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6 Common Leadership Styles — and How to Decide Which to Use When

• Rebecca Knight

Being a great leader means recognizing that different circumstances call for different approaches.

Research suggests that the most effective leaders adapt their style to different circumstances — be it a change in setting, a shift in organizational dynamics, or a turn in the business cycle. But what if you feel like you’re not equipped to take on a new and different leadership style — let alone more than one? In this article, the author outlines the six leadership styles Daniel Goleman first introduced in his 2000 HBR article, “Leadership That Gets Results,” and explains when to use each one. The good news is that personality is not destiny. Even if you’re naturally introverted or you tend to be driven by data and analysis rather than emotion, you can still learn how to adapt different leadership styles to organize, motivate, and direct your team.

Much has been written about common leadership styles and how to identify the right style for you, whether it’s transactional or transformational, bureaucratic or laissez-faire. But according to Daniel Goleman, a psychologist best known for his work on emotional intelligence, “Being a great leader means recognizing that different circumstances may call for different approaches.”

• RK Rebecca Knight is a journalist who writes about all things related to the changing nature of careers and the workplace. Her essays and reported stories have been featured in The Boston Globe, Business Insider, The New York Times, BBC, and The Christian Science Monitor. She was shortlisted as a Reuters Institute Fellow at Oxford University in 2023. Earlier in her career, she spent a decade as an editor and reporter at the Financial Times in New York, London, and Boston.

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• Int J Environ Res Public Health

Leadership Effectiveness in Healthcare Settings: A Systematic Review and Meta-Analysis of Cross-Sectional and Before–After Studies

Vincenzo restivo.

1 Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, Via del Vespro 133, 90127 Palermo, Italy

Giuseppa Minutolo

Alberto battaglini.

2 Vaccines and Clinical Trials Unit, Department of Health Sciences, University of Genova, Via Antonio Pastore 1, 16132 Genova, Italy

Alberto Carli

3 Santa Chiara Hospital, Largo Medaglie d’oro 9, 38122 Trento, Italy

Michele Capraro

4 School of Public Health, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy

Maddalena Gaeta

5 Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Forlanini 2, 27100 Pavia, Italy

Cecilia Trucchi

6 Planning, Epidemiology and Prevention Unit, Liguria Health Authority (A.Li.Sa.), IRCCS San Martino Hospital, Largo R. Benzi 10, 16132 Genoa, Italy

Carlo Favaretti

7 Centre on Leadership in Medicine, Catholic University of the Sacred Heart, Largo F. Vito 1, 00168 Rome, Italy

Francesco Vitale

Alessandra casuccio, associated data.

Data will be available after writing correspondence to the author.

To work efficiently in healthcare organizations and optimize resources, team members should agree with their leader’s decisions critically. However, nowadays, little evidence is available in the literature. This systematic review and meta-analysis has assessed the effectiveness of leadership interventions in improving healthcare outcomes such as performance and guidelines adherence. Overall, the search strategies retrieved 3,155 records, and 21 of them were included in the meta-analysis. Two databases were used for manuscript research: PubMed and Scopus. On 16th December 2019 the researchers searched for articles published in the English language from 2015 to 2019. Considering the study designs, the pooled leadership effectiveness was 14.0% (95%CI 10.0–18.0%) in before–after studies, whereas the correlation coefficient between leadership interventions and healthcare outcomes was 0.22 (95%CI 0.15–0.28) in the cross-sectional studies. The multi-regression analysis in the cross-sectional studies showed a higher leadership effectiveness in South America (β = 0.56; 95%CI 0.13, 0.99), in private hospitals (β = 0.60; 95%CI 0.14, 1.06), and in medical specialty (β = 0.28; 95%CI 0.02, 0.54). These results encourage the improvement of leadership culture to increase performance and guideline adherence in healthcare settings. To reach this purpose, it would be useful to introduce a leadership curriculum following undergraduate medical courses.

1. Introduction

Over the last years, patients’ outcomes, population wellness and organizational standards have become the main purposes of any healthcare structure [ 1 ]. These standards can be achieved following evidence-based practice (EBP) for diseases prevention and care [ 2 , 3 ] and optimizing available economical and human resources [ 3 , 4 ], especially in low-industrialized geographical areas [ 5 ]. This objective could be reached with effective healthcare leadership [ 3 , 4 ], which could be considered a network whose team members followed leadership critically and motivated a leader’s decisions based on the organization’s requests and targets [ 6 ]. Healthcare workers raised their compliance towards daily activities in an effective leadership context, where the leader succeeded in improving membership and performance awareness among team members [ 7 ]. Furthermore, patients could improve their health conditions in a high-level leadership framework. [ 8 ] Despite the leadership benefits for healthcare systems’ performance and patients’ outcomes [ 1 , 7 ], professionals’ confidence would decline in a damaging leadership context for workers’ health conditions and performance [ 4 , 9 , 10 ]. On the other hand, the prevention of any detrimental factor which might worsen both team performance and healthcare systems’ outcomes could demand effective leadership [ 4 , 7 , 10 ]. However, shifting from the old and assumptive leadership into a more effective and dynamic one is still a challenge [ 4 ]. Nowadays, the available evidence on the impact and effectiveness of leadership interventions is sparse and not systematically reported in the literature [ 11 , 12 ].

Recently, the spreading of the Informal Opinion Leadership style into hospital environments is changing the traditional concept of leadership. This leadership style provides a leader without any official assignment, known as an “opinion leader”, whose educational and behavioral background is suitable for the working context. Its target is to apply the best practices in healthcare creating a more familiar and collaborative team [ 2 ]. However, Flodgren et al. reported that informal leadership interventions increased healthcare outcomes [ 2 ].

Nowadays, various leadership styles are recognized with different classifications but none of them are considered the gold standard for healthcare systems because of heterogenous leadership meanings in the literature [ 4 , 5 , 6 , 12 , 13 ]. Leadership style classification by Goleman considered leaders’ behavior [ 5 , 13 ], while Chen DS-S proposed a traditional leadership style classification (charismatic, servant, transactional and transformational) [ 6 ].

Even if leadership style improvement depends on the characteristics and mission of a workplace [ 6 , 13 , 14 ], a leader should have both a high education in healthcare leadership and the behavioral qualities necessary for establishing strong human relationships and achieving a healthcare system’s goals [ 7 , 15 ]. Theoretically, any practitioner could adapt their emotive capacities and educational/working experiences to healthcare contexts, political lines, economical and human resources [ 7 ]. Nowadays, no organization adopts a policy for leader selection in a specific healthcare setting [ 15 ]. Despite the availability of a self-assessment leadership skills questionnaire for aspirant leaders and a pattern for the selection of leaders by Dubinsky et al. [ 15 ], a standardized and universally accepted method to choose leaders for healthcare organizations is still argued over [ 5 , 15 ].

Leadership failure might be caused by the arduous application of leadership skills and adaptive characteristics among team members [ 5 , 6 ]. One of the reasons for this negative event could be the lack of a standardized leadership program for medical students [ 16 , 17 ]. Consequently, working experience in healthcare settings is the only way to apply a leadership style for many medical professionals [ 12 , 16 , 17 ].

Furthermore, the literature data on leadership effectiveness in healthcare organizations were slightly significant or discordant in results. Nevertheless, the knowledge of pooled leadership effectiveness should motivate healthcare workers to apply leadership strategies in healthcare systems [ 12 ]. This systematic review and meta-analysis assesses the pooled effectiveness of leadership interventions in improving healthcare workers’ and patients’ outcomes.

2. Materials and Methods

A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) Statement guidelines [ 18 ]. The protocol was registered on the PROSPERO database with code CRD42020198679 on 15 August 2020. Following these methodological standards, leadership interventions were evaluated as the pooled effectiveness and influential characteristic of healthcare settings, such as leadership style, workplace, settings and the study period.

2.1. Data Sources and Search Strategy

PubMed and Scopus were the two databases used for the research into the literature. On 16th December 2019, manuscripts in the English language published between 2015 and 2019 were searched by specific MeSH terms for each dataset. Those for PubMed were “leadership” OR “leadership” AND “clinical” AND “outcome” AND “public health” OR “public” AND “health” OR “public health” AND “humans”. Those for Scopus were “leadership” AND “clinical” AND “outcome” AND “public” AND “health”.

2.2. Study Selection and Data Extraction

In accordance with the PRISMA Statement, the following PICOS method was used for including articles [ 18 ]: the target population was all healthcare workers in any hospital or clinical setting (Population); the interventions were any leader’s recommendation to fulfil quality standards or performance indexes of a healthcare system (Intervention) [ 19 ]; to be included, the study should have a control group or reference at baseline as comparison (Control); and any effectiveness measure in terms of change in adherence to healthcare guidelines or performances (Outcome). In detail, any outcome implicated into healthcare workers’ capacity and characteristics in reaching a healthcare systems purposes following the highest standards was considered as performance [ 19 ]. Moreover, whatever clinical practices resulted after having respected the recommendations, procedures or statements settled previously was considered as guideline adherence [ 20 ]. The selected study design was an observational or experimental/quasi-experimental study design (trial, case control, cohort, cross-sectional, before-after study), excluding any systematic reviews, metanalyses, study protocol and guidelines (Studies).

The leaders’ interventions followed Chen’s leadership styles classification [ 6 ]. According to this, the charismatic leadership style can be defined also as an emotive leadership because of members’ strong feelings which guide the relationship with their leader. Its purpose is the improvement of workers’ motivation to reach predetermined organizational targets following a leader’s planning strategies and foresights. Servant leadership style is a sharing leadership style in whose members can increase their skills and competences through steady leader support, and they have a role in an organization’s goals. The transformational leadership style focuses on practical aspects such as new approaches for problem solving, new interventions to reach purposes, future planning and viewpoints sharing. Originality in a transformational leadership style has a key role of improving previous workers’ and healthcare system conditions in the achievement of objectives. The transactional leadership style requires a working context where technical skills are fundamental, and whose leader realizes a double-sense sharing process of knowledge and tasks with members. Furthermore, workers’ performances are improved through a rewarding system [ 6 ].

In this study, the supervisor trained the research team for practical manuscript selection and data extraction. The aim was to ensure data homogeneity and to check the authors’ procedures for selection and data collection. The screening phase was performed by four researchers reading each manuscript’s title and abstract independently and choosing to exclude any article that did not fulfill the inclusion criteria. Afterwards, the included manuscripts were searched for in the full text. They were retrieved freely, by institutional access or requesting them from the authors.

The assessment phase consisted of full-text reading to select articles following the inclusion criteria. The supervisor solved any contrasting view about article selection and variable selection.

The final database was built up by collecting the information from all included full-text articles: author, title, study year, year of publication, country/geographic location, study design, viability and type of evaluation scales for leadership competence, study period, type of intervention to improve leadership awareness, setting of leader intervention, selection modality of leaders, leadership style adopted, outcomes assessed such as guideline adherence or healthcare workers’ performance, benefits for patients’ health or patients’ outcomes improvement, public or private hospitals or healthcare units, ward specialty, intervention in single specialty or multi-professional settings, number of beds, number of healthcare workers involved in leadership interventions and sample size.

Each included article in this systematic review and meta-analysis received a standardized quality score for the specific study design, according to Newcastle–Ottawa, for the assessment of the quality of the cross-sectional study, and the Study Quality Assessment Tools by the National Heart, Lung, and Blood Institute were used for all other study designs [ 21 , 22 ].

2.3. Statistical Data Analysis

The manuscripts metadata were extracted in a Microsoft Excel spreadsheet to remove duplicate articles and collect data. The included article variables for the quantitative meta-analysis were: first author, publication year, continent of study, outcome, public or private organization, hospital or local healthcare unit, surgical or non-surgical ward, multi- or single-professionals, ward specialty, sample size, quality score of each manuscript, leadership style, year of study and study design.

The measurement of the outcomes of interest (either performance or guidelines adherence) depended on the study design of the included manuscripts in the meta-analysis:

• for cross-sectional studies, the outcome of interest was the correlation between leadership improvement and guideline adherence or healthcare performance;
• the outcome derived from before–after studies or the trial was the percentage of leadership improvement intervention in guideline adherence or healthcare performance;
• the incidence occurrence of improved results among exposed and not exposed healthcare workers of leadership interventions and the relative risks (RR) were the outcomes in cohort studies;
• the odds ratio (OR) between the case of healthcare workers who had received a leadership intervention and the control group for case-control studies.

Pooled estimates were calculated using both the fixed effects and DerSimonian and Laird random effects models, weighting individual study results by the inverse of their variances [ 23 ]. Forest plots assessed the pooled estimates and the corresponding 95%CI across the studies. The heterogeneity test was performed by a chi-square test at a significance level of p < 0.05, reporting the I 2 statistic together with a 25%, 50% or 75% cut-off, indicating low, moderate, and high heterogeneity, respectively [ 24 , 25 ].

Subgroup analysis and meta-regression analyses explored the sources of significant heterogeneity. Subgroup analysis considered the leadership style (charismatic, servant, transactional and transformational), continent of study (North America, Europe, Oceania), median cut-off year of study conduction (studies conducted between 2005 and 2011 and studies conducted between 2012 and 2019), type of hospital organization (public or private hospital), type of specialty (surgical or medical specialty) and type of team (multi-professional or single-professional team).

Meta-regression analysis considered the following variables: year of starting study, continent of study conduction, public or private hospital, surgical or non-surgical specialty ward, type of healthcare service (hospital or local health unit), type of healthcare workers involved (multi- or single-professional), leadership style, and study quality score. All variables included in the model were relevant in the coefficient analysis.

To assess a potential publication bias, a graphical funnel plot reported the logarithm effect estimate and related the standard error from each study, and the Egger test was performed [ 26 , 27 ].

All data were analyzed using the statistical package STATA/SE 16.1 (StataCorp LP, College 482 Station, TX, USA), with the “metan” command used for meta-analysis, and “metafunnel”, “metabias” and “confunnel” for publication bias assessment [ 28 ].

3.1. Studies Characteristics

Overall, the search strategies retrieved 3,155 relevant records. After removing 570 (18.1%) duplicates, 2,585 (81.9%) articles were suitable for the screening phase, of which only 284 (11.0%) articles were selected for the assessment phase. During the assessment phase, 263 (92.6%) articles were excluded. The most frequent reasons of exclusion were the absence of relevant outcomes ( n = 134, 51.0%) and other study designs ( n = 61, 23.2%). Very few articles were rejected due to them being written in another language ( n = 1, 0.4%), due to the publication year being out of 2015–2019 ( n = 1, 0.4%) or having an unavailable full text ( n = 3, 1.1%).

A total of 21 (7.4%) articles were included in the qualitative and quantitative analysis, of which nine (42.9%) were cross-sectional studies and twelve (57.1%) were before and after studies ( Figure 1 ).

Flow-chart of selection manuscript phases for systematic review and meta-analysis on leadership effectiveness in healthcare workers.

The number of healthcare workers enrolled was 25,099 (median = 308, IQR = 89–1190), including at least 2,275 nurses (9.1%, median = 324, IQR = 199–458). Most of the studies involved a public hospital ( n = 16, 76.2%). Among the studies from private healthcare settings, three (60.0%) were conducted in North America. Articles which analyzed servant and charismatic leadership styles were nine (42.9%) and eight (38.1%), respectively. Interventions with a transactional leadership style were examined in six (28.6%) studies, while those with a transformational leadership style were examined in five studies (23.8%). Overall, 82 healthcare outcomes were assessed and 71 (86.6%) of them were classified as performance. Adherence-to-guidelines outcomes were 11 (13.4%), which were related mainly to hospital stay ( n = 7, 64.0%) and drug administration ( n = 3, 27.0%). Clements et al. and Lornudd et al. showed the highest number of outcomes, which were 19 (23.2%) and 12 (14.6%), respectively [ 29 , 30 ].

3.2. Leadership Effectiveness in before–after Studies

Before–after studies ( Supplementary Table S1 ) involved 22,241 (88.6%, median = 735, IQR = 68–1273) healthcare workers for a total of twelve articles, of which six (50.0%) consisted of performance and five (41.7%) of guidelines adherence and one (8.3%) of both outcomes. Among healthcare workers, there were 1,294 nurses (5.8%, median = 647, IQR = 40–1,254). Only the article by Savage et al. reported no number of involved healthcare workers [ 31 ].

The number of studies conducted after 2011 or between 2012–2019 was seven (58.3%), while only one (8.3%) article reported a study beginning both before and after 2011. Most of studies were conducted in Northern America ( n = 5, 41.7%). The servant leadership style and charismatic leadership style were the most frequently implemented, as reported in five (41.7%) and four (33.3%) articles, respectively. Only one (8.3%) study adopted a transformational leadership style.

The pooled effectiveness of leadership was 14.0% (95%CI 10.0–18.0%), with a high level of heterogeneity (I 2 = 99.9%, p < 0.0001) among the before–after studies ( Figure 2 ).

Effectiveness of leadership in before after studies. Dashed line represents the pooled effectiveness value [ 29 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ].

The highest level of effectiveness was reported by Weech-Maldonado R et al. with an effectiveness of 199% (95%CI 183–215%) based on the Cultural Competency Assessment Tool for Hospitals (CCATH) [ 39 ]. The effectiveness of leadership changed in accordance with the leadership style ( Supplementary Figure S1 ) and publication bias ( Supplementary Figure S2 ).

Multi-regression analysis indicated a negative association between leadership effectiveness and studies from Oceania, but this result was not statistically significant (β = −0.33; 95% IC −1.25, 0.59). On the other hand, a charismatic leadership style affected healthcare outcomes positively even if it was not statistically relevant (β = 0.24; 95% IC −0.69, 1.17) ( Table 1 ).

Correlation coefficients and multi-regression analysis of leadership effectiveness in before–after studies.

3.3. Leadership Effectiveness in Cross Sectional Studies

A total of 2858 (median = 199, IQR = 110–322) healthcare workers were involved in the cross-sectional studies ( Supplementary Table S2 ), of which 981 (34.3%) were nurses. Most of the studies were conducted in Asia ( n = 4, 44.4%) and North America ( n = 3, 33.3%). All of the cross-sectional studies regarded only the healthcare professionals’ performance. Multi-professional teams were involved in seven (77.8%) studies, and they were more frequently conducted in both medical and surgical wards ( n = 6, 66.7%). The leadership styles were equally distributed in the articles and two (22.2%) of them examined more than two leadership styles at the same time.

The pooled effectiveness of the leadership interventions in the cross-sectional studies had a correlation coefficient of 0.22 (95%CI 0.15–0.28), whose heterogeneity was remarkably high (I 2 = 96.7%, p < 0.0001) ( Figure 3 ).

Effectiveness of leadership in cross-sectional studies. Dashed line represents the pooled effectiveness value [ 30 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ].

The effectiveness of leadership in the cross-sectional studies changed in accordance with the leadership style ( Supplementary Figure S3 ) and publication bias ( Supplementary Figure S4 ).

Multi-regression analysis showed a higher leadership effectiveness in studies conducted in South America (β = 0.56 95%CI 0.13–0.99) in private hospitals (β = 0.60; 95%CI 0.14–1.06) and in the medical vs. surgical specialty (β = −0.22; 95%CI −0.54, −0.02) ( Table 2 ).

Multi-regression analysis of leadership effectiveness in cross-sectional studies.

* 0.05 ≤ p < 0.01.

4. Discussion

Leadership effectiveness in healthcare settings is a topic that is already treated in a quantitative matter, but only this systematic review and meta-analysis showed the pooled effectiveness of leadership intervention improving some healthcare outcomes such as performance and adherence to guidelines. However, the assessment of leadership effectiveness could be complicated because it depends on the study methodology and selected outcomes [ 12 ]. Health outcomes might benefit from leadership interventions, as Flodgren et al. was concerned about opinion leadership [ 2 ], whose adhesion to guidelines increased by 10.8% (95% CI: 3.5–14.6%). On the other hand, other outcomes did not improve after opinion leadership interventions [ 2 ]. Another review by Ford et al. about emergency wards reported a summary from the literature data which acknowledged an improvement in trauma care management through healthcare workers’ performance and adhesion to guidelines after effective leadership interventions [ 14 ]. Nevertheless, some variables such as collaboration among different healthcare professionals and patients’ healthcare needs might affect leadership intervention effectiveness [ 14 ]. Therefore, a defined leadership style might fail in a healthcare setting rather than in other settings [ 5 , 13 , 14 ].

The leadership effectiveness assessed through cross-sectional studies was higher in South America than in other continents. A possible explanation of this result could be the more frequent use of a transactional leadership style in this area, where the transactional leadership interventions were effective at optimizing economic resources and improving healthcare workers’ performance through cash rewards [ 48 ]. Financing methods for healthcare organizations might be different from one country to another, so the effectiveness of a leadership style can change. Reaching both economic targets and patients’ wellness could be considered a challenge for any leadership intervention [ 48 ], especially in poorer countries [ 5 ].

This meta-analysis showed a negative association between leadership effectiveness and studies by surgical wards. Other research has supported these results, which reported surgical ward performance worsened in any leadership context (charismatic, servant, transactional, transformational) [ 47 ]. In those workplaces, adopting a leadership style to improve surgical performance might be challenging because of nervous tension and little available time during surgical procedures [ 47 ]. On the other hand, a cross-sectional study declared that a surgical team’s performance in private surgical settings benefitted from charismatic leadership-style interventions [ 42 ]. This style of leadership intervention might be successful among a few healthcare workers [ 42 ], where creating relationships is easier [ 6 ]. Even a nursing team’s performance in trauma care increased after charismatic leadership-style interventions because of better communicative and supportive abilities than certain other professional categories [ 29 , 47 ]. However, nowadays there is no standardized leadership in healthcare basic courses [ 5 , 6 , 12 ]. Consequently, promoting leadership culture after undergraduate medical courses could achieve a proper increase in both leadership agreement and working wellness as well as a higher quality of care. [ 17 ]. Furthermore, for healthcare workers who have already worked in a healthcare setting, leadership improvement could consist of implementing basic knowledge on that topic. Consequently, they could reach a higher quality of care practice through working wellness [ 17 ] and overcoming the lack of previous leadership training [ 17 ].

Although very few studies have included in a meta-analysis examined in private healthcare settings [ 35 , 38 , 40 , 41 , 42 ], leadership interventions had more effectiveness in private hospitals than in public hospitals. This result could be related to the continent of origin, and indeed 60.0% of these studies were derived from North America [ 38 , 41 , 42 ], where patients’ outcomes and healthcare workers’ performance could influence available hospital budgets [ 38 , 40 , 41 , 42 ], especially in peripheral healthcare units [ 38 , 41 ]. Private hospitals paid more attention to the cost-effectiveness of any healthcare action and a positive balance of capital for healthcare settings might depend on the effectiveness of leadership interventions [ 40 , 41 , 42 ]. Furthermore, private healthcare assistance focused on nursing performance because of its impact on both a patients’ and an organizations’ outcomes. Therefore, healthcare systems’ quality could improve with effective leadership actions for a nursing team [ 40 ].

Other factors reported in the literature could affect leadership effectiveness, although they were not examined in this meta-analysis. For instance, professionals’ specialty and gender could have an effect on these results and shape leadership style choice and effectiveness [ 1 ]. Moreover, racial differences among members might influence healthcare system performance. Weech-Maldonado et al. found a higher compliance and self-improvement by black-race professionals than white ones after transactional leadership interventions [ 39 ].

Healthcare workers’ and patients’ outcomes depended on style of leadership interventions [ 1 ]. According to the results of this meta-analysis, interventions conducted by a transactional leadership style increased healthcare outcomes, though nevertheless their effectiveness was higher in the cross-sectional studies than in the before–after studies. Conversely, the improvement by a transformational leadership style was higher in before–after studies than in the cross-sectional studies. Both a charismatic and servant leadership style increased effectiveness more in the cross-sectional studies than in the before–after studies. This data shows that any setting required a specific leadership style for improving performance and guideline adherence by each team member who could understand the importance of their role and their tasks [ 1 ]. Some outcomes had a better improvement than others. Focusing on Savage et al.’s outcomes, a transformational leadership style improved checklist adherence [ 31 ]. The time of patients’ transport by Murphy et al. was reduced after conducting interventions based on a charismatic leadership style [ 37 ]. Jodar et al. showed that performances were elevated in units whose healthcare workers were subjected to transactional and transformational leadership-style interventions [ 1 ].

These meta-analysis results were slightly relevant because of the high heterogeneity among the studies, as confirmed by both funnel plots. This publication bias might be caused by unpublished articles due to either lacking data on leadership effectiveness, failing appropriate leadership strategies in the wrong settings or non-cooperating teams [ 12 ]. The association between leadership interventions and healthcare outcomes was slightly explored or gave no statistically significant results [ 12 ], although professionals’ performance and patients’ outcomes were closely related to the adopted leadership style, as reported by the latest literature sources [ 7 ]. Other aspects than effectiveness should be investigated for leadership. For example, the evaluation of the psychological effect of leadership should be explored using other databases.

The study design choice could affect the results about leadership effectiveness, making their detection and their statistical relevance tough [ 12 ]. Despite the strongest evidence of this study design [ 50 ], nowadays, trials about leadership effectiveness on healthcare outcomes are lacking and have to be improved [ 12 ]. Notwithstanding, this analysis gave the first results of leadership effectiveness from the available study designs.

Performance and adherence to guidelines were the main two outcomes examined in this meta-analysis because of their highest impact on patients, healthcare workers and hospital organizations. They included several other types of outcomes which were independent each other and gave different effectiveness results [ 12 ]. The lack of neither an official classification nor standardized guidelines explained the heterogeneity of these outcomes. To reach consistent results, they were classified into performance and guideline adherence by the description of each outcome in the related manuscripts [ 5 , 6 , 12 ].

Another important aspect is outcome assessment after leadership interventions, which might be fulfilled by several standardized indexes and other evaluation methods [ 40 , 41 ]. Therefore, leadership interventions should be investigated in further studies [ 5 ], converging on a univocal and official leadership definition and classification to obtain comparable results among countries [ 5 , 6 , 12 ].

5. Conclusions

This meta-analysis gave the first pooled data estimating leadership effectiveness in healthcare settings. However, some of them, e.g., surgery, required a dedicated approach to select the most worthwhile leadership style for refining healthcare worker performances and guideline adhesion. This can be implemented using a standardized leadership program for surgical settings.

Only cross-sectional studies gave significant results in leadership effectiveness. For this reason, leadership effectiveness needs to be supported and strengthened by other study designs, especially those with the highest evidence levels, such as trials. Finally, further research should be carried out to define guidelines on leadership style choice and establish shared healthcare policies worldwide.

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/ijerph191710995/s1 , Figure S1. Leadership effectiveness by leadership style in before after studies; Figure S2. Funnel plot of before after studies; Figure S3. Leadership effectiveness in cross sectional studies by four leadership style; Figure S4. Funnel plot of cross-sectional studies; Table S1. Before after studies included in this systematic review and meta-analysis; Table S2. Cross-sectional studies included in this systematic review and meta-analysis. All outcomes were performance.

Funding Statement

This research received no external funding.

Author Contributions

Conceptualization, V.R., A.C. (Alessandra Casuccio), F.V. and C.F.; methodology, V.R., M.G., A.O. and C.T.; software, V.R.; validation, G.M., A.B., A.C. (Alberto Carli) and M.C.; formal analysis, V.R.; investigation, G.M., A.B., A.C. (Alberto Carli) and M.C.; resources, A.C. (Alessandra Casuccio); data curation, G.M. and V.R.; writing—original draft preparation, G.M.; writing—review and editing, A.C. (Alessandra Casuccio), F.V., C.F., M.G., A.O., C.T., A.B., A.C. (Alberto Carli) and M.C.; visualization, G.M.; supervision, V.R.; project administration, C.F.; funding acquisition, A.C. (Alessandra Casuccio), F.V. and C.F. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

Ethical review and approval were waived for this study due to secondary data analysis for the systematic review and meta-anlysis.

Informed Consent Statement

Not applicable.

Data Availability Statement

Conflicts of interest.

The authors declare no conflict of interest.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Inclusive leadership could be a game-changer for business

• More on this topic

 New research has found that leadership style could have a noticeable impact on an employee's working experience and on staff retention.

Inclusive leadership is not just about embracing diversity.

Employee retention is a key focus for corporations globally, and new research from Edith Cowan University (ECU) has found that leadership style could have a noticeable impact on an employee's working experience.

The study by ECU researchers  Dr Azadeh Shafaei  and  Dr Mehran Nejati  found that inclusive leaders are crucial in organisations to create conditions for employees to experience meaningful work.

"Inclusive leadership is not just about embracing diversity. It is the art of weaving an extraordinarily rich tapestry of talents, ideals, and perspectives into the very fabric of organisational success. Inclusive leaders focus on employees need for belongingness and uniqueness and provide a psychologically safe environment that fosters creativity," Dr Shafaei said.

"This is unique because as humans, we have the need for feeling that we belong to our work group, our organisation and at the same time, we really want to be recognised and valued for what we can bring to the table.

"Inclusive leaders shape an organisational culture and help employees to learn the expected behaviours relevant to the culture and its underlying values. Inclusive leaders also cultivate high-quality relationships in the workplace based on trust that can foster collaboration and cooperation among employees," Dr Shafaei explained.

"This leadership style enhances employees' autonomy, signals that they are valued individuals who can make unbiased decisions, provides them with emotional support and increased trustworthiness, and gives them the opportunity to voice their opinions which are essential in creating meaning-making capabilities, and can lead to experiencing meaningfulness at work by employees."

Research revealed that work meaningfulness is positively related to a wide range of employee and organisational outcomes such as work and life satisfaction, engagement, psychological well-being, work motivation, career development, creativity, positive work behaviour, in-role and extra-role performance, and organisational commitment.

Work meaningfulness can bring about several positive outcomes including job satisfaction, better performance, and greater motivation.

"Inclusive leadership refers to a leadership style that invites and appreciates contributions from followers by demonstrating openness, flexibility, and availability, which can create a psychologically safe environment. Such a psychologically safe environment helps employees share their unique perspectives, discuss differences, and practice problem solving. Also, inclusive leaders promote employees' uniqueness and sense of belongingness to the organisation, the two crucial factors in creating a psychologically safe environment where employees can be themselves.

"Moreover, inclusive leaders welcome contributions from diverse team members and ensure that employees have access to organisational resources. Through demonstrating availability, flexibility, and openness, inclusive leaders provide help and support to employees to solve problems, and make them believe that mistakes are not criticized, rather are opportunities to learn from," said Dr Shafaei.

She noted that when leaders treat staff with respect and dignity, and value their contributions, they can create positive job attributes which makes employees perceive that their workplace promotes experimentation, open discussion, and learning from errors. Working in such a supportive environment created by inclusive leaders could foster greater meaningful work for employees.

Dr Shafaei noted that inclusive leadership from upper management was crucial to create a trickle-down effect to line managers.

"By demonstrating all the inclusive behaviours or creating that trusting relationship at the top end of leadership, and communicating that to other levels of employees, leaders will set an example for others on how to behave.

"If a leader can help an employee to shape a meaningful work experience for us, employees will be more committed to coming to work, and it will have a more positive effect in enhancing the intrinsic motivation within employees. This will definitely have an impact on keeping employees happy and reducing the number of turnovers in an organisation."

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Understand the 6 different leadership styles — and when to use them

Writing for the Harvard Business Review , Rebecca Knight outlines six different leadership styles developed by psychologist Daniel Goleman and how to know when you should use each one.

6 leadership styles (and when to use them)

1. Coercive leadership style

According to Goleman, coercive is the least effective leadership style in most situations, as it's characterized by top-down decision making, an authoritarian approach, and a demanding attitude.

This leadership style can yield short-term results, but it ultimately has corrosive, long-term impacts on company culture, which can cause high employee turnover and a disillusioned, disengaged workforce.

The best time to use the coercive leadership style is in certain crisis situations where swift, decisive action with a clear chain of command is needed, Goleman said. For example, a corporate takeover or in an ED. However, Goleman noted that in most cases, the coercive approach is likely to be detrimental.

2. Authoritative leadership style

The authoritative leadership style involves motivating team members by connecting their work to the larger organizational strategy, helping them understand how their everyday tasks contribute to a greater purpose, Goleman said.

This leadership style is about setting clear guidelines rather than micromanaging and about trusting your staff to work toward your shared vision with autonomy and creativity, which can help create higher levels of engagement and job satisfaction. According to Goleman, this is the most effective and inspiring leadership style.

The authoritative leadership style is useful in many situations, especially during times of change or uncertainty, Knight reports.  Finding organic ways to remind staff members of your company's mission, like a pharmaceutical executive saying, "our work will benefit many patients," or an insurance leader saying, "we're helping people secure their future," can also be a part of your daily operations.

3. Pacesetting leadership style

The pacesetting style involves holding yourself and others to high standards. However, this is a leadership style that can backfire if the focus is on failures instead of successes, Goleman said. Constantly pushing for productivity and results can also create a pressure-cooker environment.

This style's focus on perfection can make it difficult for employees to see how their efforts fit into the bigger picture, which can, in turn, lead to increased turnover. "If your best people are leaving because you're alienating them or stressing them out, then you're not acting in the long-term interests of your organization," Goleman said.

The pacesetting style should be used infrequently but can be useful in certain circumstances where employees are highly motivated and exceptionally competent, Goleman said. It could be useful in specialized groups like R&D or legal teams, for example. But still, it's important to balance pacesetting with other leadership styles to avoid negative consequences.

4. Affiliative leadership style

The affiliative leadership style involves developing strong emotional bonds, which creates a sense of camaraderie and team spirit, which then fosters a positive and supportive workplace, Knight reports. This can help team members feel like they belong and can share ideas and feedback freely while working together towards common goals.

According to Goleman, this leadership style is especially useful in shaping a positive work environment, which is especially important during a time when some companies are asking employees to come back into the office. You can create a caring and cohesive community rather than an administrative machine if you get to know your employees on a personal level and celebrate their wins, Goleman said.

The affiliative leadership style shouldn't be used in isolation, as it may not provide enough feedback to address performance problems or deal with complex challenges, Knight reports. Combining this style with either the inspirational or authoritative styles can create more balance by providing both support and direction.

5. Democratic leadership style

The democratic leadership style involves empowering team members to have a voice in the decision-making process, Knight reports. When incorporating feedback, taking the time to gather input and listen to concerns and different perspectives can show your team that their opinions and voices matter and their contributions are valuable, giving them a sense of ownership and responsibility.

The democratic leadership style is ideal to use when you're unsure about the best course of action and want to generate some ideas, Knight reports. However, it's not a good strategy to leverage when team members lack experience or information or in times of crisis.

6. Coaching leadership style

The coaching leadership style focuses on individual growth and involves dedicating time to understand your team members' long-term goals, both personally and professionally.

"Asking questions like, 'What do you want from your life, your career, this job? And, how can I help you?' encourages your employees to reflect on their aspirations and work towards achieving them," Goleman said. Taking a genuine interest in your team members' development can help your employees feel valued and motivated.

The coaching leadership style is best used during one-on-one performance evaluations but can also be used in everyday conversations, Goleman said. For example, a leader could say, "You're great at XYZ, but when you do ABC, it doesn't work as well because of these reasons. Have you considered trying this other approach instead?" Goleman said.

The importance of adapting

Research has found that the most effective leaders adapt their leadership style to different circumstances, Knight reports.

According to an article Goleman wrote in 2000, "The most effective leaders switch flexibly among the leadership styles as needed…[They] don’t mechanically match their style to fit a checklist of situations — they are far more fluid. They are exquisitely sensitive to the impact they are having on others and seamlessly adjust their style to get the best results."

For example, if you're launching a new product, you may use an authoritative style, but you may switch to a coaching style when an employee struggling with a task needs help. Then, you may switch to a pacesetting style when your team of experienced employees need to meet a challenging deadline.

Even if you're naturally introverted or tend to be data-driven rather than emotionally driven, you can learn how to adapt different leadership styles to your needs, Knight reports.

"A leader's success depends on the productivity and effectiveness of the people who work for them," Goleman said. "You're shooting yourself in the foot if you use a style of leadership that's counterproductive to their performance." (Knight, Harvard Business Review , 4/9)

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Posted on May 14, 2024

Updated on May 14, 2024

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10 Ways to Become a Better Leader

Table of Contents

Anyone can sit in a corner office and delegate tasks, but there is more to effective leadership than that. Effective leaders have major impacts on not only the team members they manage, but also their company as a whole. Employees who work under great leaders tend to be happier, more productive and more connected to their organization. And this has a ripple effect that reaches your business’s bottom line. 

Not everyone is a natural-born leader. However, there are strategies you can use to improve your leadership. Similarly, there are a handful of mistakes to avoid if you want to be a good leader.

Assessing whether you’re a good or bad leader

Business News Daily spoke with CEOs, directors and leadership experts to learn what good leadership strategies are and how you can incorporate them in your own organization.

“I think a great leader is one who makes those around them better,” Dana Brownlee, founder of Professionalism Matters, told Business News Daily. “There are many litmus tests for a great leader, but I really look to those around them: Are they growing, becoming better leaders themselves, motivated, etc.?”

If you look around and see your team members have become disengaged or stagnant in their work, it may be time to reassess and reform your strategies. According to Brownlee, the following behaviors are signs you may have a poor leadership strategy:

• No one on your team has criticized one of your ideas in the past month.
• You spend more time planning your own career progression than that of your team members.
• You haven’t had at least three completely non-work-related conversations with a team member weekly.
• Different team members would provide different answers if asked your top three priorities for the year.
• Team members are afraid to fail.

More than half of new leaders fail within their first 18 months. You can avoid becoming part of this staggering statistic by incorporating good leadership strategies that motivate your team members to accomplish their goals.

How to be a good leader

Every leader has their own style, but there are certain characteristics all great leaders share. The below practices are often the hallmarks of a successful leader. 

1. Engage in honest, open communication.

One of the most important elements of effective leadership is creating an open line of communication with your team members. Sanjay Patoliya, founder of Teclogiq and software developer at NextBits Group, said your own honesty and transparency should serve as an example for your team members.

“When you are responsible for a team of people, it is important to be straightforward,” he said. “Your company and its employees are a reflection of yourself, and if you make honest and ethical behavior … a key value, your team will follow.”

Brownlee added that people with effective leadership language are able to customize their interactions and communication styles to suit each situation and team member. “This means they take the time to figure out which communication mode is preferred by each team member; e.g., are they a text person, email, phone or face-to-face? They’re also great listeners and are authentically interested in other people.”

Listening to your employees and displaying transparency can build trust among your team and boost overall morale . Ruslan Fazlyev, former CEO and founder of e-commerce solutions provider Ecwid and current board member at Seller Labs, said that in all your communications, it’s crucial to be genuine above all else.

“There are many leadership styles; there’s no right and wrong,” he said. “But there’s genuine, and there’s fake. There’s no following to fake leadership.”

2. Connect with your team members.

Leading a group of people requires a mutual sense of trust and understanding between the leader and their team members. To achieve this, leaders should learn to connect.

Terry “Starbucker” St. Marie, a leadership writer and consultant, said that being a “more human” leader requires positivity, purpose, empathy, compassion, humility and love. These key traits will put you on the road to genuine connections with the members of your team.

“Building a real, personal connection with your teammates is vital to developing the shared trust necessary to build a strong culture of accountability and exceptional performance,” St. Marie said. “With that culture in place, the team can achieve a successful business, a happy team and a fulfilled leader.”

To build a connection with each of your team members, focus on getting to know their personalities, interests, strengths, weaknesses, hobbies and preferences. This can give you insight into their goals and motivations.

Patoliya said successful leaders allow their teams to develop autonomy and add value according to their own personal strengths. “Being able to recognize the strengths of individuals within their team, and allowing them to be responsible and accountable, not only increases employees’ confidence in themselves and their leader, but also increases their performance.”

3. Encourage personal and professional growth.

Acting as your team’s cheerleader is an important part of being an effective leader. You should be invested in their success and growth.

Keri Ohlrich, the CEO of HR consulting company Abbracci Group, said that leaders should set aside a budget, if only a small one, to dedicate to the growth of their employees.

“With options as varied as on-demand, virtual [and] in-person options, there’s ample opportunity to continue learning new skills or further developing existing ones,” she said. “Empower your employees to take the time to learn and infuse that in the work they do.”

In addition to investing in your employees’ growth financially, you should invest emotionally. John Rampton, founder and CEO of the app company Calendar, said that great leaders empower their employees to grow by giving them challenging opportunities and guiding them as needed.

“To motivate and inspire employees, leadership strategy is about empowering others to do their best and take on new challenges,” he said. “Employees like challenges and feeling the satisfaction of overcoming them. Whether it’s a tough client, a difficult sale, a hard situation or whatever the case, it’s always good to let them take on these challenges.”

When leaders believe in their employees and give them the opportunity to learn and grow, they might be surprised at how much they can accomplish. Don’t be afraid to delegate tasks and encourage freedom and creativity.

4. Keep a positive attitude.

As much as leaders wish their team’s day-to-day operations could run smoothly all the time, they’re bound to run into the occasional obstacle. Whether it’s a minor miscommunication or a major error, the way you handle a negative situation says a lot about your leadership skills.

Robert Mann, author of The Measure of a Leader (iUniverse, 2013), recommended focusing on the good in any set of circumstances. “Look at three positive things about a problem before you identify what makes it dissatisfying. The more you look at the positives in a problem, the more positively people react with one another,” he said.

In his research, Mann found that after individuals point out things they’re happy with in a problematic situation, they don’t feel so strongly about the problem and are better able to think clearly and solve it. The same is true when a leader needs to improve their strategy. If you or a team member notices a particular course of action you’ve taken that just isn’t working, figure out some things you’ve done in the past that have worked.

Patoliya added that focusing on solutions rather than problems can help your team maintain positive engagement. “A positive environment is more likely to create a more engaged and productive workforce. By displaying enthusiasm and confidence, a good leader will see the impact they can have in their working environment,” she said.

5. Teach employees instead of giving orders.

An effective leader knows how to show others what is required rather than simply telling them. Luke Iorio, former president and current partner at the Institute for Professional Excellence in Coaching (iPEC), said leaders should coach their team members toward a more collaborative, committed work environment – without coaxing them.

“[If you are] controlling people to do certain things in certain ways, you’re not going to get the level of engagement you’re looking for,” he said. “Coaching is about helping the people you lead recognize the choices they have in front of them. People will [then] take a great deal of ownership over the direction of the project.”

As opposed to simply barking orders at team members, Rampton said good leaders should encourage growth by teaching. “People wouldn’t grow if leaders never taught them anything. Leaders need to be teaching so they can grow new leaders to take their place.”

6. Set clear employee goals and expectations.

Setting clear goals and employee expectations for your team is key to employee success. When setting these objectives, encourage employee questions and feedback. Including team members in the goal-setting process can increase engagement.

Amish Shah, founder of ALTR Inc., said good leaders will explain the company vision and how team member goals fit into that equation.

“For a leader to motivate and inspire, they need to keep their team in the know about their vision,” he said. “This helps employees understand the end result they’re working towards as a unit. When goals are clearly set, everyone can track progress and identify achievements in a tangible manner.”

Ohlrich also stressed the importance of explaining how these goals impact the organization as a whole. She said that, regardless of seniority level, every employee should be able to articulate how the work they do supports the success of the company.

Don’t let team member goals go static. Periodically revisit objectives to modify or rearrange them as needed. This will let your team members know you are present and aware of what they’re working on.

7. Give direct feedback about performance.

Taso Du Val, co-founder and CEO of the Toptal freelance talent network, said direct, honest feedback – even if it’s criticism – is the best way to guide your team in the right direction. You also need to know exactly where your business is headed so you can give employees the right advice.

“If you’re not direct, people won’t know what you truly think about them and their work, and they will never be able to improve,” Du Val said. “If you don’t know the precise direction your company is headed, no matter how much you’ve communicated to your employees and leadership team regarding their individual performance, they will flounder when it comes to making decisions and taking actions. Once those basic principles are in place, deadlines, regular product plans, performance reviews, structure and processes can easily be put into place.”

In addition to providing constructive feedback and performance reviews , highlight employee accomplishments. If a team member does something great, let them know. Celebrate their wins and thank them for their hard work.

“Positive recognition will create an environment of productivity,” said Shah. “Acknowledging successes by outlining how it impacts the business, rather than with vague pats on the back, is not only encouraging, but also helps a person work better in the long run.”

8. Ask for feedback on your leadership.

Your team members aren’t the only ones who can benefit from honest feedback. A true self-assessment of your leadership can be difficult, so mentors, fellow professionals and even your own staff are invaluable in evaluating your effectiveness. According to St. Marie, talking to friends and peers can give you necessary perspective on your leadership style and approach.

Leadership coaching can also help you discover areas where you need improvement. A professional who helps you develop a plan to achieve your leadership goals can be more motivational than books and seminars alone.

“Coaching allows leaders to make the connection and apply [changes] in a real-life setting,” Iorio said. “You need time to integrate, process and reflect, and unless you go through those steps, you won’t have sustainable change.”

Fazlyev agreed, noting that your team can give you critical insight into what’s working, what’s not working and what obstructions you must overcome to achieve success.

9. Be open to new ideas.

Good leaders have the emotional intelligence to understand and accept that change is inevitable. Instead of trying to maintain a status quo just for the sake of consistency, embrace change and innovation. Be open to new ideas and alternative ways of thinking. Everyone brings a unique perspective to the table, and that is something to take advantage of, not discourage.

“When you’re open to hearing the thoughts of the talent around you is when you truly embrace every possibility and potential,” said Shah. “See things through till the end. Understand that there will be errors along the way, but if something doesn’t work, try to figure out why and how before scrapping it.”

When solving a problem, encourage team members to provide their insights. When employees feel they can openly bring new ideas to the conversation, true innovation, engagement and success can prevail.

10. Understand your own motivation.

If a person in a leadership position views their role as “just a job,” it’s going to show. To be an effective leader, you need the right motivation. Is it the money or the prestige you care about, or do you sincerely want to inspire people to do their best?

St. Marie advised leaders to really ask themselves why they want to lead. “I look at leadership as an honor and a vocation. If, in your heart, you feel leadership is your destiny and how you’ll make a difference in this world, then you are certainly starting from the right place.”

In addition to what motivates you, Ohlrich said it is vital to know what decreases your energy. “Knowing your strengths and weaknesses help[s] you diversify your team and get a well-rounded portfolio of skills. It helps you not hire carbon copies of yourself and [instead] surround yourself with others who are not like you.”

Your leadership style plays a role in how you interact with employees and should be evaluated as well. There are nine different leadership types , and the best leaders are able to adapt each style to their situations and employees. If you’re currently in a leadership role and aren’t sure where you stand on some of these qualities, you can take a quick leadership self-assessment quiz from the Leading With Courage Network to assess your leadership abilities.

Leadership mistakes to avoid

As you learn how to lead, it’s also essential to understand what not to do. Missteps can hinder a leader and prevent their team from thriving. These are some common leadership mistakes you should steer clear of if you want to be an effective leader: 

• Micromanaging your employees: Team members need guidance to succeed, but they also need autonomy and permission to make decisions on their own. Micromanaging every task can have a negative impact on performance and morale.
• Ignoring feedback: Part of demonstrating strong listening skills is showing you take action when an issue is brought to your attention. Disregarding team suggestions or concerns is an easy way to erode trust.
• Not following through: Sometimes priorities change, but if you’re consistently making promises to your team that you can’t keep, everyone could lose faith in your leadership abilities.
• Being inconsiderate of team members’ schedules: Last-minute rescheduling needs happen to everyone, especially when you’re managing a team. It’s a problem, though, when leaders are constantly canceling meetings with short notice or assigning projects with tight deadlines.
• Avoiding accountability: It’s not that good leaders never make any errors – mistakes are inevitable for even the best leaders. What matters most is that you own up to any oversights without blaming other team members and do the work to correct your mishaps. 

Strong leadership takes time and effort

Remember that being a good leader takes time. Although some individuals are naturally inclined to have strong leadership skills, this is something anyone can learn and improve upon. Being aware of what makes a good leader is the first step toward reaching your full potential as a manager. With hard work, dedication and strategic planning, you can lead your team to success.

Natalie Hamingson and Nicole Fallon contributed to this article. Source interviews were conducted for a previous version of this article. 

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