Almost 50% of the studies in the review addressed
adverse patient outcomes defined as unintentional
injuries or complications associated with clinical management,
rather than the patient’s primary condition,
resulting in death, disability or extended stay in hospital
(Baker et al. 2004). Results showed key relationships
between relational leadership and decreased
adverse events but findings were strongest for medication
errors. Transformational leadership, trust in leadership
and manager support were associated with
reduced medication errors in four of five studies.
Results linking leadership to patient falls and pressure
ulcers were mixed. Decreased restraint use and hospital-
acquired infections were associated with participative
and transformational leadership respectively.
Both transformational and resonant leadership styles
were related to lower patient mortality in three of six
studies. Transformational leadership of unit managers
resulted in lower patient mortality through increased
retention and expertise of staff which suggests that
relationally focused unit managers may affect mortality
by creating safe working environments that promote
satisfied and high performing staff and
establishing adequate staffing and resources to avoid
unnecessary deaths.
We found significant relationships between both
relational and task-oriented leadership and higher
patient satisfaction in four of seven studies. Relational
(transformational and collaborative) leadership was
associated with increased patient satisfaction in acute
care and home healthcare settings while task-orientated
leadership of nursing home ward managers was
positively related to family satisfaction with care and
transactional leadership style contributed to increased
patient satisfaction in acute care settings. This mixed
result suggests that features of each style may
contribute to patient satisfaction such as, communicating
clear care standards and performance expectations
in addition to promoting positive team working
relationships or encouraging staff participation in unit
decision making.
Only three studies were found that measured health
care utilization outcomes such as number of hospitalizations,
hospital readmissions and patient length of
hospital stay and only one study had significant
results. Paquet et al. (2013) reported that manager
support was related to lower patient length of stay.