Transformational leadership is people-focused and participative, it tries to inspire and develop people under the leadership by focusing on values and long-term goals. Conversely, directive leadership is task-focused and provides structure along with clear instructions that are necessary for coordination and transactional leadership relies on exchange of rewards or punishments to motivate followers. Then there is the laissez-faire leadership which is passive, avoidant style and characterised by less involvement of the leader.
In healthcare, leaders need to ensure both patient safety and the satisfaction of staff by navigating the complex environment. The two studies that we are looking at highlight the important role of transformational leadership in the operating room and healthcare organisations.
In a study of 150 surgeries in an operating room, Scanlon et al. (2026) found that transformational leadership does not operate effectively alone yet, its benefits are seen when it is complemented by directive leadership and especially when the surgery is highly complicated. These ambiguous situations use both people-focused (transformational) and task-focused (directive) behaviours which significantly enhances the psychological safety of the team.
Additionally, this increased psychological safety is associated with a higher rate of observed surgical errors per hour. Hence, instead of showing poor performance it suggests that there is a culture where team members feel safe to detect and voice out potential missteps early. Ultimately, this transparency leads to fewer and less severe postoperative complications for patients and this emphasises the need for surgeons to have judgement that can vary depending on to context so that they can switch between leadership behaviours as procedural demands change.
While the operating room study focused on the safety of the team, Notarnicola et al. (2024) looked at nursing leaders in Italy and the impact of leadership on job satisfaction and personal mastery (this refers to an individual’s perceived control over their life and ability to cope with challenges).
The nursing leaders reported significantly higher job satisfaction levels as compared to the mid-level nurses. This difference was possibly due to the greater trust, autonomy and prestige that came with the senior-level roles. However, in both the roles the level of personal mastery remained similar which suggested that it may be an inherent individual characteristic rather than a result of a specific leadership position.
All in all, both the studies identified transformational leadership as an important catalyst for innovation and safety. However, they also aligned with the fact that a one size fits approach does not exist and that the most effective leaders are likely to me the ones who can understand situational cues and adapt their behaviours to meet the different needs of their staff and patients.
Food for thought: If leadership used a “one size fits all” approach in your field, what challenges might arise for teamwork, communication, or outcomes?
References
- Notarnicola, I., Duka, B., Lommi, M., Grosha, E., De Maria, M., Iacorossi, L., Mastroianni, C., Ivziku, D., Rocco, G., & Stievano, A. (2024). Transformational leadership and its impact on job satisfaction and personal mastery for nursing leaders in healthcare organizations. Nursing Reports, 14(4), 3561–3574. https://doi.org/10.3390/nursrep14040260
- Scanlon, M., Barling, J., Pupco, S., Granger, S., Turner, N., Akers, A., & Beiko, D. (2026). Transformational and directive leadership in the operating room: Complementary effects under surgical complexity. Journal of Occupational and Organizational Psychology, 99(1). https://doi.org/10.1111/joop.70091