (Podsakoff, MacKenzie, Moorman, & Fetter, 1990). For data regarding transformational leadership, 12 items of the same scale were used. The items addressed behaviours like role modelling, encouraging teamwork, and openness to new opportunities (Podsakoff, MacKenzie, Moorman, & Fetter, 1990). Information on LMX were collected by using 7 items of Graen & Uhl-Bien’s (1995) instrument. The items were aimed at dimensions of leader’s relationship with members (Graen & Uhl-Bien, 1995). Data on psychological safety were collected using items from Edmonson’s (1999) instrument; items targeted behaviours related to team climate (Edmonson A., 1999). Respondents’ background consisted in items on gender, age, education, leadership position, number of team members (if applicable), specialisation (if applicable), years of working experience, and years of experience within organisation.
The questionnaire was distributed online. After completing the questionnaire, team leaders provided a list with their team members; the latter were randomly selected and further contacted by the researchers. The questionnaire was designed and applied in Dutch; for the current study the questionnaire was back translated.
Independent & dependent variables
The study aims to test the relationship between transformational – respectively transactional – leadership, LMX, and psychological safety, proposing that LMX mediates the relationship between leadership style and psychological safety. Therefore transformational, respectively transactional, leadership are the independent variables of the study; LMX is the mediator; and psychological safety is the dependent variable. Respondents’ demographics will be used as control variables.
Plan for data analysis
Data will be analysed using SPSS analysis software. Descriptive analysis will be performed for exploring the characteristics of the study population.
Even though psychological safety is a notion that lies mostly in the individual perception, it is best observed at team level (Edmonson, 2004). The study dataset contains data collected from team leaders and team members. Given the data clustering (as shown by table), multilevel regression analyses will be performed.
Level Operational (N)
Regression Respondent
2 team leader 90
1 healthcare professionals 514
Prior to performing the regression analyses, data will be tested for ensuring that the normal distribution condition is met. As well, correlation matrices will be used for deciding the control variables to be used.
The mediation will be tested using the causal steps method. As explained by MacKinnon et al. (2012), this method has four steps:
1) testing for significance the relationship between independent (i.e. transformational, respectively transactional leadership) and dependent variable (i.e. psychological safety);
2) testing for a significant relationship between the independent (i.e. transformational, respectively transactional leadership) and mediator (i.e. LMX);
3) testing for significance the relationship between mediator (i.e. LMX) and dependent variable (i.e. psychological safety) when controlling for the independent variable (i.e. transformational, respectively transactional, leadership);
4) assessing whether the relation between the independent variable (i.e. transformational, respectively transactional, leadership) and the dependent varible (i.e. psychological safety) is weaker when the mediator (i.e. LMX) is added (MacKinnon, Cheong, & Pirlott, 2012).
Validity and reliability
Validity consists in measurement assessing what is intended to be assessed for the aim of the research (Field, 2009). In order to achieve internal validity, data collection instrument used previously validated scales for transactional leadership, transformational leadership, Leader-Member exchange, psychological safety. Added to this, factor analysis will be performed. For ensuring external validity, the demographic variables of the study sample will be compared with the demographics of other Dutch hospitals.
Reliability represents data collection instrument’s capability of producing similar results under different contexts with similar characteristics (Field, 2009). Cronbach’s alpha will be computed for evaluating the reliability of the scales used in this research; a value of minimum .7 will be accepted.