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Leader–member exchange and organizational climate effects on clinician turnover intentions

Gregory A. Aarons (Department of Psychiatry, University of California San Diego, La Jolla, California, USA) (Child and Adolescent Services Research Center, San Diego, California, USA) (UC San Diego Dissemination and Implementation Science Center, La Jolla, California, USA)
Kate L. Conover (San Diego State University/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA)
Mark G. Ehrhart (Department of Psychology, University of Central Florida, Orlando, Florida, USA)
Elisa M. Torres (University of California San Diego, La Jolla, California, USA) (Child and Adolescent Services Research Center, San Diego, California, USA) (George Mason University, Fairfax, Virginia, USA)
Kendal Reeder (Department of Psychology, University of California Los Angeles, Los Angeles, California, USA) (Child and Adolescent Services Research Center, San Diego, California, USA)

Journal of Health Organization and Management

ISSN: 1477-7266

Article publication date: 1 December 2020

Issue publication date: 5 February 2021

639

Abstract

Purpose

Clinician turnover in mental health settings impacts service quality, including availability and delivery of evidence-based practices. Leadership is associated with organizational climate, team functioning and clinician turnover intentions (TI). This study examines leader–member exchange (LMX), reflecting the relationship between a supervisor and each supervisee, using mean team LMX, dispersion of individual clinician ratings compared to team members (i.e. relative LMX) and team level variability (i.e. LMX differentiation), in relation to organizational climate and clinician TI.

Design/methodology/approach

Survey data were collected from 363 clinicians, nested in children's mental health agency workgroups, providing county-contracted outpatient services to youth and families. A moderated mediation path analysis examined cross-level associations of leader–member exchange with organizational climate and turnover intentions.

Findings

Lower relative LMX and greater LMX differentiation were associated with higher clinician TI. Higher team-level demoralizing climate also predicted higher TI. These findings indicate that poorer LMX and more variability in LMX at the team level are related to clinician TI.

Originality/value

This study describes both team- and clinician-level factors on clinician TI. Few studies have examined LMX in mental health, and fewer still have examined relative LMX and LMX differentiation associations with organizational climate and TI. These findings highlight the importance of leader–follower relationships and organizational climate and their associations with clinician TIs. Mental health service systems and organizations can address these issues through fostering more positive supervisor–supervisee relationships.

Keywords

Acknowledgements

This work was supported by National Institute on Drug Abuse grants R01DA049891 and R01DA038466, and National Institute of Mental Health Grants R01MH072961; R01MH092950; R21MH082731; R21MH098124; and K01MH001695. The authors thank the community stakeholders, providers, and supervisors who participated in this study. Portions of this study were presented at the 50th Annual Convention of the Association of Behavioural and Cognitive Therapies, Dissemination and Implementation Science Special Interest Group Preconference.The authors have no conflicts of interest to report.

Citation

Aarons, G.A., Conover, K.L., Ehrhart, M.G., Torres, E.M. and Reeder, K. (2021), "Leader–member exchange and organizational climate effects on clinician turnover intentions", Journal of Health Organization and Management, Vol. 35 No. 1, pp. 68-87. https://doi.org/10.1108/JHOM-10-2019-0311

Publisher

:

Emerald Publishing Limited

Copyright © 2020, Emerald Publishing Limited

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