Health Science

Communication

Biosci. Biotech. Res. Comm. 9(4): 891-896 (2016)

Relationship between transformational leadership and

empowerment of staff, organizational support and

their perceived performance in a hospital

Ehsan A. Estahbanati

and Ghahraman Mahmoudi

M.Sc. Health Services Management, Sari Branch, Islamic Azad University,

Assistant Professor, Department of Health Services Management, Sari Branch, Islamic Azad University,

Sari, Iran

ABSTRACT

Concerning organizational complexity of hospitals and application of different specialties and skills, it is necessary that

staff apply their abilities as best as possible. The main aim of the present research is to study the relationship between

transformational leadership and empowerment of staff, organizational support and staff perceived performance in

hospitals af liated to Isfahan Medical Science University. Statistical population is all staff (except doctors) of hospitals

selected by cluster sampling and 322 persons were selected based on Morgan table. A questionnaire was used to conduct

the study and its content validity and reliability were con rmed. Inferential statistic methods such as Pearson correla-

tion coef cient, t test and multivariate regression analysis were used to analyze data. The result of Kolmogorov-Smirnov

test (p) for variables of transformational leadership, empowerments of staff, organizational support and staff perceived

performance was 0.102, 0.069, 0.142 and 0.123 respectively. Correlation coef cient (r) for the relationship between

transformational leadership and empowerment of staff, between transformational leadership and organizational sup-

port and between transformational leadership and staff perceived performance was 0.704, 0.812 and 0.716 respectively.

In addition, the amounts of t for the relationship between transformational leadership and gender, type of activity, age,

education, experience and work place of staff were 0.057, 0.058, 0.062, 0.336, 0.071 and 0.062 respectively. Transforma-

tional leadership has a direct and signi cant relationship with empowerment of staff, organizational support and staff’s

perceived performance. Therefore, it is suggested that authorities use inspirable motivation, mental motive, personal

attention and charismatic leadership to promote quality and quantity of their organization.

KEY WORDS: TRANSFORMATIONAL LEADERSHIP, EMPOWERMENT OF STAFF, ORGANIZATIONAL SUPPORT AND STAFF PERCEIVED

PERFORMANCE

891

ARTICLE INFORMATION:

*Corresponding Author: ghahraman48@yahoo.com

Received 27

Sep, 2016

Accepted after revision 28

Dec, 2016

BBRC Print ISSN: 0974-6455

Online ISSN: 2321-4007

Thomson Reuters ISI ESC and Crossref Indexed Journal

NAAS Journal Score 2015: 3.48 Cosmos IF : 4.006

reserved.

Online Contents Available at: http//www.bbrc.in/

Ehsan and Ghahraman

892 TRANSFORMATIONAL LEADERSHIP AND PERCEIVED PERFORMANCE IN A HOSPITAL BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

INTRODUCTION

The organization is the mutual relationship between

people and organizational structure shows this mutual

relationship (Parizi and Gohar, 2008). Importance of

human sources in organizations is higher than modern

technology and  nancial sources (Teimournejad and

Sarihi 2010) . Due to sources such as globalization and

technology, the speed and complexity of changes are

increasing such that organizations have to learn many

things for their survival (Markwad 2009). In modern age,

organizations face increasingly with dynamic and vari-

able environments. Therefore, they have to adapt with

environmental changes for their dynamics and survival.

In other words, concerning increasing speed of scien-

ti c, technological, socio-cultural changes in modern

age, organizations are successful and ef cient when in

addition to adaptation with modern society, they can

predict the trend of changes and they are able to lead

such changes in direction of providing optimal changes

for a better future (Jafari and Rastegar 2015). Leader-

ship is an inseparable part of management and it plays a

main role in operations of manager. If there is only one

factor that can distinguish successful organizations from

unsuccessful ones, that factor would be dynamic and

effective leadership. Therefore, it is necessary to have

an eligible leadership with dynamic situation of organi-

zations. Since leaders of the company develop objec-

tive systematic solutions for settling con icts, transfor-

mational leaders try to promote and expand freedom

space, movement and sacri ce. Therefore, they support

empowerment and promotion of sense of commitment.

Transformational leaders increase the sense of trust

and recognition among their subordinates, teams and

organizations. They allow the courage for overcoming

the obstacles and having internal commitment to their

jobs. Instead of request of subordinates who are depend-

ent on them, the leaders increase human sources inside

the organization by providing creative staff who par-

ticipates in the organization. They inform their followers

via a scienti c method through responding their require-

ments and expectations and allowing them to show their

abilities (Sahin et al 2014). Several researches addressed

appropriate results of transformational leadership and

its relationship with the variables under study. Some of

them are summarized as follows.

Dust et al (2014) studied in their research (titled as

transformational leadership, psychological empower-

ment and the mediatory role of organic-mechanic  elds

the relationship between transformational leadership

and empowerment of staff. Torombola et al (2016) stud-

ied in their research the relationship between trans-

formational leadership, organizational support and

staff perceived performance. Recently, Alhosseini and

Elbeltagi (2016) have analyzed the relationship between

transformational leadership and staff perceived perfor-

mance. Some results similar to the present research were

obtained. On the other hand, Sahin et al (2014) studied

the effect of organizational support, transformational

leadership, staff empowerment, employment, perfor-

mance and demographic variables on factors of psycho-

logical capital and concluded that factors of personal

attention and mental motive increased organizational

support, (Dust et al (2014). Kark et al (2012) concluded

that there is a relationship between gender and transfor-

mational leadership. In present research, the relationship

between transformational leadership and empowerment

of staff, organizational support, staff’s perceived perfor-

mance and related variables has been studied in order

to emphasize on the importance of application of such

approach in health care organizations.

METHODOLOGY

This is an applied research concerning the goal and it

was conducted by correlative method. Statistical popula-

tion is all therapeutic and non-therapeutic staff (expect

doctors) in hospitals selected by Isfahan medical science

university and they are nurses, licensed practical nurse,

nurse’s aide, service sources, of cial and  nancial staff,

staff of quality improvement of ces and staff of Para-

clinic departments and supportive staff. The research was

conducted in hospitals of Amiralmomenin (Shahr Reza),

Shahid Rajaei (Faridan),Saei & Ashra (Khomeini Shahr),

Shahid Beheshti (Ardestan) and Isa Ibn Maryam (Isfa-

han) that were chosen by cluster sampling. The sample

size was 322 persons in this research who were selected

based on Morgan table and among a number of people.

Data were gathered by the questionnaire conducted via

the researcher and it shows the amount of adaptation of

the questionnaire with research goals and measures con-

tent validity of the research. The questionnaire was sent

to some of professors and experts of healthcare service

management and they were not included in the statisti-

cal population. The  nal questionnaire was given to par-

ticipants after some corrections done by experts, super-

visors and advisors. Nevertheless, reliability of all four

components of the questionnaire has been calculated.

The amount of Cronbach’s alpha obtained for reliability

of questionnaires of organizational support (10), trans-

formational leadership (11), staff empowerment (12) and

perceived performance (13) was 0.76, 0.89, 0.83 and

0.85 respectively. The questionnaire included two parts.

The  rst part was demographic information such as age,

gender, education, work experience and work place. The

second part includes the main questions about the rela-

tionship between transformational leadership and staff

Ehsan and Ghahraman

BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS TRANSFORMATIONAL LEADERSHIP AND PERCEIVED PERFORMANCE IN A HOSPITAL 893

empowerment, organizational support and perceived

performance. It includes 55 closed items: 8 items asso-

ciated with organizational support, 20 items associated

with transformational leadership, 12 items associated

with staff empowerment and 15 items associated with

staff perceived performance. Likert scale was used based

on ordinal scale which was changed into interval scale.

Items were based on Likert’s  ve point scale: the choice

“always” had the lowest score (1), “sometimes” had the

score 2, “often” had the score 3, “rarely” had the score 4

and “never” had the highest score (5).

In the present research, 322 persons were chosen

among 2000 people based on Morgan table. Cluster sam-

pling was used meaning that the regions under coverage

of Isfahan medical science university were divided into

 ve regions (north, south, east, west and center) and the

number of participants in each hospital was determined

for therapeutic and non-therapeutic work groups based

on number of personnel in each hospital. The samples

were chosen randomly inside the hospitals. Inclusion

criterion was working in the hospitals under study and

they entered the research after taking permission and

consideration of principles of con dentiality. Descrip-

tive (frequency, mean, variance and standard deviation)

and inferential (Kolmogorov-Smirnov, Pearson correla-

tion and linear regression) statistics were used to analyze

data and SPSS version 17 was applied for data analysis.

RESULTS

Concerning research results, 72.2% of participants were

women, 43.7% of participants were younger than 30

years old and curve of age distribution showed strong

skewedness to young people. 73% of respondents had

B.S degree, 54.7% of respondents had less than ten year

work experience, 28.3% of participants were working in

Isa Ibn Maryam hospital and 51.9% of respondents had

therapeutic activities (table 1).

Based on results of the research about the relationship

between transformational leadership and empowerment

of staff, organizational support and staff perceived per-

formance in hospitals af liated to Isfahan medical sci-

ence university, the highest mean scores were obtained

for organizational support (3.08) and the lowest mean

score was obtained for perceived performance (1.44). In

addition, the highest standard deviation was obtained

for transformational leadership (0.843) and the lowest

standard deviation was obtained for staff performance

(0.475) (table 2).

Based on obtained data, k-s-z statistic was not sig-

ni cant for all variables in p ≤ 0.05 so distribution of

variables was not normal.

Transformational leadership has the highest corre-

lation with organizational support. If transformational

Table 1: distribution and frequency percent of

demographic variables of respondents

Frequency of variables Observed

frequency

Observed

percent

Gender Man 88 27.3

Woman 234 72.2

Total 322 100

Age Younger than 30 141 43.8

31-40 years old 129 40.1

41-50 years old 44 13.7

Older than 50 8 2.5

Total 100

Education Under diploma &

diploma

39 12.1

Associate degree 37 11.5

Bachelor of

science

235 73.0

Master of science

and PhD

11 3.4

Total 322 100

Work

experience

Under ten years 176 54.7

10-20 years 119 37.0

Over 20 years 27 8.4

Total 322 100

Name of

hospital

Amiralmomenin 64 19.9

Shahid Rajaei 43 13.4

Saei & Ashra 89 27.6

Shahid Beheshti 35 10.9

Isa Ibn Maryam 91 28.3

total 322 100

Type of

activity

Therapeutic 167 51.9

Non-therapeutic 155 48.1

Total 322 100

Table 2: frequency variables under study

Variables Mean Standard

deviation

Variance

Transformational

leadership

2.71 0.843 0.711

Staff empowerment 2.04 0.565 0.319

Organizational

support

3.08 0.571 0.326

Performance

perceived by staff

1.44 0.475 0.226

leadership changes one unit, organizational support will

change 0.812 units. Such hypothesis will be possible if

other variables are constant. Transformational leader-

ship had the lowest correlation with staff empowerment.

If transformational leadership changes one unit, staff

Ehsan and Ghahraman

894 TRANSFORMATIONAL LEADERSHIP AND PERCEIVED PERFORMANCE IN A HOSPITAL BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

Table 3: comparing score distribution of variables with

normal distribution from view of respondents

Variables Kolmogorov-

Smirnov statistic

Signi cance

level

Transformational

leadership

1.220 0.102

Staff empowerment 1.299 0.069

Organizational

support

1.437 0.142

Performance

perceived by staff

1.137 0.123

Table 4: result of t test of the relationship between transformational leadership and empowerment of staff,

organizational support and staff perceived performance

Variable Model T

Standard

coef cient

Non-standard

coef cients

Signi cance

level

Beta

Standard

error

Organizational support Constant

Transformational leadership

23.188

10.329

0.812 0.093

0.033

2.162

0.339

0.001

Staff empowerment Constant

Transformational leadership

14.688

5.699

0.704 0.101

0.036

1.489

0.203

0.001

Perceived performance Constant

Transformational leadership

13.121

3.470

0.716 0.088

0.031

1.153

0.107

0.001

empowerment will change 0.704 units. Such hypothesis

will be possible if other variables are constant (table 4).

Based on independent t test and signi cance level,

there is no signi cant difference between opinions of

different genders with different activities about transfor-

mational leadership (Sig. > 0.05). In other words, inde-

pendent t test showed that views of men and women and

also therapeutic and non-therapeutic groups were not

signi cantly different (table 5).

Based on one way variance analysis and signi cance

level, there is no signi cant difference between opinions

of groups with different age, education, work experi-

ence and work place about transformational leadership

(Sig. > 0.05). In other words, one way variance analysis

showed that views of groups with different age, educa-

tion, work experience and place were not signi cantly

different (table 6).

DISCUSSION

Concerning the results of the research, all hypotheses

(direct relationship between transformational leadership

and empowerment of staff, organizational support and

performance perceived by staff) were con rmed but the

relationship between transformational leadership and

Table 5: mean opinions about transformational

leadership in terms of gender and type of activity

Variable t statistic Signi cance level

Gender 2.391 0.057

Type of

activity

1.690 0.058

Table 6: mean opinions about transformational

leadership in terms of age, education, work

experience and type of hospital

Variable F statistic Signi cance level

Age 1.575 0.062

Education 1.133 0.336

Work experience 1.755 0.071

Type of hospital 1.531 0.062

demographic factors was rejected. Then, research results

were compared with similar researches. Regarding the

 rst hypothesis-the relationship between transforma-

tional leadership and staff empowerment, Hasanpour

et al (2011) studied the relationship between transfor-

mational leadership and empowerment and concluded

that transformational relationship was effective on staff

empowerment and it had a signi cant relationship with

sense of quali cation, right of choosing, sense of being

effective, sense of being meaningful and trust in oth-

ers. Dast et al (2014) have studied the mediatory role

of organic-mechanic  elds in the relationship between

transformational leadership and psychological empow-

erment.

Sosik et al (2015) studied the direct effect of transfor-

mational leadership on staff empowerment and Allameh

et al (2102) investigated the relationship between trans-

formational leadership and physical empowerment of

teachers in Abadeh city which was in agreement with

our research. Results showed that such relationship has

been proved in different environments (bank, school,

Ehsan and Ghahraman

BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS TRANSFORMATIONAL LEADERSHIP AND PERCEIVED PERFORMANCE IN A HOSPITAL 895

hospital, etc) with different sample sizes. None of results

of abovementioned researches were against the results

of the present research. Regarding the second hypothesis

“the relationship between transformational leadership

and organizational support”.

Yi Lin et al (2015) recently have studied the effect

of transformational leadership in nursing on work qual-

ity of nurses in Taiwan. Similarly Epitropaki and Martin

(2013) reported on transformational leadership and its

increasing in uence whereas Tremblay et al (2016) stud-

ied experiences of misused and transformational leader-

ship. Both of them obtained results similar to the present

research about the relationship between transforma-

tional leadership and organizational support. Sahin et

al (2015) also investigated the effect of organizational

support, transformational leadership, staff empower-

ment, employment, demographic variables and perfor-

mance on factors of psychological capital and concluded

that factors of personal attention and mental motive

increased organizational support. It means that among

four factors of transformational leadership, only two

factors are involved in increase of organizational sup-

port so they are not in agreement with results of the

present research. It seems that the research of Sahin et al

is not in agreement with results of the present research

due to equal number of men and women who partici-

pated in the research, the research setting (public and

private organizations), education of samples (10%) and

research place (Turkey) (results of above factors in pre-

sent research: 73% women, 27% men, 12% university

degrees, the research was conducted in hospitals of Isfa-

han). Regarding the third hypothesis “the relationship

between transformational leadership and staff perceived

performance”, Mosadeh et al (2016) and Pourbarkhord-

ari et al (2016) recently have stated that there is effect

of transformational leadership on job performance, and

all above mentioned results are in agreement with the

results of the present research about the relationship

between transformational leadership and staff perceived

performance. In their research titled as missing link,

Bohem et al (2015) described the power of organiza-

tional personality and variable leadership climate as a

mechanisms that links top managerial charisma to com-

pany performance and stated that there was no signi -

cant relationship between transformational leadership

and performance, which is not in agreement with the

 ndings of the present work.

It seems that this gap is due to variable leadership cli-

mate. Also, the place of research (Germany), the process

of samples’ selection and their participation in the study

may be among factors that cause such gap (among 20639

people who were invited to the research via e-mail, 282

persons were participated in the research). Regarding the

fourth hypothesis “the relationship between transforma-

tional leadership and demographic factors of staff”, in

their research titled as is giving value to femininity an

advantage for women?: the relationship between role of

gender, transformational leadership and identi cation,

Kark et al (2012) concluded that there was a relationship

between gender and transformational leadership. In their

research titled as transformational leadership in teams,

Brandt and Edinger (2015) have proved the effect of

gender and personality of team leader and the relation-

ship between transformational leadership and gender of

leader . Therefore, concerning the research I have done

on the relationship between transformational leadership

and gender of staff, I cannot give a clear opinion about

it. Astraskayt et al (2015) have analyzed the relationship

between annoyance in work place and transformational

leadership. In his research titled as promotion of secu-

rity in organization: role of leadership and managerial

measures.

Concerning different opinions that are not in agree-

ment with results of this research, it can be said that

Astraskayt et al (2015) have focused on negative aspects

of work place and Matson stated generally about lead-

ership style. Since no study was found about the rela-

tionship between transformational leadership and age,

work experience and education of staff, obtained results

cannot be compared with results of similar researches.

Concerning abovementioned and results of this research

and effect of transformational leadership on organiza-

tional support, staff empowerment, staff perceived per-

formance and demographic factors, it seems that hos-

pital managers should take measures for using factors

of transformational leadership such as paying attention

to staff personally, using motivational methods such as

inspirable motivation and formulating a vision inspired

from future, stimulating staff mentally and creating

doubt on thoughts governing on organization and char-

ismatic in uence in their organization. Therefore, staff

can use their ability and capacity as best as possible.

ACKNOWLEDGEMENTS

This paper was derived from the thesis titled as “The

relationship between transformational leadership and

staff empowerment, organizational support and staff

perceived performance in hospitals selected by Isfahan

medical science university. Therefore, all managers,

experts and staff of hospitals are appreciated who helped

data collection

REFERENCES

Al-Husseini S, Elbeltagi I.(2016) Transformational leadership

and innovation: a comparison study between Iraq’s public

and private higher education. Studies in Higher Education.

2;41(1):159-81.

Ehsan and Ghahraman

896 TRANSFORMATIONAL LEADERSHIP AND PERCEIVED PERFORMANCE IN A HOSPITAL BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

Allameh SM, Heydari M, Davoodi SM.(2012) Studying the rela-

tionship between transformational leadership and psychologi-

cal empowerment of teachers in Abade Township. Procedia-

Social and Behavioral Sciences 31;31:224-30.

Astrauskaite M, Notelaers G, Medisauskaite A, Kern RM. (2015)

Workplace harassment: Deterring role of transformational

leadership and core job characteristics. Scandinavian Journal

of Management 31;31(1):121-35.

Boehm SA, Dwertmann DJ, Bruch H, Shamir B. (2015) The

missing link? Investigating organizational identity strength

and transformational leadership climate as mechanisms that

connect CEO charisma with  rm performance. The Leadership

Quarterly 30;26 (2):156-71.

Brandt TM and Edinger P. (2015) Transformational leadership in

teams–the effects of a team leader’s sex and personality. Gender

in Management: An International Journal 2; 30(1):44-68.

Dust SB, Resick CJ, Mawritz MB. (2014) Transformational lead-

ership, psychological empowerment, and the moderating role

of mechanistic–organic contexts. Journal of Organizational

Behavior1, 35(3):413-33.

Epitropaki O, Martin R.(2013) Transformational–transactional

leadership and upward in uence: The role of relative leader–

member exchanges (RLMX) and perceived organizational sup-

port (POS). The Leadership Quarterly 30;24(2):299-315.

Hassanpour A, Abbasi T, Norouzi M. (2011) The role of trans-

formational leadership in employees’ performance. Studies of

management in Iran 15(1): 159-180.

Iraji Naghandar R, Hamidi M. (2013) Relation of perceived

organizational support and organizational citizenship behavior

of staff General administration of sport and youth Mazandaran.

Studies of sport management 5(21): 81-96.

Jafari B and Rastegar A (2015) The impact of transformational

leadership on empowerment with the mediation of learning

oriented. Researches of human resources 5(1): 22-35.

Kark R, Waismel-Manor R, Shamir B. (2012) Does valuing

androgyny and femininity lead to a female advantage? The

relationship between gender-role, transformational leadership

and identi cation. The Leadership Quarterly 30;23(3):620-40.

Lin PY, MacLennan S, Hunt N, Cox T.(2015) The in uences

of nursing transformational leadership style on the quality of

nurses’ working lives in Taiwan: a cross-sectional quantitative

study. BMC Nursing 14;14(1):1.

Markwad M. (2009) The principle of learning organization.

Modern Publications Iran

Masa’deh RE, Obeidat BY, Tarhini A.(2016) A Jordanian empir-

ical study of the associations among transformational leader-

ship, transactional leadership, knowledge sharing, job perfor-

mance, and  rm performance: a structural equation modelling

approach. Journal of Management Development 13;35(5).

Parizi M, Sasan Gohar P.(2008) Organization and Manage-

ment from Theory to practice. Higher Intitute of Banking Iran

2008.

Pourbarkhordari A, Zhou EH, Pourkarimi J.(2016) How

Individual-focused Transformational Leadership Enhances

Its In uence on Job Performance through Employee Work

Engagement. International Journal of Business and Manage-

ment 15;11(2):249

Safayi Shakib A, Abdoulmaleki B, Hosseinzade S, Mousivand

M.(2015) The impact of transformational leadership on organi-

zational improvement with the mediation of employee‘s struc-

tural and psychological empowerment. Journal of organiza-

tional behavior studies 4(5): 1-24.

Sahin DR, Çubuk D, Uslu T. (2014) The effect of organizational

support, transformational leadership, personnel empowerment,

work engagement, performance and demographical variables

on the factors of psychological capital. Emerging Markets

Journal 1, 3(3):1.

Sahrayi R, Zamani N, Shabani bahar G, Monsef A, Hossein

Nejad A.(2015) The relation of empowerment and perceived

organizational support with job satisfaction sport teachers of

Hamedan city. Organizational Behavior management studies

in sport 2(6): 83-91.

Sosik JJ, Chun JU, Zhu W. Hang (2014) On to your ego: The

moderating role of leader narcissism on relationships between

leader charisma and follower psychological empowerment and

moral identity. Journal of business ethics 1; 120(1):65-80.

Teimournejad K, Sarihi E. V. (2010) the impact of organiza-

tional learning on psychological empowerment of staff of the

ministry of economy and  nance. Journal of Management

Studies Improvement and Progress 62; 37-59.

Tremblay L. M, Fernet C, Lavigne GL, Austin S. (2016) Trans-

formational and abusive leadership practices: impacts on nov-

ice nurses, quality of care and intention to leave. Journal of

advanced nursing 72(3):582-92.

Voleik N and Bani F. (2014) The relationship between perceived

organizational support urban management with social respon-

sibility and job performance in municipal staff of Hamedan.

Journal of economy and urban management 2(8): 97-108.