The mechanisms of leadership effect on patient outcomes
is a most challenging aspect of this research
topic and to date much is still unknown. Although
leaders may directly impact outcomes at multiple levels
(individuals, groups or units and organizations)
their influence on patient outcomes is most likely indirect
working through others and occurring over time
(Lord & Dinh 2012). Facilitating changes in working
conditions, creating access to resources, guiding individual
and team attitudes, behavior and performance,
or enabling staff participation in unit and patient care
decision making are some potential mechanisms that
connect leadership and patient outcomes. Advanced
statistical techniques like structural equation modeling
are used to explicitly test this complex indirect relationship