Authentic leadership in healthcare: a scoping review

Niina Malila (Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland)
Nina Lunkka (Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland and Medical Research Center Oulu (MRC Oulu), Oulu, Finland)
Marjo Suhonen (Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland and Medical Research Center Oulu (MRC Oulu), Oulu, Finland)

Leadership in Health Services

ISSN: 1751-1879

Publication date: 5 February 2018

Abstract

Purpose

The purpose of this paper is to review peer-reviewed original research articles on authentic leadership (AL) in health care to identify potential research gaps and present recommendations for future research. The objectives are to examine and map evidence of the main characteristics, research themes and methodologies in the studies. AL is a leader’s non-authoritarian, ethical and transparent behaviour pattern.

Design/methodology/approach

A scoping review with thematic analysis was conducted. A three-step search strategy was used with database and manual searches. The included studies were composed of English language peer-reviewed original research articles referring to both AL and health care.

Findings

In total, 29 studies were included. The studies favoured Canadian nurses in acute care hospitals. AL was understood as its original definition. The review identified four research themes: well-being at work, patient care quality, work environment and AL promotion. Quantitative research methodology with the authentic leadership questionnaire and cross-sectional design were prevalent.

Research limitations/implications

Future research needs more variation in research themes, study populations, settings, organisations, work sectors, geographical origins and theory perspectives. Different research methodologies, such as qualitative and mixed methods research and longitudinal designs, should be used more.

Originality/value

This is presumably the first literature review to map the research on AL in health care.

Keywords

Citation

Malila, N., Lunkka, N. and Suhonen, M. (2018), "Authentic leadership in healthcare: a scoping review", Leadership in Health Services, Vol. 31 No. 1, pp. 129-146. https://doi.org/10.1108/LHS-02-2017-0007

Download as .RIS

Publisher

:

Emerald Publishing Limited

Copyright © 2018, Emerald Publishing Limited


1. Background

Authentic leadership (i.e. AL) is a leader’s non-authoritarian (Costas and Taheri, 2012), ethical and transparent behaviour pattern (Avolio et al., 2009), which can be seen as the basis and core of all positive leadership forms. The grounds of AL are based on positive and humanistic psychology. (Avolio and Gardner, 2005.) AL strives for trusting, symmetrical and close leader–follower relationships (Costas and Taheri, 2012) and promotes the open sharing of information and consideration of employees’ viewpoints (Avolio et al., 2009). AL consists of four dimensions: self-awareness, balanced processing, an internalised moral perspective and relational transparency (Walumbwa et al., 2008). AL offers help for organisational problems, such as leader’s selfishness and short-sightedness. It provides a new normative ideal that emphasises values, ethics, the common good and consistency between words and actions. (Costas and Taheri, 2012).

Health-care organisations with modern challenges, such as economic and technological changes, call for high-quality leadership (Dickson, 2009). The challenges create a need for the leader’s transparency and value awareness, as well as the moral and ethical viewpoints of leadership (Clapp-Smith et al., 2009). AL can have a positive influence on health-care organisation staff and the whole health-care system (Shirey, 2006), including high-quality patient care (Johansson et al., 2011), and it may influence positively even on society as a whole (Shirey, 2006). Regardless of the increased interest towards AL (Costas and Taheri, 2012), the theory has also been criticised (Gardiner, 2011; Algera and Lips-Wiersma, 2012). Some of the critiques are concerned with certain shortcomings, such as overlooking social and historical circumstances that may affect the ability to act as a leader (Gardiner, 2011) and focusing on the individual leader instead of examining the entire organisation (Algera and Lips-Wiersma, 2012). This review does not take a stand on the critique, but maintains an objective stance towards AL theory. In addition, the definition of AL is fairly ambiguous and has many levels (Vakkala and Syväjärvi, 2012). Besides the popular humanistic–positive perspective, another way of seeing AL is existential–experiential perspective. These perspectives have different ontological preconditions but do not contradict each other. (Koskiniemi et al., 2015.) For the sake of coherence, this article uses the prevailing definition of AL (Luthans and Avolio, 2003).

AL has been studied internationally in health-care context and it has been discovered to cause many positive effects (Stander et al., 2015). Yet, there is still little empirical research on AL in health care. As this is still a relatively new study subject in the health-care setting (Spence Laschinger et al., 2013), the scoping review method is useful for reviewing this kind of discipline with emerging evidence, as the review has a broad approach to the subject (Peters et al., 2015). Therefore, the purpose of this study is to review peer-reviewed original research articles on AL in health care to identify potential research gaps and present recommendations for future research. The objectives are to examine and map evidence of main characteristics, research themes and methodological choices in the studies.

2. Methods

This review is based on the scoping review methodology (Arksey and O’Malley, 2005; Levac et al., 2010). The objectives, inclusion criteria and methods were documented in a protocol in advance. The review had a three-step search strategy. The first step was to use two relevant online databases to conduct an initial limited search (Peters et al., 2015). The databases used for the initial search were CINAHL and Medline. After the initial papers were retrieved, the keywords from their titles, abstracts and index terms were analysed (Peters et al., 2015).

The second step was to use all the included databases using the identified keywords and index terms (Peters et al., 2015). The databases included were: CINAHL, Medline, PubMed, Scopus, ABI/INFORM Complete, Business Source Complete, Web of Science, Academic Search Premier, PsycARTICLES, Medic, Arto and Melinda. The search phrases were combinations of “authentic leadership”, “healthcare”, “medicine” and “nursing”. The searches were limited to peer-reviewed English language and Finnish language articles. A manual search was conducted using key journals involving leadership in health care. Leadership in Health Services, the Journal of Nursing Management and the Journal of Nursing Administration were searched manually for additional articles. ResearchGate was also used.

The third step was to search for additional studies in the reference lists of all the identified articles (Peters et al., 2015). The searches were conducted in December 2016. The search process was carried through with the close collaboration of the researchers. The a priori protocol was developed together by all three researchers. However, the searches were conducted by the main researcher, after which two researchers selected the articles on grounds of the criteria. An information specialist was consulted about the search strategy (Arksey and O’Malley, 2005). The RefWorks reference system was used for managing the citations.

After the searches, the relevant studies were identified by first removing duplicates, then screening the articles and finally assessing the full-text articles for eligibility (Moher et al., 2009). In this review, the inclusion criteria consisted of English language and Finnish language peer-reviewed original research articles referring to both AL and health care. Restrictions on languages were imposed because of limited resources for translation. Although the collected data could have comprised different types of evidence (Arksey and O’Malley, 2005), in this review, the information sources were limited to peer-reviewed original research articles, as the purpose was to identify possible research gaps. There were no limitations to research methodologies of the original research studies (Arksey and O’Malley, 2005), nor timeframe limitations.

The searches identified 615 records, of which 314 remained after removing duplicates. In total 135 full-text articles were screened for eligibility (Figure 1). The methodological quality of the studies that were included was not formally assessed, which allowed the review to gain a more complete overview of the topic (Arksey and O’Malley, 2005). The review resulted in 29 English language peer-reviewed original research studies. There were no Finnish language studies found that met the inclusion criteria. The data was analysed using a descriptive numerical summary analysis and a thematic analysis. Research gaps were identified as well. (Levac et al., 2010).

3. Results

3.1 Study characteristics

The included studies had a year range of 2009 to 2016 (Tables I-IV summarise the main characteristics of the included studies). Of all the included studies, the majority originated from Canada, while others were from the USA, South Africa, Australia, Belgium, India, Iran and Israel. Nurses, especially new graduate nurses (i.e. NGNs), were the most common study population. Other studied occupational groups were experienced nurses, nurses’ supervisors, nurse managers, hospital CNEs, physicians, surgeons, pharmacists, RMOs, interns, dentists, dental assistants and other employees (e.g. administration, management, specialists, support staff and research staff). The nurses had different specialities depending on the study. Most of the studies were conducted in hospitals, but clinics, dental clinics, HMOs and a cancer care agency were studied as well. Acute care (i.e. AC) was the most researched setting. Other settings were community and long-term care. Only a few studies specified the studied work sector, however, the public and private health-care sectors were mentioned in some cases. Educational and religious sectors were mentioned as well. All the included studies understood AL according to its original definition (Luthans and Avolio, 2003). The results of the included studies underlined the positive effects of AL in health care (Tables I-III).

3.2 Research themes

The review identified four research themes amongst the included studies. The themes were named as follows: well-being at work, patient care quality, work environment and AL promotion (Figure 2).

3.2.1 Well-being at work.

The largest research theme was well-being at work (Table I). This research theme included research on many psychological and rather personal issues involving working life. To be precise, the studies in this category included research on AL’s relationship with psychological well-being at work (Nelson et al., 2014), work engagement (Bamford et al., 2013; Stander et al., 2015), job satisfaction (Giallonardo et al., 2010; Wong and Spence Laschinger, 2013; Spence Laschinger and Fida, 2014b; Rahimnia and Sharifirad, 2015; Read and Spence Laschinger, 2015; Spence Laschinger and Fida, 2015; Fallatah and Spence Laschinger, 2016), creativity (Malik et al., 2016), two dimensions of thriving (learning and vitality) (Mortier et al., 2016), voice behaviour (Wong and Cummings, 2009; Wong et al., 2010), performance (Wong and Cummings, 2009; Wong and Spence Laschinger, 2013), mental health symptoms (Spence Laschinger and Fida, 2014b; Read and Spence Laschinger, 2015; Spence Laschinger et al., 2015), perceived work stress, stress symptoms (Rahimnia and Sharifirad, 2015), emotional exhaustion (Spence Laschinger et al., 2013; Spence Laschinger and Read, 2016), cynicism (Spence Laschinger et al., 2013), burnout (Wong and Cummings, 2009), job turnover intentions (Spence Laschinger et al., 2012; Spence Laschinger and Fida, 2014a; Fallatah et al., 2016) and career turnover intentions (Spence Laschinger and Fida, 2014a). The studies included a variety of study populations, settings, organisations and work sectors.

Part of the mediating factors in these studies were individual issues, such as personal and social identification (Wong et al., 2010; Fallatah et al., 2016), occupational coping self-efficacy (Spence Laschinger et al., 2015; Fallatah et al., 2016), psychological capital (Spence Laschinger and Fida, 2014b), trust in organisation (Stander et al., 2015), trust in manager (Wong and Cummings, 2009; Wong et al., 2010), person-job match (Bamford et al., 2013; Spence Laschinger et al., 2015; Spence Laschinger and Read, 2016), optimism (Stander et al., 2015), empathy (Mortier et al., 2016), job satisfaction (Spence Laschinger et al., 2012), work engagement (Giallonardo et al., 2010; Wong et al., 2010), attachment insecurity (Rahimnia and Sharifirad, 2015), emotional exhaustion (Spence Laschinger et al., 2012; Spence Laschinger and Fida, 2014a, 2014b), cynicism (Spence Laschinger and Fida, 2014a, 2014b) and burnout (Spence Laschinger et al., 2015). Other mediating factors, such as work climate (Nelson et al., 2014), civility norms (Spence Laschinger and Read, 2016), patient care quality (Spence Laschinger and Fida, 2015), use of information technology (Malik et al., 2016), relational social capital (Read and Spence Laschinger, 2015), supportive professional practice environments (Spence Laschinger and Fida, 2015; Fallatah and Spence Laschinger, 2016), supportive groups (Wong and Cummings, 2009), structural empowerment (Spence Laschinger et al., 2013; Wong and Spence Laschinger, 2013; Read and Spence Laschinger, 2015; Spence Laschinger and Fida, 2015), knowledge sharing behaviour (Malik et al., 2016), short-staffing (Spence Laschinger and Fida, 2015), co-worker incivility (Spence Laschinger and Read, 2016) and workplace bullying (Spence Laschinger et al., 2012; Spence Laschinger and Fida, 2014a), were more connected to the work community and environment.

3.2.2 Patient care quality.

The second research theme was patient care quality (Table II). The studies in this category included research on AL’s relationship with patient care quality (Wong et al., 2010; Boamah et al., 2016), patient safety performance (Stevens et al., 2014) and adverse patient outcomes (Wong and Giallonardo, 2013). The mediating factors were individual issues, such as job satisfaction (Boamah et al., 2016), work engagement (Wong et al., 2010), trust in manager (Wong et al., 2010; Wong and Giallonardo, 2013), personal and social identification (Wong et al., 2010), work–life interference and burnout, and on the other hand, communal, such as structural empowerment (Boamah et al., 2016), areas of work life (Wong and Giallonardo, 2013) and short-staffing (Boamah et al., 2016).

3.2.3 Work environment.

The third research theme was work environment (Table III). This theme included research on AL’s relationship with organisational citizenship behaviour (Coxen et al., 2016), interprofessional collaboration (Spence Laschinger and Smith, 2013; Regan et al., 2016), organisational culture and healthy work environment (Shirey, 2009). The only mediating factor mentioned was workplace trust (Coxen et al., 2016).

3.2.4 AL promotion.

The fourth research theme was AL promotion (Table IV). This theme included research on how AL can be advanced in organisations. The studies included research on identifying the benefits of team simulations for AL (Shapira-Lishchinsky, 2014) and becoming and remaining authentic nurse leaders (Murphy, 2012).

3.3 Research methods

The analysis mapped the research methodology of the included studies (Tables I-IV). Of the 29 studies, 24 had a cross-sectional design (i.e. CSD), two had time-lagged design and three had longitudinal design. The majority of the 29 included studies were conducted using quantitative research methodology (n = 25). In the quantitative studies, the data collection was performed with single or two-wave surveys using original or secondary data. The surveys included the authentic leadership questionnaire (ALQ) (n = 20), the authentic leadership inventory (ALI) (n = 4), and the leadership practices inventory (LPI) (n = 1). ALQ was developed by leading AL researchers (Walumbwa et al., 2008). ALI measures the same matters as the ALQ (Neider and Schriesheim, 2011). LPI (Kouzes and Posner, 2012) can be used to measure AL behaviour (Wong and Cummings, 2009), but it is not developed especially for AL theory. The quantitative studies used a variety of statistical analyses. Qualitative research methodology was used in few studies (n = 3). In these studies, the data were collected with team simulations and interviews. The qualitative studies used qualitative data analysis based on grounded theory, narrative inquiry and thematic analysis methods in analysing the data. There was also a mixed methods study. The data in the mixed methods study were collected with surveys and/or interviews. The study used thematic and comparative analysis.

4. Discussion

This scoping review was conducted to map relevant research of AL in health care to identify potential research gaps and present recommendations for future research. Although AL has been studied internationally in the health-care context (Stander et al., 2015), the research has not been comprehensive (Spence Laschinger et al., 2013). This review has potential to guide the future research on this subject as it identified several research gaps related to study characteristics, research themes and research methodologies. The included studies emphasised the many positive effects AL has on health-care organisations. The key findings can be seen in Tables I-IV.

This review analysed the main characteristics of the included studies. More versatile research characteristics might increase the generalisation of the results (Bamford et al., 2013) and bring more comprehensive view of AL in health care. Nurses were the most common study population in the included studies. While studying nurses’ perspectives is highly advisable, other occupational groups in health care should be studied as well, as different professions have their own special characteristics. The studies examined mostly subordinates and so it would be fruitful to study AL more on the leaders’ perspectives. Hospitals and acute care settings appeared frequently in the studies. Most of the included articles did not include information of the work sectors in question. More research is needed on AL in many different organisations, settings and work sectors, such as small clinics and large chain organisations in the public, private and third sectors. The majority of the included studies were conducted in Canada, and consequently more research would be justified to perform in other geographical regions, such as Europe. In addition, the existential–experiential perspective on AL (Koskiniemi et al., 2015) might bring different and more critical views in future research. Furthermore, the critique of AL (Gardiner, 2011; Algera and Lips-Wiersma, 2012) might be reasonable to address in the future research because it might help to develop the theory or at least expand the understanding of AL.

The review presented four research themes composed of studies with a variety of research purposes. Well-being at work, patient care quality and work environment are important research themes as leadership can influence all of them (Shirey, 2006; Wong and Giallonardo, 2013; Nelson et al., 2014). It is also very likely that AL promotion influences these other themes as AL has been found to have many positive effects on organisations (Tables I-III).

Well-being at work was the most common research theme among the included studies. Working in health-care organisations can be psychologically challenging (Boamah et al., 2016). If staff’s well-being is not looked after, it might lead to severe problems, such as burnout (Spence Laschinger and Read, 2016) and turnover intentions (Fallatah et al., 2016). However, if health-care staff experiences well-being at work, it might lead to positive outcomes, such as creativity (Malik et al., 2016), optimism and trust (Stander et al., 2015). AL is found to influence health-care staff in many positive ways (Malik et al., 2016; Mortier et al., 2016). This is probably why this research theme has been so studied. Well-being at work is a popular and important research theme and these included studies may have valid implications for future research (Table I).

Patient care quality and work environment were medium-sized research themes. Studying AL’s influence on patient outcomes is reasonable (Bamford et al., 2013), as AL can have an influence on patient outcomes (Wong and Giallonardo, 2013). Patient care quality might be one of the most central themes for AL research because patient care can be seen as the centre of the entire health-care system. Patient care is so crucially important that nowadays it is usually strictly regulated in legislation.

AL has also been discovered to enhance healthy work environments (Shirey, 2006), which is why the third research theme is important as well. The previous studies have shown that AL may enhance interprofessional collaboration (Spence Laschinger and Smith, 2013; Regan et al., 2016) which is one of the central ways AL influences work environment. We think interprofessional collaboration in health care is a very topical and popular study subject that could be studied even more in the AL context. Besides, work environment itself in health-care context is a wide concept that might bring a lot more perspectives to the AL research.

AL promotion was the smallest research theme. There is a need for more studies concerning AL development in the health-care context. The positive outcomes that AL fosters, cannot be gained without first promoting and developing AL in the organisation. Thus, health-care organisations need more information and advice on how to promote AL. Studying this research theme may develop ideas of leadership training programs. (Bamford et al., 2013).

Another interesting theme for research in health care might be AL’s distinction between other leadership theories. The future research should put a lot more emphasis on the reasons why AL is often seen as a superior leadership theory especially in health care. There is a need for more profundity and justification on this topic. AL’s relationship with organisational profitability and customer orientation might be relevant research themes as well.

Almost all the included studies used quantitative research methodology. ALQ (Walumbwa et al., 2008) is clearly a generally accepted instrument as it has been used in numerous studies (Tables I-III). The ALI could be used more in the future because it was developed more recently and has even considered criticism towards the ALQ (Neider and Schriesheim, 2011). The LPI (Kouzes and Posner, 2012) was not developed for AL theory, so it is debatable whether this instrument should be used. AL is still a relatively new study subject and consequently many different research designs should be used (Avolio et al., 2004). Qualitative research on health-care organisations may bring understanding which quantitative research cannot produce (Caronna, 2010). Mixed methods studies on the other hand may have great synergy advantages (Padgett, 2012). Thus, more qualitative and mixed methods studies might bring new angles and research themes to the subject area. In addition, longitudinal designs could be used more to investigate changes over time (Padgett, 2012).

This scoping review has limitations. The review included only peer-reviewed original research articles, thus excluding all other information sources which could have possibly contained potential information about this subject. The review included only English language articles and so more relevant studies could have been found in other languages.

5. Conclusions

This is presumably the first literature review to examine and map evidence on AL in a health-care setting with a broad approach. The review analyses the main characteristics of the included studies, presents four research themes and examines the methodologies of the studies. The results of this review are available for designing future research on this subject. Researchers from various countries interested in health-care leadership may find these results usable in their work. In addition, researchers interested in AL may find it useful to perceive the AL research in a health-care context.

The review identified several research gaps. Firstly, there is a need for more variation in study populations, settings, organisations, work sectors, geographical origins and theory perspectives. Nurses were notably the most common study population in the included studies. Other occupational groups in health care should be studied as well. Secondly, more research is needed on different research themes, especially AL promotion, patient care quality and work environment. The distinction between AL and other leadership theories and its relationship with organisational profitability and customer-orientation might also be interesting themes. The future research should put a lot more emphasis on the reasons why AL is often seen as a superior leadership theory especially in health care. Thirdly, different research methodologies, such as qualitative and mixed methods research and longitudinal designs, should be used more.

Figures

Flow diagram of study selection process

Figure 1.

Flow diagram of study selection process

Research themes of the included studies

Figure 2.

Research themes of the included studies

“Well-being at work” themed studies

Author(s), year of publication, country of origin Purpose Study population and sample size Methodology Key findings
Fallatah and Spence Laschinger (2016)
Canada
To test a theoretical model linking AL to NGNs’ job satisfaction through its effect on supportive professional practice environments 93 NGNs (AC settings) Quantitative/CSD
Secondary analysis of data collected in a two-wave survey
The ALQ
Statistical analyses
Supportive professional practice environment partially mediated the relationship between AL and job satisfaction
Fallatah et al. (2016)
Canada
To examine the influence of AL on NGNs’ job turnover intentions through NGNs’ personal identification with their leader, organisational identification, and occupational coping self-efficacy 998 NGNs (AC and community settings) Quantitative/CSD
Secondary analysis of data collected in a survey
The ALQ
Statistical analyses
AL indirectly impacts turnover intentions through personal and organisational identification and occupational coping self-efficacy
The identifications increase nurses’ confidence in their ability to manage work-related challenges that result in positive outcomes in both nurses and the organisation
Malik et al. (2016)
India
To examine the relationship between AL and employee creativity, while determining the mediating effect of knowledge sharing behaviour and moderating effect of use of information technology on this association 405 nurses and their 81 supervisors
Hospitals
Quantitative/CSD
Survey
The ALQ
Statistical analyses
AL is positively linked to creativity
Knowledge sharing behaviour mediates the relationship between AL and employee creativity, whereas use of information technology acts as a moderator between knowledge sharing behaviour and employee creativity
Mortier et al. (2016)
Belgium
To examine the relationship between perceived AL and two dimensions of thriving (learning and vitality) among nurses, and to study the mediating role of empathy in this relationship 360 nurses (several specialities)
Hospital
Quantitative/CSD
Survey
The ALI
Statistical analyses
AL enhances thriving at work
Empathic nurse managers increase vitality of their nurses
Spence Laschinger and Read (2016)
Canada
To examine how AL and person-job fit influence civility norms and how these norms, in turn, affect co-worker incivility and subsequent emotional exhaustion 993 NGNs (several specialities) Quantitative/CSD
Survey
The ALQ
Statistical analyses
Civility norms help prevent early career burnout and co-worker incivility
Leaders can influence civility norms by engaging in AL behaviours and optimising person-job fit
Rahimnia and Sharifirad (2015)
Iran
To examine the effects of AL on employees’ well-being, and to investigate the mediating roles of followers’ attachment insecurity, and to explore the impact of AL on attachment insecurity 212 health-care providers (nurses and medical professionals)
Hospitals
Quantitative/CSD
Survey
The ALI
Statistical analyses
AL negatively impacted attachment insecurity
Attachment insecurity proved to be a factor impinging upon job satisfaction, and higher levels of attachment insecurity was associated with higher levels of perceived stress and stress symptoms
Attachment insecurity partially mediated the relationship between AL and job satisfaction and fully mediated the relationship between AL, perceived stress and stress symptoms
Read and Spence Laschinger (2015)
Canada
To examine a theoretical model testing the effects of AL, structural empowerment and relational social capital on the mental health and job satisfaction of NGNs over the first year of practice 191 NGNs (AC settings)
Hospitals
Quantitative/longitudinal design
Secondary analysis of data collected in a two-wave survey
The ALQ
Statistical analyses
Structural empowerment mediated the relationship between AL and relational social capital, which in turn had a negative effect on mental health symptoms, and a positive effect on job satisfaction
Spence Laschinger and Fida (2015)
Canada
To test a model linking AL, structural empowerment, and supportive professional practice environments to nurses’ perceptions of patient care quality and job satisfaction 723 nurses (several specialities) Quantitative/CSD
Secondary analysis of data collected in a survey
The ALQ
Statistical analyses
AL had a positive effect on structural empowerment, which had a positive effect on perceived support for professional practice and a negative effect on nurses’ perceptions that inadequate unit staffing prevented them from providing high-quality patient care
These workplace conditions predicted job satisfaction
Spence Laschinger et al. (2015)
Canada
To test a model linking AL, areas of work life, occupational coping self-efficacy, burnout and mental health among NGNs, and to test the validity of the concept of interpersonal strain at work as a facet of burnout 1009 NGNs (AC settings) Quantitative/CSD
Secondary analysis of data collected in a survey
The ALQ
Statistical analyses
AL had positive effect on areas of work life, which in turn had a positive effect on occupational coping self-efficacy, resulting in lower burnout, which was associated with poor mental health
Stander et al. (2015)
South Africa
To determine whether the leadership style of AL could predict optimism, trust in the organisation and work engagement and to establish whether optimism and trust in the organisation could mediate the relationship between AL and work engagement 633 employees (other, administrative, specialist, management)
Hospitals and clinics (public)
Quantitative/CSD
Survey
The ALI
Statistical analyses
AL predicted optimism and trust in the organisation
Optimism and trust in the organisation mediated the relationship between AL and work engagement
Nelson et al. (2014)
Canada
To determine the mediational role of the work climate in explaining the impact of AL on psychological well-being at work 406 nurses
Public and private health-care sectors, and education sector
Quantitative/time-lagged design
Two-wave survey
The ALQ
Statistical analyses
AL impacts work climate in a positive manner thereby increasing levels of psychological well-being at work
Spence Laschinger and Fida (2014a)
Canada
To examine the relationship between AL and NGNs’ experiences of workplace bullying and burnout over a one1-year timeframe in Canadian health-care settings; to examine the process from workplace bullying to subsequent burnout dimensions, as well as to job and career turnover intentions 205 NGNs (AC settings)
Hospitals
Quantitative/longitudinal design
Secondary analysis of data collected in a two-wave survey
The ALQ
Statistical analyses
AL decreased work-related bullying, burnout (emotional exhaustion and cynicism), and job and career turnover intentions
Spence Laschinger and Fida (2014b)
Canada
To investigate the influence of AL, an organisational resource and psychological capital, an intrapersonal resource, on NGNs’ burnout development, occupational satisfaction, and workplace mental health over the first year of their practice 205 NGNs (AC settings)
Hospitals
Quantitative/longitudinal design
Secondary analysis of data collected in a two-wave survey
The ALQ
Statistical analyses
Both AL and PsyCap were associated with lower initial levels of burnout (emotional exhaustion and cynicism) and subsequent change over the one-year timeframe, which in turn, were associated with health- and job-related outcomes
Bamford et al. (2013)
Canada
To examine the relationships among nurses’ perceptions of nurse managers’ AL, nurses’ overall person-job match in the six areas of work life and their work engagement 280 nurses (AC settings)
Hospitals
Quantitative/CSD
Secondary analysis of data collected in a survey
The ALQ
Statistical analyses
AL causes greater overall person-job match in the six areas of work life and greater work engagement
Spence Laschinger et al. (2013)
Canada
To examine the effect of AL and structural empowerment on the emotional exhaustion and cynicism of NGNs and experienced AC nurses 342 NGNs and 273 experienced nurses (AC settings)
Hospitals
Quantitative/CSD
Secondary analysis of data from two studies collected in surveys
The ALQ
Statistical analyses
AL negatively influenced burnout (emotional exhaustion and cynicism) through workplace empowerment
Wong and Spence Laschinger (2013)
Canada
To test a model linking AL of managers with nurses’ perceptions of structural empowerment, performance and job satisfaction 280 nurses (AC settings)
Hospitals
Quantitative/CSD
Survey
The ALQ
Statistical analyses
AL significantly and positively inuenced structural empowerment, which in turn increased job satisfaction and self-rated performance
Spence Laschinger et al. (2012)
Canada
To test a model linking AL to NGNs’ experiences of workplace bullying and burnout, and subsequently, job satisfaction and intentions to leave their jobs 342 NGNs (AC settings)
Hospitals
Quantitative/CSD
Survey
The ALQ
Statistical analyses
AL had a negative direct effect on workplace bullying, which in turn had a direct positive effect on burnout
AL influenced job satisfaction indirectly through bullying and burnout
AL had direct effect on job satisfaction, which in turn, was related to lower turnover intentions
Giallonardo et al. (2010)
Canada
To examine the relationships between NGNs’ perceptions of preceptor AL, work engagement and job satisfaction 170 nurses (AC settings) Quantitative/CSD
Survey
The ALQ
Statistical analyses
AL fosters work engagement and job satisfaction
Engagement is an important mechanism by which AL affects job satisfaction
Wong et al. (2010)
Canada
To test a theoretical model linking AL with staff nurses’ trust in their manager, work engagement, voice behaviour and perceived unit care quality 280 nurses (AC settings)
Hospitals
Quantitative/CSD
Survey
The ALQ
Statistical analyses
AL and trust in the manager play a role in fostering trust, work engagement, and voice behaviour
Personal identification partially mediated the relationship between AL and trust in manager
Wong and Cummings (2009)
Canada
To test a model linking AL behaviours with trust in management, perceptions of supportive groups and work outcomes (voice behaviour, job performance, burnout) 147 clinical-care providers, and 188 other professionals and nonclinical employees
Cancer care agency
Quantitative/CSD
Secondary analysis of data collected in a survey
The LPI
Statistical analyses
Supportive leader behaviour and trust in management are necessary for staff to be willing to voice concerns and offer suggestions to improve the workplace and patient care

“Work environment” themed studies

Author(s), year of publication, country of origin Purpose Study population and sample size Methodology Key findings
Coxen et al. (2016)
South Africa
To determine whether AL affects organisational citizenship behaviour through workplace trust (conceptualized as trust in the organisation, immediate supervisor and co-workers) 633 employees (other, administration, management, specialist)
Hospitals and/or clinics (public)
Quantitative study/CSD
Survey
The ALI
Statistical analyses
AL has significant influence on workplace trust
AL did not have significant influence on organisational citizenship behaviour
AL had significant indirect effect on organisational citizenship behaviour through trust in organisation and in co-workers
Regan et al. (2016)
Canada
To examine the influence of structural empowerment, AL and professional nursing practice environments on experienced nurses’ perceptions of interprofessional collaboration 220 experienced nurses (long-term care, community, other settings)
Hospitals
Quantitative study/CSD
Secondary analysis of data collected in a survey
The ALQ
Statistical analyses
AL may enhance IPC
Spence Laschinger and Smith (2013)
Canada
To examine NGNs’ perceptions of the influence of AL and structural empowerment on the quality of interprofessional collaboration in health-care work environments 194 NGNs (AC settings) Quantitative study/CSD
Secondary analysis of data collected in a survey
The ALQ
Statistical analyses
AL may promote IPC
Shirey(2009)
USA
To showcase the relationship among AL, organisational culture, and healthy work environments using a stress and coping lens 21 nurse managers (AC settings)
Hospitals
Qualitative study/CSD
Secondary analysis of data collected in a one-time demographic questionnaire and a 14-question face-to-face interview that incorporated components of the Critical Decision Method
Thematic analysis
Nurse managers working in positive organisational cultures generally worked in healthy work environments and engaged in more AL behaviours
Nurse managers working in negative organisational cultures worked in unhealthy work environments and reported less optimism and more challenges engaging in AL practices

“AL Promotion” themed studies

Author(s), year of publication, country of origin Purpose Study population and sample size Methodology Key findings
Shapira-Lishchinsky (2014)
Israel
To explore nurses’ ethical decision-making in team simulations to identify the benefits of these simulations for AL 50 nurses (several specialities)
Hospitals and HMOs (public, private, religious)
Qualitative/CSD
Team simulations in 10 teams
Qualitative data analysis based on Grounded Theory
Team-based simulation as a training tool may lead to AL among nurses
Murphy(2012)
USA
To explore the experiences of hospital chief nurse executives (CNEs) in becoming and remaining authentic nurse leaders 1 current and 2 former hospital CNEs
Hospitals
Qualitative/CSD
2 semi-structured interviews focused on the life stories of participants
Narrative inquiry
Reframing, reflection in alignment with values, and courage are important as nurse leaders progress to authenticity

“Patient care quality” themed studies

Author(s), year of publication, country of origin Purpose Study population and sample size Methodology Key findings
Boamah et al. (2016)
Canada
To test a hypothesised model linking NGNs’ perceptions of theirmanager’s AL behaviours to structural empowerment, short-staffing and work-life interference and subsequent burnout, job satisfaction and patient care quality 406 NGNs (several specialities)
Hospitals
Quantitative/time-lagged design
Secondary analysis of data collected in a two-wave survey
The ALQ
Statistical analyses
AL was positively linked to structurally empowering working conditions, which in turn, negatively influenced short-staffing and work-life interference
Short-staffing and work-life interference predicted burnout development, with short-staffing increasing burnout both directly and indirectly, through its effect on work-life interference
Burnout negatively affects job satisfaction and patient care quality, while job satisfaction positively influences patient care quality
Short-staffing and work-life interference mediated the relationship between AL, structural empowerment and burnout
Stevens et al. (2014)
Australia
To investigate to what extent an engaging or AL style is related to higher levels of patient safety performance 29 medical staff and 22 dental staff
Hospitals and dental clinics
Mixed methods/CSD
Survey and/or interview of participants’ perceptions of leadership style in their unit (qualitative and quantitative data)
Data was analysed in terms of themes, and compared with the unit specific hand hygiene (HH) compliance data
Environmental factors, role modelling by the leader and education to counter false beliefs about hand hygiene and infection control may be more important determinants of patient safety performance in this regard than actual overall leadership style
Wong and Giallonardo (2013)
Canada
To test a model examining relationships among AL, nurses’ trust in their manager, areas of work life and nurse-assessed adverse patient outcomes 280 nurses (AC settings)
Hospitals
Quantitative/CSD
Secondary analysis of data collected in a survey
The ALQ
Statistical analyses
AL is linked to increased trust, greater congruence in areas of work life and lower frequencies of adverse patient outcomes
Wong et al. (2010)
Canada
To test a theoretical model linking AL with staff nurses’ trust in their manager, work engagement, voice behaviour and perceived unit care quality 280 nurses (AC settings)
Hospitals
Quantitative/CSD
Survey
The ALQ
Statistical analyses
AL and trust in manager play a role in fostering trust, work engagement, and perceived quality of care
Personal identification mediated the relationship between AL and trust in the manager

References

Algera, P.M. and Lips-Wiersma, M. (2012), “Radical authentic leadership: co-creating the conditions under which all members of the organization can be authentic”, The Leadership Quarterly, Vol. 23 No. 1, pp. 118-131.

Arksey, H. and O’Malley, L. (2005), “Scoping studies: towards a methodological framework”, International Journal of Social Research Methodology, Vol. 8 No. 1, pp. 19-32.

Avolio, B.J. and Gardner, W.L. (2005), “Authentic leadership development: getting to the root of positive forms of leadership”, The Leadership Quarterly, Vol. 16 No. 3, pp. 315-338.

Avolio, B.J., Walumbwa, F.O. and Weber, T.J. (2009), “Leadership: current theories, research, and future directions”, Annual Review of Psychology, Vol. 60 No. 1, pp. 421-449.

Avolio, B.J., Gardner, W.L., Walumbwa, F.O., Luthans, F. and May, D.R. (2004), “Unlocking the mask: a look at the process by which authentic leaders impact follower attitudes and behaviors”, The Leadership Quarterly, Vol. 15 No. 6, pp. 801-823.

Bamford, M., Wong, C.A. and Laschinger, H. (2013), “The influence of authentic leadership and areas of worklife on work engagement of registered nurses”, Journal of Nursing Management, Vol. 21 No. 3, pp. 529-540.

Boamah, S.A., Read, E.A. and Spence Laschinger, H.K. (2016), “Factors influencing new graduate nurse burnout development, job satisfaction, and patient care quality: a time-lagged study”, Journal of Advanced Nursing, doi: 10.1111/jan.13215.

Caronna, C.A. (2010), “Why use qualitative methods to study health care organizations? Insights from multi-level case studies”, in Bourgeault, I., Dingwall, R. and De Vries, R. (Eds), The SAGE Handbook of Qualitative Methods in Health Research, Sage Publications, London, pp. 71-87.

Clapp-Smith, R., Vogelgesang, G. and Avey, J. (2009), “Authentic leadership and positive psychological capital: the mediating role of trust at the group level of analysis”, Organizational Studies, Vol. 15 No. 3, pp. 227-240.

Costas, J. and Taheri, A. (2012), “The return of the primal father’ in postmodernity? A Lacanian analysis of authentic leadership”, Organization Studies, Vol. 33 No. 9, pp. 1195-1216.

Coxen, L., van der Vaart, L. and Stander, M.W. (2016), “Authentic leadership and organisational citizenship behaviour in the public health care sector: the role of workplace trust”, SA Journal of Industrial Psychology, Vol. 42 No. 1, pp. 1-13.

Dickson, G. (2009), “Transformations in Canadian health systems leadership: an analytical perspective”, Leadership in Health Services, Vol. 22 No. 4, pp. 292-305.

Fallatah, F. and Spence Laschinger, H.K. (2016), “The influence of authentic leadership and supportive professional practice environments on new graduate nurses’ job satisfaction”, Journal of Research in Nursing, Vol. 21 No. 2, pp. 125-136.

Fallatah, F., Spence Laschinger, H.K. and Read, E.A. (2016), “The effects of authentic leadership, organizational identification, and occupational coping self-efficacy on new graduate nurses’ job turnover intentions in Canada”, Nursing Outlook, doi: http://dx.doi.org/10.1016/j.outlook.2016.11.020.

Gardiner, R.A. (2011), “A critique of the discourse of authentic leadership”, International Journal of Business and Social Science, Vol. 2 No. 15, pp. 99-104.

Giallonardo, L.M., Wong, C.A. and Iwasiw, C.L. (2010), “Authentic leadership of preceptors: predictor of new graduate nurses’ work engagement and job satisfaction”, Journal of Nursing Management, Vol. 18 No. 8, pp. 993-1003.

Johansson, G., Sandahl, C. and Andershed, B. (2011), “Authentic and congruent leadership providing excellent work environment in palliative care”, Leadership in Health Services, Vol. 24 No. 2, pp. 135-149.

Koskiniemi, A., Perttula, J. and Syväjärvi, A. (2015), “Existential-experiential view of self-sourced (in)authentic healthcare identity”, Journal of Leadership Studies, Vol. 9 No. 2, pp. 6-18.

Kouzes, J.M. and Posner, B.Z. (2012), The Leadership Challenge: How to Make Extraordinary Things Happen in Organizations, Jossey-Bass, San Francisco, CA.

Levac, D., Colquhoun, H. and O’Brien, K. (2010), “Scoping studies: advancing the methodology”, Implementation Science, Vol. 5 No. 1, pp. 69-69.

Luthans, F. and Avolio, B. (2003), “Authentic leadership development”, in Cameron, K.S., Dutton, J.E. and Quinn, R.E. (Eds), Positive Organizational Scholarship: Foundations of a New Discipline, Berrett-Koehler Publishers, San Francisco, CA, pp. 241-258.

Malik, N., Dhar, R.L. and Handa, S.C. (2016), “Authentic leadership and its impact on creativity of nursing staff: a cross sectional questionnaire survey of Indian nurses and their supervisors”, International Journal of Nursing Studies, Vol. 63, pp. 28-36.

Moher, D., Liberati, A., Tetzlaff, J. and Altman, D.G. and The PRISMA Group (2009), “Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement”, Annals of Internal Medicine, Vol. 151 No. 4, pp. 264-269.

Mortier, A.V., Vlerick, P. and Clays, E. (2016), “Authentic leadership and thriving among nurses: the mediating role of empathy”, Journal of Nursing Management, Vol. 24 No. 3, pp. 357-365.

Murphy, L.G. (2012), “Authentic leadership: becoming and remaining an authentic nurse leader”, Journal of Nursing Administration, Vol. 42 No. 11, pp. 507-512.

Neider, L.L. and Schriesheim, C.A. (2011), “The authentic leadership inventory (ALI): development and empirical tests”, The Leadership Quarterly, Vol. 22 No. 6, pp. 1146-1164.

Nelson, K., Boudrias, J.-S., Brunet, L., Morin, D., De Civita, M., Savoie, A. and Alderson, M. (2014), “Authentic leadership and psychological well-being at work of nurses: the mediating role of work climate at the individual level of analysis”, Burnout Research, Vol. 1 No. 2, pp. 90-101.

Padgett, D.K. (2012), Qualitative and Mixed Methods in Public Health, Sage Publications, Thousand Oaks, CA.

Peters, M.D.J., Godfrey, C.M., Khalil, H., McInerney, P., Parker, D. and Baldini Soares, C. (2015), “Guidance for conducting systematic scoping reviews”, International Journal of Evidence-Based Healthcare, Vol. 13 No. 3, pp. 141-146.

Rahimnia, F. and Sharifirad, M.S. (2015), “Authentic leadership and employee well-being: the mediating role of attachment insecurity”, Journal of Business Ethics, Vol. 132 No. 2, pp. 363-377.

Read, E.A. and Spence Laschinger, H.K. (2015), “The influence of authentic leadership and empowerment on nurses’ relational social capital, mental health and job satisfaction over the first year of practice”, Journal of Advanced Nursing, Vol. 71 No. 7, pp. 1611-1623.

Regan, S., Spence Laschinger, H.K. and Wong, C.A. (2016), “The influence of empowerment, authentic leadership, and professional practice environments on nurses’ perceived interprofessional collaboration”, Journal of Nursing Management, Vol. 24 No. 1, pp. E54-E61.

Shapira-Lishchinsky, O. (2014), “Simulations in nursing practice: toward authentic leadership”, Journal of Nursing Management, Vol. 22 No. 1, pp. 60-69.

Shirey, M.R. (2006), “Authentic leaders creating healthy work environments for nursing practice”, American Journal of Critical Care, Vol. 15 No. 3, pp. 256-268.

Shirey, M.R. (2009), “Authentic leadership, organizational culture, and healthy work environments”, Critical Care Nursing Quarterly, Vol. 32 No. 3, pp. 189-198.

Spence Laschinger, H.K. and Fida, R. (2014a), “A time-lagged analysis of the effect of authentic leadership on workplace bullying, burnout, and occupational turnover intentions”, European Journal of Work and Organizational Psychology, Vol. 23 No. 5, pp. 739-753.

Spence Laschinger, H.K. and Fida, R. (2014b), “New nurses burnout and workplace wellbeing: the influence of authentic leadership and psychological capital”, Burnout Research, Vol. 1 No. 1, pp. 19-28.

Spence Laschinger, H.K. and Fida, R. (2015), “Linking nurses’ perceptions of patient care quality to job satisfaction: the role of authentic leadership and empowering professional practice environments”, Journal of Nursing Administration, Vol. 45 No. 5, pp. 276-283.

Spence Laschinger, H.K. and Read, E.A. (2016), “The effect of authentic leadership, person-job fit, and civility norms on new graduate nurses’ experiences of coworker incivility and burnout”, Journal of Nursing Administration, Vol. 46 No. 11, pp. 574-580.

Spence Laschinger, H.K. and Smith, L.M. (2013), “The influence of authentic leadership and empowerment on new-graduate nurses’ perceptions of interprofessional collaboration”, Journal of Nursing Administration, Vol. 43 No. 1, pp. 24-29.

Spence Laschinger, H.K., Wong, C.A. and Grau, A.L. (2013), “Authentic leadership, empowerment and burnout: a comparison in new graduates and experienced nurses”, Journal of Nursing Management, Vol. 21 No. 3, pp. 541-552.

Spence Laschinger, H.K., Wong, C.A. and Grau, A.L. (2012), “The influence of authentic leadership on newly graduated nurses’ experiences of workplace bullying, burnout and retention outcomes: a cross-sectional study”, International Journal of Nursing Studies, Vol. 49 No. 10, pp. 1266-1276.

Spence Laschinger, H.K., Borgogni, L., Consiglio, C. and Read, E. (2015), “The effects of authentic leadership, six areas of worklife, and occupational coping self-efficacy on new graduate nurses’ burnout and mental health: a cross-sectional study”, International Journal of Nursing Studies, Vol. 52 No. 6, pp. 1080-1089.

Stander, F.W., de Beer, L.T. and Stander, M.W. (2015), “Authentic leadership as a source of optimism, trust in the organisation and work engagement in the public health care sector”, SA Journal of Human Resource Management, Vol. 13 No. 1, pp. 1, p. 12.

Stevens, S.C., Hemmings, L., Scott, C., Lawler, A. and White, C. (2014), “Clinical leadership style and hand hygiene compliance”, Leadership in Health Services, Vol. 27 No. 1, pp. 20-30.

Vakkala, H. and Syväjärvi, A. (2012), “Henkilöstöjohtamista kuntien muutostilanteissa: autenttisuus ja ihmisläheinen johtamisote”, Kunnallistieteellinen Aikakauskirja, Vol. 40 No. 4, pp. 346-363.

Walumbwa, F.O., Avolio, B.J., Gardner, W.L., Wernsing, T.S. and Peterson, S.J. (2008), “Authentic leadership: development and validation of a theory-based measure”, Journal of Management, Vol. 34 No. 1, pp. 89-126.

Wong, C.A. and Cummings, G.G. (2009), “The influence of authentic leadership behaviors on trust and work outcomes of health care staff”, Journal of Leadership Studies, Vol. 3 No. 2, pp. 6-23.

Wong, C.A. and Giallonardo, L.M. (2013), “Authentic leadership and nurse-assessed adverse patient outcomes”, Journal of Nursing Management, Vol. 21 No. 5, pp. 740-752.

Wong, C.A. and Spence Laschinger, H.K. (2013), “Authentic leadership, performance, and job satisfaction: the mediating role of empowerment”, Journal of Advanced Nursing, Vol. 69 No. 4, pp. 947-959.

Wong, C.A., Spence Laschinger, H.K. and Cummings, G.G. (2010), “Authentic leadership and nurses’ voice behaviour and perceptions of care quality”, Journal of Nursing Management, Vol. 18 No. 8, pp. 889-900.

Corresponding author

Niina Malila can be contacted at: niina.malila@netti.fi