Swart Rachelle R, Jacobs Maria J G, Van Merode Frits, Boersma Liesbeth J
Department of Radiation Oncology (Maastro), GROW Research Institute for Oncology and Reproduction, Maastricht University Medical Centre+, Maasstricht, the Netherlands.
Tilburg School of Economics and Management, Tilburg University, Tilburg, the Netherlands.
J Healthc Leadersh. 2025 Jul 5;17:297-314. doi: 10.2147/JHL.S516923. eCollection 2025.
Healthcare organizations face challenges in balancing efficiency and innovation, known as ambidexterity. Leadership plays an important role, with transformational leadership driving innovation and transactional leadership supporting efficiency. The dominant leadership framework is the Full-Range Leadership Theory (FRLT), which identifies three leadership behaviors: transformational, transactional, and passive avoidant. Organizational structures, following Mintzberg, Pugh and Galbraith, including span of control (SoC), unit grouping, and lateral linkages, significantly influence leadership dynamics. This study examines the impact of structural changes on perceived leadership styles in a Dutch radiotherapy center (RTc) following the implementation of proton therapy, a radical innovation.
A mixed-method approach combined leadership surveys, with data collected at three time points, before and after structural changes in 2022. The multifactor leadership questionnaire (MLQ) was distributed among the employees in November 2021, March 2022, and March 2023. Three interventions were introduced: (1) appointing dedicated team leaders (TLs) to improve information flow and reduce management SoC; (2) integrating a Patient Care (PC) manager into the advisory board to facilitate direct communication within the governance structure, including other hierarchical layers; and (3) adding a proton therapy manager as a liaison to improve coordination. Leadership perceptions were measured using the Multifactor Leadership Questionnaire (MLQ) at three time points (T1, T2, T3). The Independent-Samples Mann-Whitney -Test (p<0.05), was used to compare T1, T2, and T3, managers' self-ratings with employee ratings, and scores between photon and proton treatment employees.
Transformational leadership significantly increased across all groups, with PC scores rising from 2.3 at T1/T2 to 2.5 at T3, and MT-PC scores from 1.8 at T1 to 2.4 at T3. Passive avoidant leadership significantly decreased (eg, MT-PC: 1.6 at T1 to 1.0 at T3). Transactional leadership showed less pronounced and non-significant changes. Photon therapy staff experienced earlier improvements in leadership perceptions, while proton therapy staff showed delayed but stronger shifts by T3.
In this study, structural changes positively influenced leadership perceptions, supporting ambidexterity. Significant increases in transformational leadership and decreases in passive avoidant leadership align leadership styles with the dual demands of innovation and operational efficiency, demonstrating the importance of organizational design in healthcare leadership. Our findings show that healthcare management could use organizational structure changes to promote transformational leadership.
医疗保健组织在平衡效率和创新（即所谓的双元性）方面面临挑战。领导力起着重要作用，变革型领导力推动创新，交易型领导力支持效率。主导的领导力框架是全范围领导力理论（FRLT），它确定了三种领导行为：变革型、交易型和被动回避型。遵循明茨伯格、普格和加尔布雷斯的组织结构，包括控制跨度（SoC）、单位分组和横向联系，会显著影响领导动态。本研究考察了荷兰一家放疗中心（RTc）在实施质子治疗（一项重大创新）后结构变化对感知领导风格的影响。
采用混合方法，结合领导力调查，在2022年结构变化前后的三个时间点收集数据。多因素领导力问卷（MLQ）于2021年11月、2022年3月和2023年3月分发给员工。引入了三项干预措施：（1）任命专职团队领导（TL）以改善信息流并减少管理SoC；（2）将患者护理（PC）经理纳入咨询委员会，以促进治理结构内包括其他层级的直接沟通；（3）增加一名质子治疗经理作为联络人以改善协调。在三个时间点（T1、T2、T3）使用多因素领导力问卷（MLQ）测量领导认知。使用独立样本曼-惠特尼检验（p<0.05）比较T1、T2和T3、经理自评与员工评分以及光子治疗和质子治疗员工之间的得分。
所有组的变革型领导力均显著增加，PC得分从T1/T2时的2.3升至T3时的2.5，MT-PC得分从T1时的1.8升至T3时的2.4。被动回避型领导力显著下降（例如，MT-PC：从T1时的1.6降至T3时的1.0）。交易型领导力变化不太明显且无统计学意义。光子治疗人员在领导认知方面较早出现改善，而质子治疗人员在T3时虽出现延迟但变化更强。
在本研究中，结构变化对领导认知产生了积极影响，支持了双元性。变革型领导力显著增加，被动回避型领导力下降，使领导风格与创新和运营效率这双重需求保持一致，证明了组织设计在医疗保健领导力中的重要性。我们的研究结果表明，医疗保健管理可以利用组织结构变化来促进变革型领导力。
