Transformational, transactional among physician and laissez-faire leadership among physician executives

J Health Organ Manag. 2008;22(6):599-613. doi: 10.1108/14777260810916579.


Purpose: The purpose of this paper is to examine the empirical validity of transformational, transactional and laissez-faire leadership and their sub-scales among physician managers.

Design/methodology/approach: A nation-wide, anonymous mail survey was carried out in the United States, requesting community health center executive directors to provide ratings of their medical director's leadership behaviors (34 items) and effectiveness (nine items), using the Multifactor Leadership Questionnaire 5X-Short, on a five-point Likert scale. The survey response rate was 40.9 percent, for a total 269 responses. Exploratory factor analysis was done, using principal factor extraction, followed by promax rotation).

Findings: The data yielded a three-factor structure, generally aligned with Bass and Avolio's constructs of transformational, transactional and laissez-faire leadership. Data do not support the factorial independence of their subscales (idealized influence, inspirational motivation, individualized consideration, and intellectual stimulation under transformational leadership; contingent reward, management-by-exception active, and management-by-exception passive under transactional leadership). Two contingent reward items loaded on transformational leadership, and all items of management-by-exception passive loaded on laissez-faire.

Research limitations/implications: A key limitation is that supervisors were surveyed for ratings of the medical directors' leadership style. Although past research in other fields has shown that supervisor ratings are strongly correlated with subordinate ratings, further research is needed to validate the findings by surveying physician and other clinical subordinates. Such research will also help to develop appropriate content of leadership training for clinical leaders.

Originality/value: This study represents an important step towards establishing the empirical evidence for the full range of leadership constructs among physician leaders.

Publication types

  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Attitude of Health Personnel*
  • Community Health Services / organization & administration*
  • Factor Analysis, Statistical
  • Health Facility Administrators / psychology*
  • Humans
  • Leadership*
  • Models, Organizational
  • Organizational Culture*
  • Physician Executives / psychology*
  • Public Sector
  • South Carolina
  • Surveys and Questionnaires
  • United States
  • United States Health Resources and Services Administration