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Leadership is a key driver of healthcare worker well-being and engagement.  This study sought to evaluate healthcare worker leadership behaviours in relation to staff burnout, engagement and safety culture across 31 US hospitals, with the findings applicable across human services.

Positive assessments of local leadership behaviours by staff were strongly associated with lower staff emotional exhaustion (burnout), better safety climate, better teamwork climate, lower perceptions of workload, and reduced intentions to leave. Respondents reporting positive leadership behaviours also reported less frustration with their jobs; getting appropriate feedback about their performance; learning from errors; better handling of errors; resolving conflicts; better ability to ask questions; and less frequent intentions to leave the job. Surprisingly, similar effects were apparent for respondents in direct clinical care vs. those in indirect clinical care.

Staff saw effective leaders as being available, setting expectations and providing feedback that was frequent, useful, and positive. Results demonstrated that these core leadership norms are essential across roles and even clinical vs. nonclinical work settings.  

Availability of leaders may impact workload if leaders make time to mix with staff where they may recognize that workload is excessive and institute changes to remedy this.  Leaders’ availability and presence may improve the perception of workload merely by the process of having concerns heard and validated.  Similarly, an individual may be less likely to leave a work setting if their concerns are addressed or validated, which is directly related to the ability of leadership to recognize pain points and address them satisfactorily.

Leaders who provide effective feedback may drive improved outcomes via psychological safety. Psychological safety refers to a shared belief that risk-taking (that is, speaking up or proposing new ideas) among team members is acceptable, promoting team learning and continuous improvement; advancements that may promote professional satisfaction and quality of care.  As leaders provide feedback, they may also be providing mechanisms for reducing effort (for example, by proposing more efficient ways of performing tasks) and providing rewards (for example, by commending a job well done), both of which could serve to mitigate effort-reward imbalance and promote well-being.

These results highlight and build on a growing body of literature documenting the importance of leadership in improving staff satisfaction through communication, establishment of clear expectations and feedback, career development and goal setting.

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All accessed 8/5/2023:

Tawfik DS et al.  Leadership Behaviour associations with domains of safety culture, engagement, and healthcare worker well-being. The Joint Commission Journal on Quality and Patient Safety, Volume 49, Issue 3, 2023. Pages 156-165. https://doi.org/10.1016/j.jcjq.2022.12.006