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
1
and Ghahraman Mahmoudi
2
*
1
M.Sc. Health Services Management, Sari Branch, Islamic Azad University,
2
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
th
Sep, 2016
Accepted after revision 28
th
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
© A Society of Science and Nature Publication, 2016. All rights
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
B
Organizational support Constant
Transformational leadership
23.188
10.329
0.812 0.093
0.033
2.162
0.339
0.001
0.001
Staff empowerment Constant
Transformational leadership
14.688
5.699
0.704 0.101
0.036
1.489
0.203
0.001
0.001
Perceived performance Constant
Transformational leadership
13.121
3.470
0.716 0.088
0.031
1.153
0.107
0.001
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
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