Site maintenance Wednesday, November 13th, 2024. Please note that access to some content and account information will be unavailable on this date.
Skip to main content
Full access
Articles
Published Online: 30 October 2018

Who Wants Feedback? Effects of Transformational Leadership and Leader-Member Exchange on Mental Health Practitioners’ Attitudes Toward Feedback

Abstract

Objective:

The purpose of this study was to identify the mechanisms through which different aspects of leadership affect mental health practitioners’ attitudes toward supervisory feedback.

Methods:

Data were collected from 363 practitioners nested in 68 treatment teams in public-sector mental health organizations. A multilevel path analysis was conducted to examine the associations of transformational leadership (supervisor’s ability to inspire others to follow a course of action) and leader-member exchange (quality of the supervisor-practitioner relationship) with practitioner attitudes toward feedback.

Results:

Transformational leadership and leader-member exchange were directly and positively associated with practitioners’ attitudes toward feedback. Transformational leadership was also indirectly associated with practitioners’ attitudes toward feedback through the quality of supervisor-practitioner relationships.

Conclusions:

Study results contribute to the growing body of evidence suggesting that leaders play a key role in shaping mental health service delivery. Both leadership behavior and high-quality supervisor-practitioner relationships are important in supporting practitioners in delivering evidence-based mental health care. Policymakers, administrators, and researchers should consider an integrative approach when developing leadership training interventions.
Implementation frameworks and quality improvement initiatives emphasize the importance of supervision and feedback in advancing practitioners’ use of evidence-based practices (EBPs) in community mental health services (15). Appropriate supervision improves practitioners’ views about EBPs, increases fidelity of EBP implementation, and assists with the adaptation of EBPs to specific client problems, populations, or settings (610). However, a supervisor’s leadership behavior may play a key role in influencing practitioners’ attitudes toward receiving supervisory feedback to support EBP delivery (11,12).
Feedback is an important component of efforts to improve quality of care (13). A growing body of research is investigating how targeted, ongoing feedback that is relevant to practitioner needs can be used to improve the implementation of EBPs (2,4,1416). For example, audit and feedback interventions can improve implementation by highlighting discrepancies between practitioners’ current practice and their target performance and creating an action plan for improvement (17,18). Inherent in these interventions is the assumption that practitioners are open to feedback, but individual attitudes toward feedback may vary. Supervisory leadership behavior may influence practitioners’ willingness to seek out feedback and to apply it when it is given (19,20).
Transformational leadership theory and leader-member exchange (LMX) theory, two of the most influential theories in the business and management literatures, describe how leadership affects team and employee performance (21). The full range leadership model developed by Bass and Avolio (22) identified several dimensions of leadership behaviors, with the transactional and transformational styles being the most effective and well-researched. This study examined supervisor transformational leadership because of its focus on creating a vision and buy-in for strategic initiatives such the implementation of EBPs and its promising role in previous implementation studies (12). Transformational leaders inspire employees to follow a particular course of action by considering individual employees’ unique talents, stimulating new ways of thinking and solving problems, and creating a shared vision and sense of purpose among employees (22,23). Transformational leadership has been shown to have a positive association with practitioners’ attitudes toward EBPs during implementation, and it has been linked to feedback-seeking behavior and use of supervision (12,19,2428).
LMX theory focuses on the dyadic relationships between leaders and followers, and on how social exchanges create and sustain the quality of such relationships (29). Low- LMX relationships are based on economic exchange and characterized by formal agreements and tit-for-tat mentality (30,31), whereas high-LMX relationships are more social in nature and characterized by reciprocity, support, and commitment (3234). Research on LMX and implementation of EBPs is limited, with the exception of a study by Aarons and Sommerfeld (35) that found no significant association between LMX and attitudes toward EBPs. However, outside of the context of EBP implementation, research has consistently demonstrated a correlation between LMX and staff perceptions about supervision, reception to general feedback, and feedback-seeking behavior (20,3640).
Researchers have called for more integrated studies of transformational leadership and LMX on the basis of evidence that the two leadership dimensions complement and influence each other (4145). For example, Wang et al. (45) suggest that transformational leaders nurture higher-quality LMX because their charismatic appeal makes employees more receptive to interaction. Conversely, supervisor-employee interaction (i.e., LMX) may be necessary for the impact of transformational leadership to fully emerge (42,43,46). Moreover, transformational leadership may be ‘personalized’ through the individual exchanges that build LMX (45,47).
This study examined both transformational leadership and LMX as they relate to each other and to practitioners’ attitudes toward feedback (48,49). We examined how transformational leadership and LMX may work together or independently to influence practitioners’ attitudes toward feedback to support EBP delivery. Despite growing evidence of the importance of feedback for EBP implementation, there has been relatively little focus on practitioner attitudes toward feedback in mental health settings. This study provides a starting point for understanding leadership-related mechanisms that may influence practitioner attitudes toward feedback and subsequent adoption and use of EBPs (18). We conducted a multilevel path analysis using survey data from 363 mental health practitioners to examine how transformational leadership and LMX relate to one another and to practitioners’ attitudes toward feedback that supports EBP delivery.
Extending from the literature discussed earlier, the study hypotheses were as follows: transformational leadership will be positively associated with mental health practitioners’ attitudes toward feedback (hypothesis 1), LMX will be positively associated with mental health practitioners’ attitudes toward feedback (hypothesis 2), and transformational leadership will be indirectly associated with mental health practitioners’ attitudes toward feedback through LMX (hypothesis 3).
Study findings have the potential to inform leadership interventions aimed at increasing staff openness to feedback, feedback-seeking behavior, and incorporation of feedback into day-to-day service delivery. In turn, openness fostered through effective leadership may enhance clinical practice, improve EBP implementation and sustainment, and ultimately increase the quality of care provided to clients.

Methods

Participants

This study was part of a larger research project focusing on organizational issues and improving public-sector mental health care for children, adolescents, and their families through implementation of EBPs. Participants were recruited from a roster of all public-sector mental health clinics in San Diego County that received county funding for services. Eligibility criteria included provision of behavioral health services to children, adolescents, families, or some combination and at least one identified team leader or supervisor. The study focused on teams, rather than organizations, because community-based mental health service delivery is often centered on treatment teams or clinics. Teams were defined as groups of practitioners who share the same primary work supervisor and regularly interact with each other to accomplish work objectives. On the basis of administrative data, we identified 99 mental health treatment teams. One team was excluded for nonresponse despite repeated contact attempts, seven teams declined to participate, and 90 teams agreed to participate (91% team response rate). Twenty-three teams were subsequently excluded because they did not have a clearly identified supervisor. The final team sample consisted of 68 mental health teams (91% team response rate) across 18 organizations.
Of the 440 eligible staff members on those 68 teams, 435 agreed to participate (99% staff response rate). Administrative staff members (N=15) were excluded from the study, resulting in an initial sample size of 420 (11). Data from 57 participants were excluded because participants did not provide enough information to identify their work team, resulting in a final practitioner sample size of 363 (50). The mean±SD team size was 5.34±3.4 practitioners.

Procedure

Study approval from the appropriate institutional review boards and informed consent from practitioners were obtained before survey administration. Data were collected in 2007–2008. Trained research assistants administered the survey in paper format to participants in meetings at each program location. The survey took approximately 60 minutes to complete, and research assistants checked surveys for completeness. If participants did not finish during the allotted time, research assistants and participants agreed on a designated time (usually a week later) when the research assistant would return to collect completed surveys. Practitioners were not compensated for their participation in the survey, but light refreshments were provided during survey administration. Ethical principles as outlined in the Declaration of Helsinki were followed.

Measures

Transformational leadership.

The Multifactor Leadership Questionnaire (MLQ) form 5X was used to assess transformational leadership (51). The MLQ asks respondents to indicate the extent to which their supervisor engages in specific leadership behaviors. Consistent with past research (51,52), transformational leadership was represented by four domains: idealized influence, inspirational motivation, intellectual stimulation, and individualized consideration. For example, participants were asked whether their supervisor “expresses confidence that goals will be achieved.” Response options ranged from 0, not at all, to 4, to a very great extent, on a 5-point Likert scale. We computed mean transformational leadership subscale and overall scale scores, with higher scores indicating a higher level of transformational leadership. Previous research found high reliability for each domain (Cronbach’s α=0.91, 0.86, 0.94, and 0.93, respectively) (26). The overall Cronbach’s alpha reliability coefficient for transformational leadership in this study was 0.95.

LMX.

Scandura and Graen’s (53) seven-item measure of LMX was used. A sample item from the LMX scale is “How would you characterize your working relationship with your supervisor?” Responses were given on a 5-point Likert scale ranging from 0, extremely ineffective, to 4, extremely effective. We computed a mean LMX scale score from all items, with higher scores indicating higher quality of the leader-follower relationship. Previous studies using this measure reported Cronbach’s alphas of 0.92 and 0.94 (54,55). The Cronbach’s alpha reliability coefficient in this study was 0.92.

Feedback.

The feedback subscale of the Evidence-Based Practice Attitude Scale–50 (11) was used to assess practitioners’ attitudes toward feedback (the most recent version of the scale can be accessed at https://implementationscience.biomedcentral.com/articles/10.1186/s13012-017-0573-0) (56). The feedback subscale consists of three items asking about attitudes toward EBPs: “I enjoy getting feedback on my job performance,” “Getting feedback helps me to be a better therapist/case manager,” and “Getting supervision helps me to be a better therapist/case manager.” Participants rated the extent to which they agreed with each item, and response options ranged from 0, not at all, to 4, to a very great extent. We computed a mean feedback subscale score by using all items, with higher scores indicating a more positive attitude toward receiving feedback. Previous research indicated that these three items represent a single factor, with loadings ranging from 0.62 to 0.68 (11). The Cronbach’s alpha reliability coefficient in this study was 0.80.

Analysis

In preparation for data analysis, we examined all variable distributions for normality. Skew and kurtosis for study variables were assessed by dividing skew or kurtosis values by their respective standard error and evaluating the coefficient against a table of Z scores (57). The feedback variable was negatively skewed and was logarithmically transformed (57). However, because this transformation did not influence the findings, we retained the original variable for ease of interpretation.
On the basis of conceptual and empirical studies suggesting that transformational leadership operates at higher levels to influence the organizational context and practitioner-level outcomes, we treated transformational leadership as a team-level construct (21,58,59). Similar to past studies, supervisor transformational leadership style was measured as the average transformational leadership score given by practitioners who share the same supervisor within their respective work teams (24,43,50). In contrast, because LMX represents the quality of practitioners’ individual relationships with their supervisor (53), LMX was treated as an individual-level variable (43,54), as was practitioners’ attitudes toward receiving feedback. To ensure the data supported team-level aggregation of transformational leadership, we computed the intraclass correlation coefficient (ICC) and the average within-group correlation (60,61). The ICC suggested that variance between work teams in terms of transformational leadership was significantly different than zero (ICC=0.28, p<0.001, 95% confidence interval=0.18–0.41). The average within-group correlation for transformational leadership was 0.67, suggesting acceptable team agreement (60). Taken together, these statistics support treatment of transformational leadership as a team-level variable.
We also examined multicollinearity between transformational leadership and LMX. The correlation between team-level transformational leadership and the individual-level LMX variable was 0.48. In addition, the variance inflation factor (1.28) indicated that both leadership variables fell well within the acceptable range of less than 10, suggesting that the two variables represented two relatively distinct constructs and could be appropriately used together in the analysis (62).
Missing data patterns were explored prior to analysis. None of the variables had more than 5% missing values. Full information maximum likelihood estimation, which uses all available data to generate parameter estimates, was used to handle missing data.
To examine the study hypotheses, we conducted a multilevel path analysis by using Mplus, version 7 (63). Model fit was evaluated by using the chi-square statistic, comparative fit index (CFI), Tucker-Lewis index (TLI), and the root mean square error of approximation (RMSEA; 6466). Practitioner level of education, job position, and job tenure were included in the model as control variables. The Sobel test for significant mediation was used to further examine the mediation effects (67,68).

Results

Table 1 presents descriptive statistics for the sample and mean±SD scores for the central study variables. Figure 1 shows the standardized direct associations for the multilevel path analysis, and Table 2 shows estimates for the direct and indirect effects of LMX and transformational leadership on attitudes toward feedback. Overall, model fit statistics indicated good model fit (χ2=8.09, df=7, p=0.32; CFI=0.99; TLI=0.98; and RMSEA=0.02). Results showed that transformational leadership (β=0.09, SE=0.03, p<0.01) and LMX (β=0.15, SE=0.04, p<0.01) were directly and significantly associated with practitioner attitudes toward feedback. Both higher levels of transformational leadership and supervisor-practitioner relationships of higher quality were related to more positive practitioner attitudes toward feedback, supporting hypotheses 1 and 2. In addition, the results indicated an indirect relationship between transformational leadership and practitioner attitudes toward feedback through LMX (β=0.07, SE=0.02, p<0.01), a finding that was further supported by the significant Sobel test (p<0.01). Higher levels of transformational leadership were associated with more positive practitioner attitudes toward feedback through higher quality supervisor-practitioner relationships, supporting hypothesis 3. None of the control variables had statistically significant associations.
TABLE 1. Characteristics of 363 practitioners at public-sector mental health organizations
VariableN%RangeMissing (%)
Race-ethnicity   1
 African American278  
 Asian164  
 Hispanic or Latino8524  
 Native American1<1  
 Caucasian18852  
 Other4312  
Gender   1
 Female29381  
 Male6819  
Position in organization   2
 Student intern278  
 Registered intern15744  
 Licensed provider8624  
 Unlicensed provider5917  
 Other278  
Education   1
 Some high school1<1  
 High school graduate21  
 Some college93  
 Associate degree72  
 Bachelor’s degree4914  
 Some graduate education236  
 Master’s degree24067  
 Ph.D. or M.D.236  
 Other72  
 MSDRangeMissing (%)
Age35.6410.4421–665
Job tenure (years)2.423.760–291
Transformational leadershipa2.41.860–43
Leader-member exchangeb2.59.920–43
Attitudes toward feedbackc3.16.740–42
a
Scores range from 0 to 4, with higher scores indicating a higher level of transformational leadership by one’s supervisor.
b
Scores range from 0 to 4, with higher scores indicating higher quality of the leader-follower relationship.
c
Scores range from 0 to 4, with higher scores indicating a more positive attitude toward receiving feedback.
FIGURE 1. Multilevel path model of direct relationships between transformational leadership, leader-member exchange, and providers’ attitudes toward feedback from a supervisora
aStandardized direct effects are shown (N=363).
*p<0.01, **p<0.001
TABLE 2. Estimates of direct and indirect effects on attitudes toward feedback, by predictora
 DirectIndirect
PredictorβSEΒSE
Leader‒member exchange.15*.04  
Transformational leadership.09*.03.07*.02
a
Direct and indirect effects are standardized.
*
p<0.01
We conducted post hoc multilevel path analyses to determine whether any of the individual dimensions of the transformational leadership scale were driving the results. These models produced the same pattern of significant results as the model with the full transformational leadership scale (i.e., each transformational leadership dimension had a significant direct relationship with attitudes toward feedback, as well as a significant indirect relationship with attitudes toward feedback through LMX), suggesting that no single dimension was driving the findings.

Discussion

Leadership is increasingly becoming a focal point for research on effective implementation of EBPs (12,21,35,69,70). Transformational leadership has been linked to EBP adoption, implementation climate, practitioner attitudes toward EBPs, fidelity, and sustainment (10,28,50,71,72). This study extends research on transformational leadership by demonstrating its effects on practitioner attitudes toward feedback. LMX is less frequently studied in implementation research but played an important role in this study, suggesting that researchers should consider its contribution to the implementation process.
This study also contributes to work investigating how various forms of leadership operate independently and together to affect desired organizational goals (41,44,45,73). Our study explored the relationship between transformational leadership and LMX and showed how they may function simultaneously in an organization to influence how practitioners experience supervision and feedback. The finding that transformational leadership affects outcomes through LMX is in line with other results suggesting similar mechanisms of action (34,45).
Because ongoing supervisory monitoring and feedback are critical for implementation of EBPs and high-quality clinical practice, fostering an environment that encourages openness to feedback is essential (3,10). Our results suggest that supervisors with a strong transformational leadership style can inspire and motivate practitioners to be open to feedback and that a high-quality supervisor-practitioner relationship provides a channel through which transformational leadership has its influence. Supervisors can build trust with practitioners by alleviating their concerns about seeking and receiving feedback and reassuring them that the benefits of feedback (e.g., developing new skills and improving care) outweigh the costs (e.g., admitting mistakes) (74).
This study focused on practitioners’ perceptions, but other research has suggested that leader-practitioner agreement on ratings of leadership behaviors is important to consider as well. For example, greater discrepancies between leader and practitioner perceptions of leadership behavior are associated with more negative organizational cultures (75). Moreover, when leaders rate their own implementation leadership lower than do practitioners (i.e., “humble leadership”), organizational climate supporting EBP implementation is better (76). These results illustrate the complexity of leader-practitioner dynamics and the need to develop and test nuanced approaches to leadership for promoting EBP implementation (21).
Given evidence of the critical role leadership plays in developing a workforce that can respond to demands for implementation, administrators and policymakers should invest in evidence-based leadership training interventions. Research suggests that supervisors can be taught transformational leadership skills and coached to develop stronger bonds with their employees (53,77,78). Similar to the process of training practitioners during EBP implementation, effective leadership training requires personalized training and coaching for leaders across multiple organizational levels (21). The Leadership and Organizational Change for Implementation (LOCI) strategy is being tested in multiple service settings to evaluate its impact on outcomes such as organizational climate for EBPs, attitudes toward EBPs, and EBP fidelity (21). As in LOCI, leadership interventions should be multifaceted and support leaders in strategies to articulate vision, motivate practitioners, and develop stronger relationships with practitioners as well as lead implementation of EBPs (79). Experiential team-building workshops may also facilitate the development of higher quality supervisor-practitioner relationships (80).
Some limitations should be considered when interpreting our results. First, we assessed practitioners’ attitudes toward feedback rather than their actual feedback-seeking behavior or their incorporation of feedback into practice. Although it is reasonable to expect that attitudes about feedback influence whether one seeks or uses feedback, care should be taken when drawing conclusions about the findings. Second, the cross-sectional design inhibits our ability to draw causal inferences. It is possible that practitioners who are more open to feedback tend to view their supervisors more favorably, and more research is needed to investigate the directionality of relationships between variables. Third, although the relationships between leadership and practitioners’ attitudes toward feedback were robust, the modest parameter estimates suggest a need to explore additional predictors of practitioner attitudes toward feedback in future studies. These predictors may include practitioner-level variables (e.g., emotional intelligence or goal orientation), team- or organizational-level variables (e.g., organizational culture and climate), and the fit between the practitioner and job demands and abilities (19,20). Fourth, data were collected exclusively from staff members, potentially introducing common method bias (81). Finally, the generalizability of the study’s findings to other mental health treatment settings may be limited given that many participants were in the early career role of working toward licensure (i.e., student interns or registered interns). The results may also have limited generalizability to organizations and practitioners with different client populations, geographic locations, and leadership structures. In addition, the age of the study data warrants caution when generalizing to current settings. Future research with prospective designs, more objective measures, and different sample compositions can address some of these limitations.

Conclusions

This study contributes to evidence indicating that leadership plays a key role in shaping the organizational context of mental health service organizations. Future research should focus on developing and testing effective methods for translating research findings regarding leadership into usable interventions and strategies for mental health treatment organizations (21). To improve practitioner attitudes toward feedback that supports the implementation of EBPs, leadership interventions should train supervisors in both transformational leadership and the cultivation of high-quality relationships with staff.

Acknowledgments

The authors thank the community-based organizations and clinicians for their participation in this study.

References

1.
Aarons GA, Hurlburt M, Horwitz SM: Advancing a conceptual model of evidence-based practice implementation in public service sectors. Adm Policy Ment Health 2011; 38:4–23
2.
Douglas S, Button S, Casey SE: Implementing for sustainability: promoting use of a measurement feedback system for innovation and quality improvement. Adm Policy Ment Health 2016; 43:286–291
3.
Fixsen DL, Naoom SF, Blase KA, et al: Implementation Research: A Synthesis of the Literature. Tampa, FL, University of Florida, Louis de la Parte Florida Mental Health Institute, National Implementation Research Network, 2005
4.
Forman-Hoffman VL, Middleton JC, McKeeman JL, et al: Quality improvement, implementation, and dissemination strategies to improve mental health care for children and adolescents: a systematic review. Implement Sci 2017; 12:93–105
5.
Herschell AD, Kolko DJ, Baumann BL, et al: The role of therapist training in the implementation of psychosocial treatments: a review and critique with recommendations. Clin Psychol Rev 2010; 30:448–466
6.
Bearman SK, Schneiderman RL, Zoloth E: Building an evidence base for effective supervision practices: an analogue experiment of supervision to increase EBT fidelity. Adm Policy Ment Health 2017; 44:293–307
7.
Gioia D, Dziadosz G: Adoption of evidence-based practices in community mental health: a mixed-method study of practitioner experience. Community Ment Health J 2008; 44:347–357
8.
Hurlburt M, Aarons GA, Fettes D, et al: Interagency collaborative team model for capacity building to scale-up evidence-based practice. Child Youth Serv Rev 2014; 39:160–168
9.
Nelson TD, Steele RG, Mize JA: Practitioner attitudes toward evidence-based practice: themes and challenges. Adm Policy Ment Health 2006; 33:398–409
10.
Torrey WC, Bond GR, McHugo GJ, et al: Evidence-based practice implementation in community mental health settings: the relative importance of key domains of implementation activity. Adm Policy Ment Health 2012; 39:353–364
11.
Aarons GA, Cafri G, Lugo L, et al: Expanding the domains of attitudes towards evidence-based practice: the Evidence Based Practice Attitude Scale–50. Adm Policy Ment Health 2012; 39:331–340
12.
Aarons GA: Transformational and transactional leadership: association with attitudes toward evidence-based practice. Psychiatr Serv 2006; 57:1162–1169
13.
Weiss KB, Wagner R: Performance measurement through audit, feedback, and profiling as tools for improving clinical care. Chest 2000; 118(suppl):53S–58S
14.
Aarons GA, Green AE, Palinkas LA, et al: Dynamic adaptation process to implement an evidence-based child maltreatment intervention. Implement Sci 2012; 7:32–40
15.
Hysong SJ, Kell HJ, Petersen LA, et al: Theory-based and evidence-based design of audit and feedback programmes: examples from two clinical intervention studies. BMJ Qual Saf 2017; 26:323–334
16.
Nadeem E, Gleacher A, Beidas RS: Consultation as an implementation strategy for evidence-based practices across multiple contexts: unpacking the black box. Adm Policy Ment Health 2013; 40:439–450
17.
Ivers N, Jamtvedt G, Flottorp S, et al: Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev 2012; 6:CD000259
18.
Ivers NM, Sales A, Colquhoun H, et al: No more “business as usual” with audit and feedback interventions: towards an agenda for a reinvigorated intervention. Implement Sci 2014; 9:14–21
19.
Anseel F, Beatty AS, Shen W, et al: How are we doing after 30 years? A meta-analytic review of the antecedents and outcomes of feedback-seeking behavior. J Manage 2015; 41:318–348
20.
Ashford SJ, De Stobbeleir K, Nujella M: To seek or not to seek: is that the only question? Recent developments in feedback-seeking literature. Annu Rev Organ Psychol Organ Behav 2016; 3:213–239
21.
Aarons GA, Ehrhart MG, Moullin JC, et al: Testing the leadership and organizational change for implementation (LOCI) intervention in substance abuse treatment: a cluster randomized trial study protocol. Implement Sci 2017; 12:29–40
22.
Bass BM, Avolio B: MLQ: Multifactor Leadership Questionnaire. Binghamton, NY, Binghamton University, Center for Leadership Studies, 1995
23.
Bass BM, Avolio BJ, Jung DI, et al: Predicting unit performance by assessing transformational and transactional leadership. J Appl Psychol 2003; 88:207–218
24.
Aarons GA, Sommerfeld DH, Willging CE: The soft underbelly of system change: The role of leadership and organizational climate in turnover during statewide behavioral health reform. Psychol Serv 2011; 8:269–281
25.
Levy PE, Cober RT, Miller T: The effect of transformational and transactional leadership perceptions on feedback‐seeking intentions. J Appl Soc Psychol 2002; 32:1703–1720
26.
Runhaar P, Sanders K, Yang H: Stimulating teachers’ reflection and feedback asking: an interplay of self-efficacy, learning goal orientation, and transformational leadership. Teach Educ 2010; 26:1154–1161
27.
Madzar S: Subordinates’ information inquiry: exploring the effect of perceived leadership style and individual differences. J Occup Organ Psychol 2001; 74:221–232
28.
Aarons GA, Farahnak LR, Ehrhart MG: Leadership and strategic organizational climate to support evidence-based practice implementation; in Dissemination and Implementation of Evidence-Based Practices in Child and Adolescent Mental Health. Edited by Beidas RS, Kendall PC. New York, Oxford University Press, 2014
29.
Graen GB, Uhl-Bien M: Relationship-based approach to leadership: development of leader-member exchange (LMX) theory of leadership over 25 years: applying a multi-level multi-domain perspective. Leadership Q 1995; 6:219–247
30.
Blau PM: Exchange and Power in Social Life. New York, Wiley, 1964
31.
Wayne SJ, Shore LM, Liden RC: Perceived organizational support and leader-member exchange: a social exchange perspective. Acad Manage J 1997; 40:82–111
32.
Liden RC, Sparrowe RT, Wayne SJ: Leader-member exchange theory: the past and potential for the future. Res Pers Hum Resour Manage 1997; 15:47–119
33.
Uhl-Bien M, Maslyn JM: Reciprocity in manager-subordinate relationships: components, configurations, and outcomes. J Manage 2003; 29:511–532
34.
Dulebohn JH, Bommer WH, Liden RC, et al: A meta-analysis of antecedents and consequences of leader-member exchange integrating the past with an eye toward the future. J Manage 2012; 38:1715–1759
35.
Aarons GA, Sommerfeld DH: Leadership, innovation climate, and attitudes toward evidence-based practice during a statewide implementation. J Am Acad Child Adolesc Psychiatry 2012; 51:423–431
36.
Moss SE, Sanchez JI, Brumbaugh AM, et al: The mediating role of feedback avoidance behavior in the LMX-performance relationship. Group Organ Manage 2009; 34:645–664
37.
Erdogan B, Bauer TN: Leader-member exchange (LMX) theory: the relational approach to leadership; in The Oxford Handbook of Leadership and Organizations. Edited by Day D. New York, Oxford University Press, 2014
38.
Sparr JL, Sonnentag S: Fairness perceptions of supervisor feedback, LMX, and employee well-being at work. Eur J Work Organ Psychol 2008; 17:198–225
39.
Eichhorn KC: A model of feedback-seeking based on the leader–member exchange and communication antecedents. Int J Leadership Stud 2009; 4:184–201
40.
Kudisch JD, Fortunato VJ, Smith AF: Contextual and individual difference factors predicting individuals’ desire to provide upward feedback. Group Organ Manage 2006; 31:503–529
41.
Avolio BJ, Sosik JJ, Jung DI, et al: Leadership models, methods, and applications; in Handbook of Psychology, vol. 12. Industrial and Organizational Psychology. Edited by Weiner IB, Borman WC, Ilgen DR, et al. Hoboken, NJ, Wiley, 2003
42.
Boer D, Deinert A, Homan AC, et al: Revisiting the mediating role of leader‒member exchange in transformational leadership: the differential impact model. Eur J Work Organ Psychol 2016; 6:883–899
43.
Carter MZ, Armenakis AA, Hubert SF, et al: Transformational leadership, relationship quality, and employee performance during continuous incremental organizational change. J Organ Behav 2013; 34:942–958
44.
Gerstner CR, Day DV: Meta-analytic review of leader–member exchange theory: correlates and construct issues. J Appl Psychol 1997; 82:827–844
45.
Wang H, Law KS, Hackett RD, et al: Leader-member exchange as a mediator of the relationship between transformational leadership and followers’ performance and organizational citizenship behavior. Acad Manage J 2005; 48:420–432
46.
Dvir T, Eden D, Avolio BJ, et al: Impact of transformational leadership on follower development and performance: a field experiment. Acad Manage J 2002; 45:735–744
47.
Dasborough MT, Ashkanasy NM: Emotion and attribution of intentionality in leader–member relationships. Leadership Q 2002; 13:615–634
48.
Hernandez M, Eberly MB, Avolio BJ, et al: The loci and mechanisms of leadership: exploring a more comprehensive view of leadership theory. Leadership Q 2011; 22:1165–1185
49.
Bass BM: Two decades of research and development in transformational leadership. Eur J Work Organ Psychol 1999; 8:9–32
50.
Brimhall KC, Fenwick K, Farahnak LR, et al: Leadership, organizational climate, and perceived burden of evidence-based practice in mental health services. Adm Policy Ment Health 2016; 43:629–639
51.
Bass BM, Avolio BJ: Full Range Leadership Development: Manual for the Multifactor Leadership Questionnaire. Palo Alto, CA, Mind Garden, 1997
52.
Kearney E, Gebert D: Managing diversity and enhancing team outcomes: the promise of transformational leadership. J Appl Psychol 2009; 94:77–89
53.
Scandura TA, Graen GB: Moderating effects of initial leader–member exchange status on the effects of a leadership intervention. J Appl Psychol 1984; 69:428–436
54.
Brimhall KC, Lizano EL, Mor Barak ME: The mediating role of inclusion: a longitudinal study of the effects of leader–member exchange and diversity climate on job satisfaction and intention to leave among child welfare workers. Child Youth Serv Rev 2014; 40:79–88
55.
Nishii LH, Mayer DM: Do inclusive leaders help to reduce turnover in diverse groups? The moderating role of leader-member exchange in the diversity to turnover relationship. J Appl Psychol 2009; 94:1412–1426
56.
Rye M, Torres EM, Friborg O, et al: The Evidence-Based Practice Attitude Scale-36 (EBPAS-36): a brief and pragmatic measure of attitudes to evidence-based practice validated in US and Norwegian samples. Implement Sci 2017; 12:44–54
57.
Tabachnick BG, Fidell LS: Using Multivariate Statistics, 6th ed. Boston, Pearson, 2013
58.
Boehm SA, Dwertmann DJG, Bruch H, et al: The missing link? Investigating organizational identity strength and transformational leadership climate as mechanisms that connect CEO charisma with firm performance. Leadership Q 2015; 26:156–171
59.
Klein KJ, Kozlowski SW: Multilevel Theory, Research, and Methods in Organizations: Foundations, Extensions, and New Directions. San Francisco, Jossey-Bass, 2000
60.
Brown RD: Interrater agreement reconsidered: the role of maximum possible variance. Presented at the 15th Annual Conference of the Society for Industrial and Organizational Psychology, New Orleans, April 13–16, 2000
61.
Shrout PE, Fleiss JL: Intraclass correlations: uses in assessing rater reliability. Psychol Bull 1979; 86:420–428
62.
O’Brien RM: A caution regarding rules of thumb for variance inflation factors. Qual Quant 2007; 41:673–690
63.
Muthén BO, Muthén LK: Mplus Version 7: User’s Guide. Los Angeles, Muthén & Muthén, 2012
64.
Hayduk L, Cummings G, Boadu K, et al: Testing! Testing! One, two, three—testing the theory in structural equation models! Pers Indiv Differ 2007; 42:841–850
65.
Hu LT, Bentler PM: Fit indices in covariance structure modeling: sensitivity to underparameterized model misspecification. Psychol Method 1998; 3:424–453
66.
Hu LT, Bentler PM: Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equation Model 1999; 6:1–55
67.
Sobel ME: Asymptotic confidence intervals for indirect effects in structural equation models. Sociol Methodology 1982; 13:290–312
68.
Soper DS: Sobel Test Calculator for the Significance of Mediation, 2014. https://www.danielsoper.com/statcalc/calculator.aspx?id=31
69.
D’Aunno T: The role of organization and management in substance abuse treatment: review and roadmap. J Subst Abuse Treatment 2006; 31:221–233
70.
Simpson DD, Flynn PM: Moving innovations into treatment: a stage-based approach to program change. J Subst Abuse Treatment 2007; 33:111–120
71.
Ehrhart MG, Torres EM, Green AE, et al: Leading for the long haul: a mixed-method evaluation of the Sustainment Leadership Scale (SLS). Implement Sci 2018; 13:17–88
72.
Wisdom JP, Chor KHB, Hoagwood KE, et al: Innovation adoption: a review of theories and constructs. Adm Policy Ment Health 2014; 41:480–502
73.
Avolio BJ, Gardner WL, Walumbwa FO, et al: Unlocking the mask: a look at the process by which authentic leaders impact follower attitudes and behaviors. Leadership Q 2004; 15:801–823
74.
Auh S, Menguc B, Imer P, et al: Frontline employee feedback-seeking behavior: how is it formed and when does it matter? J Serv Res (Epub ahead of print, June 12, 2018)
75.
Aarons GA, Ehrhart MG, Farahnak LR, et al: Discrepancies in leader and follower ratings of transformational leadership: relationship with organizational culture in mental health. Adm Policy Ment Health 2017; 44:480–491
76.
Aarons GA, Ehrhart MG, Torres EM, et al: The humble leader: association of discrepancies in leader and follower ratings of implementation leadership with organizational climate in mental health. Psychiat Serv 2017; 68:115–122
77.
Arthur CA, Hardy L: Transformational leadership: a quasi-experiment study. Leadership Organ Dev J 2014; 35:38–53
78.
Barling J, Weber T, Kelloway EK: Effects of transformational leadership training on attitudinal and financial outcomes: a field experiment. J Appl Psychol 1996; 81:827–832
79.
Richter A, von Thiele Schwarz U, Lornudd C, et al: iLead—a transformational leadership intervention to train healthcare managers’ implementation leadership. Implement Sci 2016; 11:108–124
80.
Graen GB, Hui C, Taylor EA: Experience-based learning about LMX leadership and fairness in project teams: a dyadic directional approach. Acad Manage Learn Educ 2006; 5:448–460
81.
Podsakoff PM, MacKenzie SB, Podsakoff NP: Sources of method bias in social science research and recommendations on how to control it. Annu Rev Psychol 2012; 63:539–569

Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services

Cover: Cover image © Africa Studio.

Psychiatric Services
Pages: 11 - 18
PubMed: 30373496

History

Received: 2 April 2018
Revision received: 5 August 2018
Accepted: 30 August 2018
Published online: 30 October 2018
Published in print: January 01, 2019

Keywords

  1. Leadership
  2. evidence-based practice
  3. attitudes, implementation
  4. quality improvement

Authors

Details

Karissa M. Fenwick, M.S.W., L.C.S.W.
Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Fenwick, Hurlburt); Child and Adolescent Services Research Center (Hurlburt, Aarons) and Department of Psychiatry (Aarons), University of California, San Diego; Department of Social Work, Binghamton University, State University of New York, Binghamton (Brimhall).
Kim C. Brimhall, M.S.W., C.S.W.
Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Fenwick, Hurlburt); Child and Adolescent Services Research Center (Hurlburt, Aarons) and Department of Psychiatry (Aarons), University of California, San Diego; Department of Social Work, Binghamton University, State University of New York, Binghamton (Brimhall).
Michael Hurlburt, Ph.D.
Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Fenwick, Hurlburt); Child and Adolescent Services Research Center (Hurlburt, Aarons) and Department of Psychiatry (Aarons), University of California, San Diego; Department of Social Work, Binghamton University, State University of New York, Binghamton (Brimhall).
Gregory Aarons, Ph.D. [email protected]
Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Fenwick, Hurlburt); Child and Adolescent Services Research Center (Hurlburt, Aarons) and Department of Psychiatry (Aarons), University of California, San Diego; Department of Social Work, Binghamton University, State University of New York, Binghamton (Brimhall).

Notes

Send correspondence to Dr. Aarons ([email protected]).
Previous versions of this work were presented at the annual meeting of the Academy of Management, Anaheim, California, August 5–9, 2016, and the annual meeting of the Society for Social Work and Research, New Orleans, January 11–15, 2017.

Competing Interests

The authors report no financial relationships with commercial interests.

Funding Information

National Institute of Mental Health10.13039/100000025: K01MH001695, R01MH072961, R01MH092950
This work was supported by National Institute of Mental Health grants R01MH072961, K01MH001695, and R01MH092950 and National Institute on Drug Abuse grant R01DA038466.

Metrics & Citations

Metrics

Citations

Export Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.

For more information or tips please see 'Downloading to a citation manager' in the Help menu.

Format
Citation style
Style
Copy to clipboard

View Options

View options

PDF/EPUB

View PDF/EPUB

Get Access

Login options

Already a subscriber? Access your subscription through your login credentials or your institution for full access to this article.

Personal login Institutional Login Open Athens login
Purchase Options

Purchase this article to access the full text.

PPV Articles - Psychiatric Services

PPV Articles - Psychiatric Services

Not a subscriber?

Subscribe Now / Learn More

PsychiatryOnline subscription options offer access to the DSM-5-TR® library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

Media

Figures

Other

Tables

Share

Share

Share article link

Share