The Influence of Leadership and Extreme Contexts on Physical and Psychological Outcomes

Abstract

The need to consider context in organizational and leadership research has been highlighted by many scholars (e.g., Johns, 2006; Rousseau & Fried, 2001), and in today’s increasingly volatile world, the need to understand leadership in extreme environments has never been greater. This dissertation investigates the impacts of leadership in extreme contexts (i.e. where there exists “risks of severe physical, psychological or material consequences […] to organizational members or their constituents” Hannah, Uhl-Bien, Avolio, & Cavarretta, 2009, p. 897), using two studies in the extreme context of healthcare. Study 1 used growth-curve models to examine the changes in psychological outcomes (i.e. empathy, self-efficacy, daytime sleepiness) of medical and nursing students during their first eight-months of practical experience. Predictors of changes were also studied, including leadership behaviours (i.e. transformational leadership, laissez-faire leadership, abusive supervision), and context-relevant experiences (e.g., patient morbidity and mortality, beneficiary contact, boredom). Findings show that both leadership and context-relevant experiences influence the development of empathy, self-efficacy, and daytime sleepiness. Study 2 investigated the impact of leadership (i.e. transformational leadership, laissez-faire leadership, over-controlling leadership) in the operating room on proximal and distal surgical outcomes (i.e. proximal: errors, blood loss; distal: complications during recovery at the hospital, complications post-discharge). Leadership effects were hypothesized to occur through the mediators of psychological safety and boredom, but no support was found for any mediating effects. However, certain direct relationships between leadership and surgical outcomes were moderated by surgical complexity. Leadership predicted proximal and distal surgical outcomes, but the strength of the relationship depends on the complexity of the surgery. Results of both studies are presented, and the findings, avenues of future research, and practical implications are discussed. The dissertation concludes with a general discussion of the studies and areas of future research.