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Review

Transformational Leadership—Quality Achievements and Benefits for the Healthcare Organizations: A Scoping Review

by
Eleni Tsapnidou
1,*,
Martha Kelesi
1,
Michael Rovithis
2,
Georgios Katharakis
1,
Georgia Gerogianni
1,
Chrysoula Dafogianni
1,
Georgia Toylia
1,
Georgia Fasoi
1 and
Areti Stavropoulou
1,3
1
Department of Nursing, Faculty of Health and Care Sciences, University of West Attica, Ag. Spyridonos Str., 12243 Athens, Greece
2
Department of Business Administration and Tourism, School of Management and Economics Sciences, Hellenic Mediterranean University, Gianni Kornarou, Estavromenos 1, 71410 Heraklion, Greece
3
Faculty of Health, Science, Social Care and Education, Kingston University, London KT2 7LB, UK
*
Author to whom correspondence should be addressed.
Hospitals 2024, 1(1), 87-103; https://doi.org/10.3390/hospitals1010008
Submission received: 15 May 2024 / Revised: 8 July 2024 / Accepted: 18 July 2024 / Published: 26 July 2024
Browse Figure
Versions Notes

Abstract

:
Effective nursing leadership is critical for healthcare organizations’ sustainability as nurse leaders influence many organizational aspects, including staff retention, quality of care, resource management, and development. The aim of this study is to highlight the quality achievements and benefits that transformational leadership may have for healthcare organizations. An extensive literature search has been conducted through MEDLINE and Scopus. The 6-stage framework proposed by Arksey and O’Malley was applied, guided the scoping review process. Data extracted from the included studies were systematically charted. This approach allowed for a comprehensive understanding of the advantages of transformational leadership in healthcare organizations. Of the 1245 searched articles, 26 encountered the study’s inclusion criteria. Analysis of the studies led to the formulation of two thematic categories, namely, (a) transformational leadership and human resources and (b) transformational leadership and healthcare delivery. Results indicated that transformational nursing leadership can benefit healthcare organizations in terms of effective resource management, high quality of care, and sustainability. Visionary leaders support staff retention, innovation, and research and promote organizational status and development. Through continuous support and training, transformational nurse leaders can ensure nurses’ job satisfaction and engagement, patients’ satisfaction, the best therapeutic outcomes, and high levels of organizational achievement.

1. Introduction

In the contemporary healthcare context, nursing leadership appears to gain significant attention because of its critical role in rapidly introducing innovative and yet unexpected changes in the healthcare systems during the COVID-19 pandemic [1]. The aging workforce, the shortage of nurses, the constantly emerging demographic changes, along with the increasing societal demands for providing safe and quality care, are only a few of the reasons why efficient leadership is required [2,3]. Additionally, the physical and mental exhaustion from which the nursing workforce suffers, due to the increased turnover rates, the heavy workload, the lack of professional recognition, and the negative work–life balance, leads to increased levels of stress, low job satisfaction, professional depreciation, and nurses’ drop-out [4,5].
Leadership styles impact staff and patient outcomes, quality of care, and employee satisfaction and determine organizational function and productivity [6]. Leadership is also one of the main attributes that improve the working environment and achieve better patient and nursing outcomes and organizational goals [6]. Leading with empathy, ensuring high levels of job satisfaction, promoting quality care, positive patient outcomes, effectiveness, and sustainability appeared to be issues of debate for the scientific community [7]. When inappropriate leadership styles are practiced, it may result in low quality or compromised care, difficulties in retaining the existing nursing staff, ineffective use of resources, and financial drain for the organization [8]. Applying leadership practices that invest in recruiting and retaining high-qualified nursing staff is the key element to achieving better outcomes at a lower cost [8]. The relevant literature refers to many different leadership styles, such as servant leadership, transactional leadership, laissez-faire, resonant, authentic leadership, and transformational leadership, also known as inspirational, visionary, charismatic, empowering, adaptive, change-oriented, and innovative. These are the types of leadership being applied in the healthcare sector, each with different principles, characteristics, and outcomes. Transformational leadership’s main characteristics are communication, influence, vision, motivation, and increased productivity [9]. Servant leadership requires trust and provision [10], while transactional leadership’s main characteristics are reward and recognition, immobility, and short-term commitment [11,12]. Laisezz-faire leadership involves avoidance, absence of involvement, and lack of trust [12,13], resonant leadership entails high emotional intelligence, commitment, coaching, and engagement [14,15]. The main characteristics of the authentic leadership style are honesty, non-authoritarian behavior, sincerity, and trustiness [16].
Relevant studies focus on effective nursing leadership styles and their impact on the above-mentioned challenges of the profession; however, transformational leadership seems to have earned the distinction [17,18]. Transformational leadership is, according to Leithwood, that which “facilitates a redefinition of a people’s mission and vision, a renewal of their commitment and the restructuring of their systems for goal accomplishment. It is a relationship of mutual stimulation and elevation that converts followers into leaders and may convert leaders into moral agents. Hence, transformational leadership must be grounded in moral foundations.” [19]. Whereas Bass had identified that transformational leadership “occurs when leaders broaden and elevate the interests of their employees, when they generate awareness and acceptance of the purposes and mission of the group, and when they stir employees to look beyond their own self-interest for the good of the group’’ [20]. More specifically, transformational leadership is praised for attaining high levels of job satisfaction and preventing employees’ turnover [21,22,23]. These visionary leadership practices reduce stress and burnout among nurses and promote professional engagement, patient safety, and organizational image [6,7,24,25]. Change-oriented leadership is also known to support innovation and technology integration, increasing care quality and minimizing the human error factor [26,27]. Further analysis of the achievements of transformational leadership is important for expanding the existing knowledge in the field and highlighting how patients, healthcare professionals, and organizations can benefit from this specific style of leadership.

2. Material and Methods

2.1. Aim of the Study

The aim of this study was to explore the advantages and accomplishments that transformational leadership may offer to healthcare organizations. The study questions, which this paper seeks to answer, are the following:
  • Q1: How can healthcare organizations benefit from transformational nursing leadership in correlation with the nursing staff?
  • Q2: What are the advantages of implementing transformational leadership for healthcare organizations in terms of care delivery?

2.2. Design

A scoping review follows a structured approach to finding and evaluating existing literature on a particular topic, using specific criteria to thoroughly explore, summarize, and present the findings in order to answer the research questions [28]. For that reason, the systematic 6-stage methodological framework, initially proposed by Arksey and O’Malley [28] was applied to this study. The objectives of this study, which aimed to identify the benefits and quality achievements of transformational leadership in healthcare organizations, were best addressed through a scoping review approach.

2.3. Identifying Relevant Studies

Eligibility criteria. The study included peer-reviewed articles, including primary cross-sectional, descriptive, and qualitative research, as well as mixed-methods. The inclusion criteria involved papers written in the English language, published between 2020 and 2024, and focusing exclusively on transformational leadership and how beneficial it can be for healthcare organizations. Several studies did not answer the research questions or aspects of the current framework; many of them were generally related to the leadership impact on human capital or care delivery. Also, articles that were published before 2020, not related to the healthcare context, not peer reviewed, and not found as full-text articles in the English language were excluded.
Information sources and search strategy. An extensive literature search was conducted in the databases of Scopus and MEDLINE. The search was limited to these databases to ensure quality and reliability through their established standards. Also, these databases were selected for their comprehensive multidisciplinary coverage and substantial repository of relevant scholarly articles. Based on the established eligibility criteria, articles containing the terms “nursing leadership”, “transformational leadership”, “healthcare organizations”, and “nursing staff” were incorporated into a systematic database search strategy using Boolean operators, as detailed in Table 1, to meet the research objectives.

2.4. Study Selection

Out of the 120 studies that met the study criteria, 26 have been identified as more suitable to answer the study questions. The research selection process was described using the PRISMA flowchart [29]. With a large number of the initial searched articles, the reference management software package of EndNote v. 20 was used to manually compare the information of each article and remove the duplicates. Once the duplicate articles were identified, the records within EndNote were merged to consolidate the information and avoid redundancy. The included studies described ways that healthcare organizations benefit from implementing transformational nursing leadership to support and empower their nursing staff. Also, the advantages of adopting transformational leadership within healthcare organizations to improve and elevate the quality-of-care delivery were identified. The diagram presented in Figure 1 illustrates the PRISMA format.

2.5. Charting the Data

In line with Arksey and O’Malley’s framework [28], the data acquired from the aforementioned procedures must be structured systematically within a tabular format. In adherence to their guidelines, a comprehensive data table was formulated to delineate the essential elements of each scholarly article. A systematic data extraction protocol was devised to facilitate meticulous documentation, validated through an initial trial study encompassing a subset of 5 articles, and further enhanced through collaborative refinement by three researchers. Subsequent to this procedural step, the chosen articles were distributed among the researchers, with each researcher autonomously extracting data through the utilization of the prescribed data table. Appendix A provides a comprehensive summary detailing attributes such as author(s), date of publication, country of the study, research objectives, sample, methodology, and results/findings (see Table A1).

2.6. Data Analysis

The extracted data were grouped according to the two review questions. The analysis of the studies, led to the formulation of two thematic categories, namely, (a) transformational leadership and human resources and (b) transformational leadership and healthcare delivery. The categories were derived directly from the data presented in the results and findings table of the studies being analyzed. The primary analysis was performed by three authors and refined and discussed through collaboration by all contributors. The reporting results were defined according to the PRISMA-ScR checklist [29].

2.7. Consultation

The initial results of the study were discussed with three external stakeholders from three different health sectors in Greece, individuals with extensive experience in leadership and value-based care. Participants were asked to evaluate both the results and the discourse and provide feedback on important themes to highlight in relation to the results.

3. Results

3.1. Characteristics of Included Studies

In Table 2, the research characteristics are outlined for the total of the 26 studies included in the scoping review. Geographically, the research encompassed all the continents, with a significant portion originating from Europe (8) and Asia (13), followed by the USA (3) and Australia (2). Of the total sixteen studies, half of them were published in 2021, the other half in 2022, seven in 2023, and the remaining three studies were published in 2020 (1) and 2024 (2). Ten of the studies analyzed (10) utilized cross-sectional methodologies, seven exclusively employed descriptive methods, and six used a mixed-method approach. There were only two studies that used qualitative methods, and only one study was longitudinal. From the grouped categories, there were twelve studies that referred to transformational leadership and human capital, and the rest of the studies (14) referred to transformational leadership and care delivery.

3.2. Transformational Leadership and Human Resources

Transformational nurse leaders create a positive work environment for nurses, resulting in higher levels of job satisfaction, increased staff morale, organizational commitment, and lower turnover rates [30,31]. They encourage the research culture by promoting innovation, collaboration, and increasing satisfaction within the team [32,33]. They ensure effective job performance and nurses’ retention, which reduces the costs of constantly hiring and training new, inexperienced nursing staff [34]. Issues of enhanced professional engagement, stability of existing workforce, and safe working environment are also supported by visionary leadership [35,36]. According to the findings of this study, empowering leadership can also be a strong predictor of improved nurse outcomes, which relate to optimal nurses’ performance, nurses’ retainment, provision of best clinical practice, satisfied employees, work–life balance, availability of resources, and appropriate professional environment [21,37,38]. This study has also found a positive correlation between adaptive nursing leadership and empowering strategies concerning the nurses’ resilience in order to ensure the nursing workforces’ sustainability [39]. Concerning primary care nurses, this study found that transformational leadership practices are the most predominant [18]. Change-oriented leaders also adopt a blame-free culture, and they promote positive patient outcomes and patient safety [17,40].

3.3. Transformational Leadership and Healthcare Delivery

Transformational leadership has been negatively corelated with patient adverse events, as transformational leaders prioritize patient safety and risk management by implementing proactive measures to prevent errors, risk reduction strategies, and creating a safe caring environment [41]. Transformational leaders are also found to use their emotional intelligence to develop a patient safety culture [42], a healthy working environment, and skilled and competent staff [43]. The visionary leadership practices, according to the literature, reduce liability exposure and promote the organization’s reputation and image, as a provider of high-quality patient care [44,45].
The literature revealed that inspirational nurse leaders play a substantial role in implementing and monitoring evidence-based practice and in providing relevant training [46]. Transformational nursing leaders use various strategies to apply theoretical knowledge to clinical practice, such as feedback on individual performance, empowering patients to actively participate in their care, promote interprofessional education, and collaboration with interdisciplinary teams [47,48]. They further encourage nurses to become actively involved in improvement projects, using their change management skills [49].
The recent experience of the pandemic outbreak revealed the imminent need for risk management and staff readiness [50]. According to the literature, empowering nursing leaders to develop comprehensive disaster preparedness and response plans means ensuring that healthcare teams are trained to effectively respond to emergencies, such as natural disasters or public health crises like the COVID-19 pandemic [51,52].

4. Discussion

Transformational nurse leaders support, in various ways, high levels of job satisfaction and work engagement [21,25,27]. According to the findings of this study, visionary leadership contributes to healthcare organizations’ sustainability and prosperity through their employees, the shortage of whom can become significantly costly for the services provided [37]. The review of the literature unveiled, that change-oriented nursing leaders promote structural empowerment, job satisfaction, and organizational commitment, as they invest in the professional development and education of their nursing staff, supporting lifelong learning and competency development [27,38]. Transformational nursing leaders are also known as change managers, and, as such, they are eligible for the development of a supportive environment for the cultivation of research activities among the nurses [32]. In order for healthcare organizations to benefit from the stability of the nursing workforce, it is of great importance that a culture of resilience and adaptability be developed, and transformational leadership can contribute to that through its focus on the nurses’ empowerment and retainment [39]. The extensive utilization of emotional intelligence is also part of empowering nursing leadership and promotes collaboration and teamwork, ultimately improving patient care delivery [42,53].
Inspirational leaders’ contribution to the quality of the care provided has been proven to be substantial. These leaders encourage and support evidence-based practice initiatives by continuously monitoring performance, identifying areas for improvement, and directing professional developments towards strategic objectives [18,46,54]. Taking into consideration the nurses’ increased turnover rates, the heavy workload, the burnout, and the negative work–life balance [55,56,57,58], leading with emotional intelligence is crucial for creating a positive and safety-focused working environment [32,39,40,59]. This creates a culture of engagement, growth, and development among healthcare staff, which in turn ensures higher retention rates [60,61]. In a meta-analysis carried out in 2022, registered nurses whose leaders were implementing transformational leadership reported providing high-quality nursing care [53]. Accordingly, a positive relationship between charismatic leaders and the delivery of quality care was found as a result of the inspiration, support, and encouragement of visionary nursing leadership practices [62]. These issues are crucial for effectively confronting the challenges of highly demanding healthcare environments.
Transformational leadership has been associated with multiple benefits for healthcare organizations in terms of the quality of nursing care, proactive measures to prevent errors, and risk management [30,41]. It has also been related to fewer patient complications, as transformational leaders guarantee a safe care setting [27]. This minimizes legal risk and enhances organizations’ social profile as high-value healthcare establishments [44,45]. A strong reputation attracts patients, healthcare professionals, and strategic partnerships, fostering organizational growth and sustainability.
According to the literature, transformational nursing leaders may also cultivate organizational resilience and adaptability by preparing the organization to effectively respond to external challenges, crises, and disruptions [52]. This is beneficial for the healthcare organization because it ensures continuity of operation and quality of care delivery under adverse conditions. In addition, innovative leadership helps healthcare organizations confront the challenges evolving in the contemporary healthcare landscape and remain competitive [51].
The achievements of healthcare organizations lie within their empowerment of nursing staff, in terms of information, training, and monitoring the embodiment of innovation in their routine, cutting costs of time-consuming activities, and reducing the human error factor [26,33,63].

5. Conclusions

The findings of this study highlight the transformational nursing leaderships’ ability to ensure high job satisfaction, work engagement, and improved performance. Within this multi-faceted and diverse context, healthcare professionals and policymakers strive to shape an attractive profile of healthcare organizations for both patients and stakeholders. Transformational leadership seems to confront the complexities and constraints of healthcare systems efficiently and gain considerable quality achievements for healthcare organizations. Investing in transformational nursing leadership may lead to development and organizational empowerment. Preparing and promoting inspirational leaders can be beneficial for staff development, improving patient outcomes, competitiveness, and sustainability. This study found that charismatic leaders focus on quality of care, innovation, and technology integration, which are critical issues in the contemporary healthcare environment. Further research should focus on the ways transformational leadership can alter the care quality and delivery process using technological advancements, increasing the quality of care and decreasing its expenses.

Author Contributions

Conceptualization, A.S., E.T. and G.K.; methodology, G.K. and E.T.; formal analysis, G.K., G.G. and M.R.; investigation, E.T., C.D. and G.T.; data curation, M.K., G.F. and G.T.; writing—original draft preparation, A.S. and E.T.; writing—review and editing, G.T. and M.R.; visualization, G.G., C.D. and A.S.; supervision, A.S., M.R. and M.K. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Informed Consent Statement

Not applicable.

Data Availability Statement

Data sharing is not applicable.

Conflicts of Interest

The authors declare no conflicts of interest.

Appendix A

Table A1. Research studies by author(s), country, aim, data sample, study design, data collection and analysis method and finding(s).
Table A1. Research studies by author(s), country, aim, data sample, study design, data collection and analysis method and finding(s).
Author(s), YearCountry aAimParticipantsStudy Design bData Collection MethodData Analysis MethodFinding(s)
1Abd-EL Aliem and Aly Abou Hashish, 2021 [52]Saudi ArabiaRelationship between transformational leadership practices of first-line nurse managers and nurses’ resilience and job involvement.271 frontline nurse managers (FLNMs) or staff nurses working with FLNMs at a University Hospital in Saudi Arabia
(60 FLNMs and 211 Staff Nurses)		Descriptive correlational research3 Questionnaires: (a) The Leadership Practices Inventory (LPI) for nurse managers, (b) The Organizational Resilience Questionnaire (ORQ) and (c) Job Involvement Questionnaire (JIQ) for nurses with online survey instrumentIBM SPSS (v. 23) and IBM SPSS AMOS (v. 23) using inferential statistics and Structural Equation ModelingEffective leadership can positively impact nurses’ resilience and job involvement, ultimately contributing to the well-being and performance of the nursing workforce.
2AL-Dossary, 2022 [35]Saudi ArabiaCorrelation between leadership style and organizational commitment, as well as leadership style and employee engagement among managers and nurses.71 hospitals in Saudi Arabia, including public, private, and public-private partnership hospitals with 390 healthcare professionals (329 nurses and 61 nurse managers) Cross-sectional study3 Questionnaires: (a) Multi-factor Leadership Questionnaire (MLQ), (b) Organizational Commitment Questionnaire (OCQ), and (c) Utrecht Work Engagement Scale (UWES) with online survey instrumentSPSS version 20.0 involving techniques like t-tests and Pearson’s correlation analysisTransformational leadership was the most preferred style among the nurse managers, followed by transactional leadership and laissez-faire leadership styles.
3Allan and Rayan, 2023 [21]JordanRelationship between authentic leadership, job satisfaction, and organizational commitment among Jordanian nurses.nurse administrators announced the study details via WhatsApp (166 registered nurses were recruited)Comparative, correlational design and a
cross-sectional survey		2 questionnaires: (a) Authentic Leadership Questionnaire and (b) Turnover Intention Scale. The study survey was conducted online using Google FormsIBM SPSS, v. 26, using descriptive statistics, t-test, one-way analysis, Pearson correlation multiple hierarchical linear regressionA statistically significant,
positive correlation between authentic leadership and staff performance and a negative correlation between authentic leadership and intention to leave.
4Po et al., 2023 [36]Myanmar—ChinaImpact of transformational leadership on job performance of nurses in general hospitals in Myanmar.13 general hospitals in Myanmar (474 nurses from tertiary-level general hospitals)Descriptive predictive studyQuestionnaires including Job Performance Scale, Job Demands Scale, Job Resources Scale, Personal Resources Scale, Job Crafting Scale, and Global Transformational Leadership Scale were used for data collectiondescriptive statistics, correlation analysis, and multiple logistic regressionVarious factors such as job demands, personal resources, work engagement, and job crafting were significant predictors of nurses’ job performance.
5Brzozowski et al., 2022 [18]USAPerceptions of their formal leader’s leadership behaviors and outcomes, and differences based on individual and work setting characteristics.335 primary care nurses Cross-sectional studyMultifactor Leadership Questionnaire 5X Short Form (MLQ-5x) Rater Version, a 45-item instrument, was used through a web-based surveyCross-sectional survey data were analyzed through ANOVA with specific parametersLeadership in primary care settings is influenced by a combination of individual and work setting characteristics. Leaders need to adapt to the unique needs of nurses and settings.
6Dehghani et al., 2023 [40]IranEffect of ethical leadership perceived by nurses on missed nursing care.2 hospitals affiliated with Yazd University of Medical Sciences, Iran (230 nurses working in internal medicine and surgery units) Cross-sectional studyData collection tools included a demographic profile questionnaire, a moral leadership questionnaire in nursing, and missed nursing care assessment toolsDescriptive statistics methods and parametric tests such as t-test, analysis of variance, Pearson’s correlation coefficient, and multiple regressionA significant inverse relationship between perceived ethical leadership and missed nursing care.
7Grandfield et al., 2023 [47]NetherlandsConnections between nurse managers’ job design, work environment, and the outcomes for both nurses and patients.47 US hospitals (541 nurse managers’)Cross-sectional surveyThe nurse manager survey tool included measures of SOC, support positions, nurse manager experience, and the work environment of nurse manager (National Database of Nursing Quality Indicators NDNQI annual survey) A model using multilevel path analysis to assess the relationships among job design, work environment, and outcomesNurse managers’ practices have a significant impact on the outcomes for direct care nurses and patients.
8Grealish et al., 2020 [48]AustraliaChallenges of implementing fundamental care for older patients in acute hospital settings.Set in 1 medical and 1 surgical unit of a tertiary hospital in southeast
Queensland. 		Explanatory sequential mixed methodsObservations of nursing practice using the Work Sampling Technique through interviews (38 activities in 5 categories)IBM SPSS v. 26,
descriptive statistical methods calculating the percentages of observed activities through quantitative data analysis		Nurses prioritize reportable activities, which can lead to missed fundamental care, particularly in patients with high care needs.
9Htet et al., 2021 [41]Myanmar—ThailandLevel of proactive work behavior and predictability of education level, transformational leadership of nurse managers among nurses in Myanmar.University-affiliated general hospitals in the Yangon (183 Registered Nurses (RNs) who have been practicing for at least one year and hold a nursing license from the Myanmar Nurse and Midwife Council)Descriptive statistics and multiple regression.Instruments used: Utrecht Work Engagement Scale, Global Transformational Leadership Scale, Survey of Perceived Organizational Support, Proactive Work Behavior Scale.SPSS software, with statistical tests, multiple regression, descriptive statistics for data analysisTransformational leadership and work engagement were significant predictors of proactive work behaviors among nurses.
10Khrais and Alsadi, 2021 [42]JordanRelationship between emotional intelligence and transformational leadership among nursing professionals.1 large government-owned hospital in Amman, Jordan (57 nurse managers)Descriptive, correlational studyTool designed by the researchers to collect demographic information and a Multifactor Leadership Questionnaire to measure transformational leadership behaviorsStudent’s t-test and Pearson’s correlationsA significant relationship between emotional intelligence and transformational leadership among the participant cohort.
11Kitson et al., 2021 [49]AustraliaStrategies for promoting evidence-based practice implementation into everyday policy and practices.55 nursing leaders from Australia, Canada, England and SwedenDescriptive, exploratory case studySemi-structured interviews face-to-face or through telephone lasting 30–60 min, in English or SwedishExcel spreadsheets with several subcategories and themes describing various perspectivesHighlighted the importance of nursing leaders in promoting evidence-based practice implementation.
12Labrague and Obeidat, 2021 [37]PhilippinesMediating role of transformational leadership between work-family conflict and outcome variables.10 acute care hospitals in the Western Visayas Region of the Philippines (754 nurses)Cross-sectional studyPen and paper questionnaires completed by the participants during their break timeBivariate statistics, including analysis of variance, independent t-test, Pearson’s correlation coefficient and multiple regression analysisTransformational leadership was found to have significant and positive correlations with job engagement and quality of care.
13Labrague, 2023 [30]USAMediating role of work satisfaction between transformational leadership and selected patient outcomes among nurses.283 emergency room nursesCross-sectional studyClosed packages containing questionnairesSPSS software v.29, with descriptive statistics like means, percentages, standard deviations, and bootstrapping proceduresWork satisfaction played a mediating role in the relationship between transformational leadership and selected patient outcomes among nurses.
14López-Medina et al., 2021 [46]SpainNurses and ward managers’ experiences with nursing leadership in the implementation of evidence-based practice.8 focus groups from five public hospitals (57 clinical nurses and ward
managers) 		Qualitative studyTemplate analysis, using
the Promoting Action on Research Implementation in Health Services framework (Consolidated Criteria for Reporting Qualitative Research guide)		NVivo software with predefined categories, coding of units of meaning in the text, analysis performed in three steps: coding, categorization, and grouping into themes.Highlight the need for empowering clinical nurses for decision-making and the importance of transformational leadership to create an environment favorable to evidence-based practice.
15Lyu et al., 2022 [34]ChinaLevel of intention to stay (ITS) and the influence of various factors on ITS among male nurses in China.5 target hospitals (430 male nurses) Descriptive predictive study8 different questionnaires Demographic Data Profile (DDP), McCain’s Intent to Stay Scale (MISS), Leadership Practices Inventory (LPI-observer), Career Growth of Nurse Scale (CGNS), Group Cohesion Scale (GCS), Gender Role Conflict Short Form (GRC-SF), Three-Component Model (TCM) Employee Commitment Survey and McCloskey/Mueller Satisfaction Scale (MMSS) Descriptive statistics, the Chi-square test, the biserial correlation coefficient, and binary logistic regressionWorkgroup cohesion was the most significant factor influencing intention to stay among male nurses.
16Lyu et al., 2022 [31]ChinaFactors such as years of experience, transformational leadership and job satisfaction can predict the intention to stay among Chinese male nurses working in ICU.5 university hospitals in Anhui with a high concentration of male nurses working in ED and ICU (214 male nurses)Cross-sectional study3 Questionnaires: (a) Demographic Data Profile (DDP), (b) McCain’s Intent to Stay Scale (MISS) and (c) Job Satisfaction Scale (JSS)Descriptive Statistics, Pearson’s Correlation Coefficient and Multiple Regression AnalysisSupporting career growth, improving job satisfaction, and promoting transformational leadership can be effective strategies.
17Niinihuhta et al., 2022 [38]FinlandHow nurse leaders’ work-related well-being is related to their superior’s transformational leadership style and their experiences of structural empowerment.A total of 155 nurse leaders participating, which represents a 44% response rate from a potential pool of 350 nurse leadersCross-sectional studyElectronic questionnaire with (a) Demographic questions, (b)
Transformational Leadership Scale (TLS) and (c) Conditions for Work Effectiveness		SPSS v. 27 for descriptive statistics such as age, number of employees, leadership level, work experience, and leadership experience were recoded into different groups for analysisThere is a need for organizations to address specific aspects of leadership and empowerment to enhance the well-being of nurse leaders.
18O’Brien et al., 2022 [32]IrelandExperiences of a nursing team implementing and integrating a clinical trial within their practice.3 focus groups (18 participants of nursing team)Qualitative studyA semi-structured topic guide was designed for the
focus groups (FGs) along with interviews		FG interviews were digitally recorded and transcribed verbatim.
Thematic analysis was used to analyze the data 		Shed light on the experiences of the nursing team undertaking and integrating a clinical trial within their practice and identified facilitators and challenges to their participation.
19Peutere et al., 2024 [45]FinlandWhether nurse understaffing and limited nursing work experience are associated with patient mortality.1 public hospital (Hospital stays lasting >1 day, N = 254,446 Hospitals, N = 5, Units, N-40)Longitudinal study2 administrative databases: (a)
working-hour data retrieved from the employer’s shift-scheduling software,
Titania® and (b) clinical, patient-level database, Auria
admission and discharge dates and times, units, type of hospital stay (inpatient or outpatient), patient sex, age, diagnoses, and dates of death 		Stata v. 17 along with survival analyses using the mestreg command and mixed-effects survival modelsDaily exposure to nurse understaffing and limited nursing work experience was associated with an increased risk of in-hospital mortality among patients.
20Quesado et al., 2022 [33]PortugalHow leadership style influences nursing team satisfaction and its impact on the quality of care provided.95 nurses enrolled by a snowball sample techniqueCross-sectional studyA self-administered online questionnaireQuantitative data were analyzed with SPSS v. 26, and qualitative data were analyzed through conventional content analysis assisted by QDA Miner Lite v.4There is a significance of transformational leadership in influencing nurses’ satisfaction with their team.
21Salam et al., 2023 [39]LebanonResilience predictors and perceptions of transformational leadership among registered nurses in South Lebanon.3 private hospitals in an underserved area in South Lebanon (240 registered nurses working for more than a year)Cross-sectional studyThe survey instruments
included demographic questions, the True Resilience Scale ©, and the Global Transformational Leadership Scale		SPSS v. 23 including multiple linear regression after a descriptive analysis of the study variablesComponents of transformational leadership such as inspirational motivation and individual consideration, had significant correlations with resilience scores.
22Thompson et al., 2023 [44]UKSelf-reported reasons for compromised care and the impact on patient outcomes among (RMNs) in mental health inpatient services in the UK.1126 Registered Mental Health Nurses—RMNsSecondary analysis of a cross-sectional studyA questionnaire survey with 3 themes of Understaffing, Professional Code Expectations and Moral
Distress and Management		QuirkosTM software through an inductive, interpretative
approach, constructed codes from the open text response data and grouped these into subthemes		The impact of staffing levels on care quality is multifaceted and not straightforward.
23Valbuena-Durán et al., 2021 [17]ColombiaWhat different leadership styles, influence work team coordination and the attainment of institutional goals and strategies.1 tertiary-level public health care institution
in Bucaramanga, Colombia (75 Nursing professionals and 170 Nursing assistants)		Analytical and cross-sectional studyMultifactorial Leadership Questionnaire comprised of 82 items, of which
65 are hierarchically organized by first- and second-order variables
to assess leadership and 17 assess organizational results		STATA v. 14 statistical program along with a univariate analysis and Shapiro-
Wilk normality test		Highlight the importance of implementing effective leadership styles in nursing to improve organizational outcomes, work satisfaction, and retention of nursing staff.
24Yilmaz and Duygulu 2021 [43]TurkeyAssess the patient safety culture (PSC) in healthcare institutions, specifically focusing on the perceptions of charge nurses and staff nurses.4 hospitals in Konya province (70-unit charge nurses and 357 staff nurses)Descriptive correlational and cross-sectional studyDemographic Data Form, Leadership Practices Inventory and Patient Safety Culture Hospital QuestionnaireSPSS Statistics v. 22, means, t test, percentages, standard deviation and Spearman’s tests were used in the analysis of the dataPositive relationship between nurses’ transformational leadership practices and patient safety culture in hospitals.
25Yu et al., 2024 [50]ChinaExperiences and challenges faced by nurse managers in public general hospitals in China.14 nurse managers from secondary and tertiary hospitals located in the central region of ChinaDescriptive qualitative approachSemi-structured interviews via telephoneInterview transcripts were analyzed and collated using thematic analysisNurse managers have a pivotal role in determining a competent and sufficient number of nurses.
26Zhang et al., 2022 [51]ChinaRelationship between psychological empowerment and transformational leadership among nurses in China.10 hospitals in China (1317 nurses hold a Chinese registered license and work full-time)Cross-sectional studyA survey questionnaire which included (a) Sociodemographic characteristics, (b) transformational leadership questionnaire, (c) Psychological Empowerment Questionnaire and (d) Innovative behavior scaleSPSS v23.0 software with correlation analysis, univariate analysis and multiple regression analysisFactors such as leadership style, empowerment, and participation in research activities play a role in influencing nurses’ innovative behavior.
a Country: Study Country or First Author Country. b Study design: Cross-Sectional Analysis; Descriptive Analysis; Qualitative Analysis; longitudinal Analysis; Mixed Methods.

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Hospitals 01 00008 g001
Figure 1. PRISMA flow diagram.
Figure 1. PRISMA flow diagram.
Hospitals 01 00008 g001
Table 1. Search with term and boolean operators.
Table 1. Search with term and boolean operators.
TermBoolean OperatorTermBoolean OperatorTerm
Nursing leadershipANDHealthcare organizations
Transformational leadershipANDHealthcare organizations
Transformational leadershipANDHealthcare organizationsANDNursing staff
Nursing leadershipANDHealthcare organizationsANDNursing staff
Nursing leadershipORTransformational leadershipANDHealthcare organizations
Nursing leadershipORTransformational leadershipANDNursing staff
Healthcare organizationsORNursing staffANDTransformational leadership
Healthcare organizationsORNursing staffANDNursing leadership
Table 2. Summary of the characteristics of the included studies.
Table 2. Summary of the characteristics of the included studies.
CharacteristicsStudies n (%)
Era of studies
Europe8 (30.8)
Asia13 (50.0)
USA3 (11.5)
Australia2 (7.7)
Africa0 (0)
Year of publication
20201 (3.8)
20218 (30.8)
20228 (30.8)
20237 (26.9)
20242 (7.7)
Type of studies
Cross-sectional study10 (38.5)
Longitudinal study1 (3.8)
Qualitative study 2 (7.7)
Descriptive study7 (26.9)
Mixed methods6 (23.1)
Categorization of studies
Transformational leadership and human capital12 (46.2)
Transformational leadership and care delivery14 (53.8)
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MDPI and ACS Style

Tsapnidou, E.; Kelesi, M.; Rovithis, M.; Katharakis, G.; Gerogianni, G.; Dafogianni, C.; Toylia, G.; Fasoi, G.; Stavropoulou, A. Transformational Leadership—Quality Achievements and Benefits for the Healthcare Organizations: A Scoping Review. Hospitals 2024, 1, 87-103. https://doi.org/10.3390/hospitals1010008

AMA Style

Tsapnidou E, Kelesi M, Rovithis M, Katharakis G, Gerogianni G, Dafogianni C, Toylia G, Fasoi G, Stavropoulou A. Transformational Leadership—Quality Achievements and Benefits for the Healthcare Organizations: A Scoping Review. Hospitals. 2024; 1(1):87-103. https://doi.org/10.3390/hospitals1010008

Chicago/Turabian Style

Tsapnidou, Eleni, Martha Kelesi, Michael Rovithis, Georgios Katharakis, Georgia Gerogianni, Chrysoula Dafogianni, Georgia Toylia, Georgia Fasoi, and Areti Stavropoulou. 2024. "Transformational Leadership—Quality Achievements and Benefits for the Healthcare Organizations: A Scoping Review" Hospitals 1, no. 1: 87-103. https://doi.org/10.3390/hospitals1010008

APA Style

Tsapnidou, E., Kelesi, M., Rovithis, M., Katharakis, G., Gerogianni, G., Dafogianni, C., Toylia, G., Fasoi, G., & Stavropoulou, A. (2024). Transformational Leadership—Quality Achievements and Benefits for the Healthcare Organizations: A Scoping Review. Hospitals, 1(1), 87-103. https://doi.org/10.3390/hospitals1010008

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