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Well-structured teams and the buffering of hospital employees from stress Buttigieg, S. Health Services Management Research. Diversity faultlines, shared objectives, and top management team performance van Knippenberg, D. How can earlobes signal leadership potential? Leading Groups and Teams Markiewicz, L. BMJ Books , p. ABC Series Research output: Team climate and effectiveness outcomes West, M.
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HCT Press , p. Recent developments in reflexivity research: A review Widmer, P. A psychometric test on a Taiwanese sample of work groups Tseng, H-M. Cross-cultural variations in climate for autonomy, stress and organizational productivity relationships: Journal of International Business Studies. The impact of leadership and quality climate on hospital performance Shipton, H. International Journal for Quality in Health Care.
Climate and teamwork West, M. Building Research Based Practice. CIPD Publishing , p. Effective Teams in Organizations West, M. Blackwell Publishing , p. Team performance West, M. Sage Publications Research output: How innovation can alleviate negative consequences of demanding work contexts: The influence of climate for innovation on organizational outcomes King, E. Leader trustworthy behavior and organizational trust: Journal of Applied Social Psychology.
Managing diversity in organizations: European Journal of Work and Organizational Psychology. Workplace duties or opportunities? Challenge stressors, regulatory focus, and creativity Sacramento, C. Organizational Behavior and Human Decision Processes. Transformational leadership predicted higher innovation climate during implementation while leader member exchange predicted higher innovation climate during SAU. Strategies designed to enhance supervisor transformational leadership have the potential to facilitate implementation efforts by promoting a strong climate for EBPI and positive provider attitudes toward adoption and use of EBP.
Evidence-based practices EBPs are those health interventions that are supported by rigorous scientific research, allow for clinical expertise in their application, and provide for consumer choice, preference, and culture. Transformational leadership is motivational, individually considerate, intellectually stimulating, and can engage staff in supporting the mission and vision of a leader and promote a climate for innovation and change. Leader-member exchange represents the relationship between a leader and follower that can enhance buy-in and willingness to perform well on the job. Leader-member exchange has been shown to act as a mediator of the effect of transformational leadership on staff performance and behavior.
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Eggleston and Bhagat 24 suggest that different leadership approaches are required dependent upon whether an organization is in a stable operating state or undergoing change. Some studies have shown that charismatic leadership emerges as the most important approach for leading an organization when experiencing significant organizational change. Innovation climate is a type of strategic organizational climate.
Strategic climates are those that support a particular organizational goal such as adopting an EBP. Innovation climate is associated with organizational outcomes including improved implementation of ideas, 27 greater organizational innovation, 5 and more general benefits such as employee and consumer satisfaction 28 and perceived service effectiveness by consumers.
One potential mechanism for translating organizational or team support for innovation into employee behaviors is through influencing employee attitudes. Employee attitudes are important in the actual adoption and implementation of innovations 30 , 31 although this process is complex. The service system contracts with community-based organizations CBOs to provide in-home services. SafeCare incorporates a generalized problem solving approach into three modules: More detailed information can be found in the SafeCare manual.
Service providers in the EBPI condition received a minimum of a week-long didactic and interactive i. SAU focused primarily on parenting, family crises, household management and child caregiving, and tended to approach this via discussion and general advice rather than the more structured, behavioral skill-based SafeCare approach. SAU used a variety of parenting materials and guides, some published and some developed within a given CBO.
Based on our literature review we developed the following hypotheses: H1 transformational leadership will be positively associated with greater innovation climate, H2 transformational leadership will be positively associated with leader-member exchange, H3 leader-member-exchange will be positively associated with greater innovation climate, H4 the effect of transformational leadership on innovation climate will be mediated by leader-member exchange, H5 transformational leadership will have a stronger positive relationship with innovation climate for the EBPI group, while leader-member exchange will be more important during SAU, and H6 more positive innovation climate will be associated with more positive provider attitudes toward adopting EBP.
To our knowledge this is the first study to examine associations of transformational leadership and leader member exchange with innovation climate and attitudes toward EBP in a statewide implementation study. Assignment to treatment condition began by randomizing the two urban regions.
For the four rural regions all possible assignment permutations were evaluated and assignment to condition was based on the best pre-implementation balance. Each survey took approximately 45—90 minutes to complete. Participants received a written description of the study and informed consent was obtained prior to beginning the survey.
Participants received a gift certificate for participating in the study. This study was approved by the appropriate institutional review boards. Changes to the contracting and service delivery system instituted after wave four precluded use of data from subsequent waves. Thus, we limited our study to the three waves providing the needed data and relevant timing of changes in the service system. Each respondent is included in the analyses only once, even if they participated in multiple waves of the study. Participants were service providers working in 30 teams providing comprehensive home-based services to families involved with the child-welfare system.
Respondents were Caucasian Almost half indicated social work Respondents worked at their present agency an average of 2. The only group difference in demographics was that there were more female providers in the SAU All providers were eligible to participate and the response rate across the three waves averaged The validity of the MLQ is supported by studies demonstrating its prediction of important organizational outcomes 14 , 15 and performance. Leader Member Exchange was assessed with the Leader-Member Exchange Scale, 20 a single-factor 7-item scale that assesses the quality of the relationship between a leader and subordinate.
The leader-member exchange scale has been used in numerous studies with demonstrated validity in studies of organizational support, climate, work attitudes, and staff turnover. The scale has well established reliability and validity and has been validated across international contexts 29 and for large and small groups.
Respondents indicated their level of agreement to each statement using the Likert-type scale described above. EBPAS validity is supported by associations with clinic structure and policies, 34 organizational culture and climate, 35 and leadership. Transformational leadership, leader-member exchange, and innovation climate are believed to operate at the team level i. The a wg inter-rater agreement statistic 54 , 55 was used to assess the degree to which members within each of the participating teams agreed in their responses to the leadership and innovation climate scales and to assess whether composing the individual-level responses to higher-level constructs was justified.
We conducted multigroup path analyses that adjusted for the nested data structure i. As shown in Figure 1 , we proposed and tested a model in which the effects of transformational leadership on innovation climate are partially mediated through leader member exchange. Transformational leadership is anticipated to have direct effects on leader-member exchange and innovation climate, and indirect effects on innovation climate through leader member exchange.
We also tested whether there was a significant effect of innovation climate on provider attitudes toward adopting EBP. Our primary interest was whether these associations differ during active implementation of an EBP vs. Specifically we expected that transformational leadership would be more likely to affect innovation climate during active implementation efforts. We conducted multigroup path analyses in which we compared the two conditions EBPI vs. SAU by examining the magnitude and significance of path coefficients between the two conditions.
Next, we tested each path by estimating multigroup models, one in which the path of interest was constrained to be equal, compared to a model in which the paths were each freely estimated. The constrained and free models were compared using scaled chi-square difference test statistics. All models were estimated using the Mplus software. However, missing data among the remaining cases was low In additional analyses available by request we estimated structural equation models that utilized a transformational leadership latent variable comprised of MLQ subscales.
The subscale factor loadings were similar to one another and overall results were essentially identical to the path analysis approach. Thus, we report the more parsimonious path analysis.
The bivariate correlations demonstrated generally similar patterns between the two groups, although the absolute strength of certain associations differed somewhat. Study hypotheses were examined in the multivariate framework of the path analysis. Our analyses supported leadership and innovation climate as characteristics of the team. Figure 1 shows the path model results. We found partial support for H1 in that transformational leadership was positively associated with innovation climate, for the EBPI group.
As expected H2 , we identified a strong positive relationship between transformational leadership and leader-member exchange for both the EBPI and SAU groups. Partial support was found for H3 as leader-member exchange was significantly associated with innovation climate only in the SAU group.
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Next, H4 was partially supported in that leader-member exchange fully mediated the association of transformational leadership with innovation climate only for the SAU group. No mediation was found between transformational leadership and innovation climate by leader-member exchange for the EBPI group. For H5 active implementation i. Conversely, for providers in a more stable environment i. We found that transformational leadership had a strong direct association with innovation climate, but only for the teams actively implementing SafeCare.
For these teams, innovation climate was also associated with more positive staff attitudes toward adopting EBP. This suggests that transformational leadership may influence innovation climate and more positive attitudes toward adopting EBP during the active implementation phase.
The strong positive association of transformational leadership with innovation climate for the EBPI but not the SAU group reinforces the importance of more direct effects of transformational leadership during active implementation of innovation and organizational change. This finding is highly congruent with research demonstrating that leader support for innovation implementation is important in improving organizational climate for implementation of innovation. It appears that context matters for EBPI. In the present study, teams in both conditions were performing essentially the same function i.
Although the magnitude of differences of path coefficients was small, this suggests that it is during organizational change that transformational leadership should be bolstered to positively impact the implementation process, and ultimately, staff willingness to adopt EBP.
Mean differences on most measures between groups were small. In addition, bivariate correlations were similar across groups with some exceptions. It is only when the multivariate analyses were conducted that group differences became more apparent. Further studies are needed to verify the results found here. In particular, studies are needed to examine the impact of leader development strategies on innovation climate, staff attitudes toward adopting EBPs, and EBP implementation efficiency and sustainability.
Some limitations of the present study should be noted. First, our data relied on self-report from providers in the service system.