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",isbn:"978-1-83968-681-8",printIsbn:"978-1-83968-680-1",pdfIsbn:"978-1-83968-682-5",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,hash:"ddc0dea7e5b98335c187688d9c0c5b42",bookSignature:"Dr. Urvashi Sharma",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/10298.jpg",keywords:"Internet of Things, Smart Biosensor and Hardware, Reliability, Patients Data, Context-Specific and Aware, Integrated and Connected, Funding Structures, Policy and Its Implications, Electronic Medical Records, Electronic Health Records, Design, Implementation and Evaluation",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"September 3rd 2020",dateEndSecondStepPublish:"October 1st 2020",dateEndThirdStepPublish:"November 30th 2020",dateEndFourthStepPublish:"February 18th 2021",dateEndFifthStepPublish:"April 19th 2021",remainingDaysToSecondStep:"4 months",secondStepPassed:!0,currentStepOfPublishingProcess:4,editedByType:null,kuFlag:!1,biosketch:"Dr. Sharma obtained her Ph.D. from Brunel University London, U.K. Her work has contributed to understanding the role of a user and the context in relation to the successful application of e-health modalities in primary care settings in the U.K.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"105398",title:"Dr.",name:"Urvashi",middleName:null,surname:"Sharma",slug:"urvashi-sharma",fullName:"Urvashi Sharma",profilePictureURL:"https://mts.intechopen.com/storage/users/105398/images/system/105398.jpg",biography:"Dr Urvashi Sharma started her research career as a biomedical engineer exploring barriers and facilitators to remote patient monitoring and use of electronic health records. Her work has contributed to understanding the role of a user and the context in relation to successful application of e-health modalities in primary care settings in the U.K. Through her work, she also explored whether employing randomised controlled trials to ascertain the effectiveness of technological interventions is viable. 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From chapter submission and review, to approval and revision, copyediting and design, until final publication, I work closely with authors and editors to ensure a simple and easy publishing process. I maintain constant and effective communication with authors, editors and reviewers, which allows for a level of personal support that enables contributors to fully commit and concentrate on the chapters they are writing, editing, or reviewing. I assist authors in the preparation of their full chapter submissions and track important deadlines and ensure they are met. I help to coordinate internal processes such as linguistic review, and monitor the technical aspects of the process. As an ASM I am also involved in the acquisition of editors. 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Venkateswarlu",coverURL:"https://cdn.intechopen.com/books/images_new/371.jpg",editedByType:"Edited by",editors:[{id:"58592",title:"Dr.",name:"Arun",surname:"Shanker",slug:"arun-shanker",fullName:"Arun Shanker"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"878",title:"Phytochemicals",subtitle:"A Global Perspective of Their Role in Nutrition and Health",isOpenForSubmission:!1,hash:"ec77671f63975ef2d16192897deb6835",slug:"phytochemicals-a-global-perspective-of-their-role-in-nutrition-and-health",bookSignature:"Venketeshwer Rao",coverURL:"https://cdn.intechopen.com/books/images_new/878.jpg",editedByType:"Edited by",editors:[{id:"82663",title:"Dr.",name:"Venketeshwer",surname:"Rao",slug:"venketeshwer-rao",fullName:"Venketeshwer Rao"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"4816",title:"Face Recognition",subtitle:null,isOpenForSubmission:!1,hash:"146063b5359146b7718ea86bad47c8eb",slug:"face_recognition",bookSignature:"Kresimir Delac and Mislav Grgic",coverURL:"https://cdn.intechopen.com/books/images_new/4816.jpg",editedByType:"Edited by",editors:[{id:"528",title:"Dr.",name:"Kresimir",surname:"Delac",slug:"kresimir-delac",fullName:"Kresimir Delac"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"59850",title:"Micro-Finance: A Driver for Entrepreneurship",doi:"10.5772/intechopen.75031",slug:"micro-finance-a-driver-for-entrepreneurship",body:'\nPakistan has started embracing women in all walks of life—business women, entrepreneurs, working women, and owners. Micro-finance institutions, women beneficiaries, and natural environment have been identified as few of the indicators of this study. The key informants were samples from a leading micro-finance institution—kashf Foundation customers, who were compared with non-Kashf Foundation customers in Pakistan. Two variables have been analyzed where handicrafts are taken as the independent variable while the socio-economic status of women is taken as the dependent variable. As women have become a source of income in a country like Pakistan, they have been given the power of decision making and their status in society has also increased. Schuler and Hashmi [1], in their study of the impact of micro-credit programs initiated by Grameen Bank and Bangladesh Rural Advancement Committee (BRAC) to empower women through various economic opportunities, measure the effectiveness of these programs by the increase in contraceptive use among poor rural women in Bangladesh. They define women empowerment in a specific socio-economic way as the increasing capacity of women to be physically mobile, have increased economic security, and reduce their vulnerability to household violence among others.
\nYounus [2] re-invented the concept of social business models and entrepreneurialism. The Grameen Bank model went on to become a benchmark for many studies conducted for poverty alleviation, social cause, and micro-finance service providers.
\nDubreuil and Mirada [3] advocated the relationship between micro-finance and women’s micro-entrepreneurship in developed countries. Micro-finance institutions have played an obvious role in empowering women by providing them the social credit to start up their own business. With a greater rate of loan repayment, women are found to be more involved in starting up their businesses with less capital resources. Lack of financial resources deprives females of a chance to earn their income and contribute to a country’s economy but in recent years, micro-loans have enabled women to become active members of the society socio-economically. Sirika [4] debates on the socio-economic status of artisan women in West Wallaga. She compares, in her research, the socio-economic status of artisans in the past and the current situation. Women in this region are producers of utensils and other products which people use in their day-to-day chores. Their role in sustainable development is of special concern. The economic status of handicrafts women is ranked high as compared to non-artisan women. There are many challenges for these women and once again their work needs promotion and guidance. Their skills need to be enhanced and they need proper training in marketing techniques, negotiating prices, etc. They should be provided a place in the market to display their work. Hence, non-government organizations (NGOs) and other organizations should focus on the empowerment of these women along with other matters of interest.
\nSinha [5] conducted her research to study the impact of motivation and social support on enterprise creation and women entrepreneurship. For the purpose, a sample of 400 men and women entrepreneurs of the northeast India was taken. The sample was selected using stratified random sampling. In her study, the author reports that industrialization is an important factor for developing human resources in any region. Women constituted half of the population of the country according to the 1991 census. Northeast India women were more involved in income-generating activities. They were running different trades in the area and they were dominant in many trading bazaars of Northeast India. According to her, one of the motivating factors for women to start an enterprise was independent economic status. More educated women took enterprise as a challenge, while women who were not highly qualified and educated started micro-enterprises to earn an income. For most of the women, home was the first preference, so it was also needed to make the family members understanding and accommodating. These women lacked proper financing for these micro-businesses and they bore high interest rates on loans they took for their work. They preferred to enter the handloom and handicrafts industry. Briefly, Sinha states that these women needed guidance and appreciation because they lacked many skills such as training, technology up-gradation, designing and new product development, packaging, and marketing. Different organizations working for entrepreneurship development should lead women in a defined direction using their spirits to excel in the industry. Despite all the aforementioned problems, women of this region have a very high potential to develop socio-economically.
\nPark and Changqing [6] established the Grameen Bank model in China to measure the effectiveness of reaching far-off clients in poverty-stricken areas. The model was created to gauge the performance of NGOs compared to formal financial institutions, but concluded that further innovations in methodology was required. Ahmed et al. [7] observed that reforms in foreign trade begin at the micro-level. By enhancing economic growth, the former can be achieved. Omoregie [8] describes each entrepreneurial activity as a challenge with abundant opportunities. He uses the buyer experience cycle and utility matrix, and the entrepreneurial process renewal, regeneration, and entrepreneuring model to close the gaps, enhance the opportunities, and build for a sustainable entrepreneurial environment. Rahman and Luo [9] critically evaluated the overall performance of three NGO-type micro-finance services in the Shaanxi province of China and compared them with the existing Grameen bank model. They concluded that more focus on outreach, credit performance, financial sustainability, and regulatory situation is required and awareness is to be generated for the selected micro-finance service providers to successfully govern the micro-finance lending. Samia [10] conducted an exploratory study to understand the entrepreneurial behavior among the women in the Pakistan and concluded that micro-finance lending helped more than half of the women with rural backgrounds to start a new business activity.
\nBarr [11] argued that micro-finance can help foster market innovations, noting that a sound credit history can play a vital role in channelizing these innovations. Jegatheesan et al. [12] embraced the idea of entrepreneurialism with micro-finance in Africa. They concluded that government strategies and acceptance of such activities is required for successful outcomes of such initiatives.
\nKrishnaraj [13] analyses rural women handicraft as a type of subsistence production. She argues that women’s work in bamboo craft production at household levels is affected by three factors: socio-economic contexts (caste and class), larger development and growth policies at state level and the way the household of these subsistence workers respond to these two larger contexts. Handicrafts are a source of women empowerment. In Pakistan, the handicrafts work is not as much appreciated due to which the women from underdeveloped areas remain in poverty and misery. It is one of the reasons why the arts and crafts in Pakistan are not well marketed. Lack of creative market strategies and negligence of government toward this sector also led to the negligence of this craft. When we look at the trend of handicrafts in far flung and under developed areas of Pakistan, we see that there are very hard-working women who make beautiful handicrafts but when the time comes to sale these products, there are no potential customers. They ultimately must sell those beautiful products to ignorant people who do not have any idea about the products’ actual cost, so they demand a very low price; handicrafts women must sell these products at the price offered to earn their living. However, the trend is different in the large cities of Pakistan where there are various foundations and organizations that not only support the females to start up their businesses, but also provide financial support to the minorities. Hence, a woman who has a little money to start up her business will take a certain loan amount from such micro-finance institutions or organizations and operate their work. In this way, they earn a considerable amount of income and are able to repay the amount of loan. They easily support their families. They send their children to schools and get the necessities of lives. This is how their presence is acknowledged in society and this is how their decision making power is also increased.
\nMaskiell [14] analyzes the impact of colonial policies and the intermixing of economic and cultural aspects of “Phulkari” among Punjabi women during the British Raj and how this has continued to make work feminine or masculine in the cultural imagination. She uses the term “gendered work” to explain her point.
\nThe introduction of products of modern technologies such as ceramics, plastic, and metallic utensils that are steadily replacing the utility of indigenous craft products in both urban and rural areas, is affecting the economic status of the artisans. Under these circumstances, artisans have lost and are still losing their traditional rural markets and their position within the community. This is chiefly true about artisan women. In the area, it is not the manufacturing industries that have been introduced but their products. If there manufacturing industries, they would have at least absorbed some of artisans. The consequences are many; first, the product is affecting progress of indigenous technology. Second, it is leading to widespread unemployment by destroying the labor-intensive crafts and reducing livelihood options; it is directly or indirectly intensifying environmental degradation. Besides, by affecting the progress of indigenous technology, this affects the positive interdependence between agriculture and craft sectors. Furthermore, enhanced machinery is hardly ever introduced in rural areas. Even when introduced, women are usually excluded from access to jobs in the new institutions by the associated criteria set for recruiting for employment. Another major challenge to the handicrafts women is that they cannot access the loans while living in far flung areas and they do not have any helping member who can help them to access the micro-finance institutions in large cities. They also cannot come to the big cities. Large NGOs and other micro-finance institutions should focus on such small groups of women from backward areas; they should guide and direct women in the proper right direction so that their work is brought to the commercial level and also displayed in large artisan exhibitions. In an article, attention was drawn toward the tendency among governmental agencies and most non-governmental organizations (NGOs) over the past two decades to apply a welfare model to women poverty alleviation projects [15]. Since the 1970s, various developing countries and donor agencies as well as NGOs have looked upon women as indirect participants of development of a nation and region. Thus, most projects for women have concentrated on their reproductive role rather than their productive role. Women work need assistance and guidance. The government should take some steps to improve the handicrafts sector in Punjab and in other far and backwards areas too. The potential of the female workers should be creatively utilized and used in the development of handicrafts.
\nWomen are disproportionately represented among the poor, and the number of women in poverty in the rural areas of developing countries is growing faster than the number of men. In 1988, an estimated 564 million rural women lived below the poverty line, representing an increase of 47% since 1965–1970. In comparison, the number of men living below the poverty line increased 30% over the same period. Factors contributing to the increase in rural poverty are economic recession, civil strife, and natural disasters. In addition, the rise in the number of households supported solely by women is an important variable explaining the increase in poverty among women. These households tend to be overrepresented among the poor. In both the urban and rural areas of developing countries, women are important contributors to the economic support of their households. In Africa, for example, it is estimated that 96 percent of rural women engage in farm work and 40% of small farms are managed by women. Because of this work, women contribute both cash and subsistence income to household support. Data from many countries show that the poorer the household, the more women work for income, and the larger the proportion of household income derived from women’s earnings. In some landless households in India, for instance, women are often the main or even the sole income earners in their households.
\nThe whole study revolves around the impact of handicrafts on the socio-economic status of women. A proposition has been developed since female entrepreneurs have a high status in society. Different elements have been considered keeping in view Punjab as the area of study.
\nThe research is intended to study the impact of one independent variable, which is handicrafts, over the other dependent variable, which is status of women. Both variables have their own dimensions.
\n\n
To conduct the research, 20 respondents were selected.
59 of the respondents were customers of the Kashf Foundation; the other 50 were handicraft working women from a backward area of Punjab near Mianwali.
An adopted questionnaire consisting of 11 questions formulated by the Kashf foundation was used to study the impact of handicrafts on the status of women. Therefore, purposeful sampling technique was used.
The null hypothesis was the following:
H0: handicrafts have significant impact on the socio-economic status of women in Punjab.
H₁: handicrafts do not have significant impact on the socio-economic status of women in Punjab.
A total of 109 questionnaires were circulated among the respondents. The data received from the respondents was analyzed. To test the hypothesis, Chi-square test was used to know whether the chi-square was accepted or rejected.
\nThe data obtained was analyzed using chi-square. The observed and expected values were calculated. Each question had two options, which were Yes and No. Hence, these options were assigned the values 2 and 1 (Yes = 2, No = 1). In this way, it was observed how many respondents opted Yes and how many opted No. Degree of freedom was calculated using the appropriate formula and .05 level of significance.
\nThe calculations for chi-square are as follows.
\nObserved values
\nResponse | \nKashf Foundation customers | \nNon-Kashf Foundation customers | \nTotal | \n
---|---|---|---|
Yes | \n152 | \n196 | \n348 | \n
No | \n34 | \n12 | \n46 | \n
Total | \n186 | \n208 | \n394 | \n
Expected values
\nResponse | \nKashf Foundation customers | \nNon-Kashf Foundation customers | \nTotal | \n
---|---|---|---|
Yes | \n164.284264 | \n183.715736 | \n348 | \n
No | \n21.71573604 | \n24.28426396 | \n46 | \n
Total | \n186 | \n208 | \n394 | \n
Chi-square
\nResponse | \nKashf Foundation customers | \nNon-Kashf Foundation customers | \nTotal | \n
---|---|---|---|
Yes | \n0.918548967 | \n0.82139475 | \n1.73994372 | \n
No | \n6.949022623 | \n6.214029846 | \n13.1630525 | \n
Total | \n7.867571591 | \n7.0354246 | \n14.903 | \n
The following formula has been used
\nwhere
\nO = observed value.
E = expected value.
\nDegree of freedom was calculated by
\nwhere r = no. of rows, c = no. of columns.
\nDecision rule states that we need to reject H0 if:
\nAt 5% level of significance, we have 90 degrees of freedom and chi-square is 114.27.
\nThe calculated value of chi-square is less than the critical value of chi-square, that is,
\nHence, we accept H0.
\nThe analysis at hand endorses the impact of handicrafts on the socio-economic status of women in Punjab. The results were calculated by applying chi-square on the data. The reason for opting for chi-square was because we have
quantitative data
two variables
adequate sample size
data in frequency form
From the supported material and findings of the results, it is therefore concluded that handicrafts women are producers of indoor and outdoor implements that rural communities are depending on. In addition, their works in the sector are sources of livelihood diversification that reduce pressure on land and hence, alleviate environmental degradation. These women need assistance to set up saving and credit cooperatives, making capital available for further investment. Groups’ saving, and credit cooperatives are helpful to link the local cooperative unit to mainstream financial institutions in the country. There is a need to teach people the fact that existence of their technology is wholly based on the available surrounding natural resources and devastation of the resource cycle lead to interruption of the craft works. Micro-finance institutions that give loans with minimum interest rate should be set up in rural areas. Even if there are many lacking facilities, the handicrafts women can still empower their socio-economic status via earnings from their work. It was also concluded that Kashf Foundation customers have a better socio-economic status than those of non-Kashf Foundation customers.
\nAge: Income Level:
Do you think handicrafts are a leading factor in poverty alleviation?
Yes
No
What according to your perception are the sources of your empowerment in your society?
Yes
No
Do you think micro-loans/credit can be a driver in expanding your business?
Yes
No
Who is the principal decision maker in your house hold?
Yes
No
Since you have been involved in handicrafts, are you involved in decision making?
Yes
No
Has the attitude of your household members changed since you started contributing to the income-generating activities?
Yes
No
Have you been benefitting out of your micro-enterprise activity?
Yes
No
Are you facing any kind of financial independence after you have been a part of micro-enterprise activity?
Yes
No
Has your ability in doing purchases without seeking approval increased?
Yes
No
Has your role in your reference community increased greatly?
Yes
No
Since you have been working, do you think your quality of your life has improved?
Yes
No
“Leadership is not only about individuals, but also about teams” [1].
Nowadays, leadership in health services is an important issue that aims to protect and improve human health. Rapid changes and developments in the health sector increase the importance of developing managership and leadership skills for health managers [2]. Regional and national health systems tend to redesign their functions and priorities by making structural changes in social and economic terms to cope with the increasing health problems [3]. The inclusion of complex technology and intense human relations in hospital services, which constitute a significant part of health care services, leads to the emergence of important managerial problems [4]. The existence of effective, creative, visionary, motivated, knowledgeable, principled leaders for the development of the institution is important to eliminate various problems in health services. To be able to do this, it is necessary to determine the qualifications that can contribute to the effective leadership of corporate managers [2, 5].
Leadership in health services is of great importance in terms of following innovations and adapting to existing situations [6]. Leadership can be defined as a multidimensional process, which means that a person motivates others to direct their activities and develop their skills under certain circumstances [3, 7]. The leader is the person who sets the goals of his group and who influences and directs the members of the group in line with these goals [8]. In addition, a good leader must be dynamic, passionate, have a motivational effect on other people, be solution oriented, and try to inspire others. Nurses, who work together with other health personnel in hospitals, constitute an important group in leadership. Nursing, which is a key force for patient safety and safe care, is a human-centered profession, and therefore leadership is a key skill for nurses at all levels. The leadership styles of nurse managers are believed to be an important determinant of job satisfaction and job commitment of nurses. Nurses who are mobilized and empowered to perform specific personal or group goals by a good leader nurse are willing to implement evidence-based practices and are highly motivated, well informed, and committed to organizational goals. Therefore, they perform patient care in a more effective and planned process. It has become imperative to examine the role of leadership styles of nurse managers on staff outcomes after miscarriage of health workforce, which is a global nursing problem, increasing health care costs and workload [9, 10].
There is a limited number of articles in the literature about the leadership styles of nurses. In these studies, the importance of leadership styles and practices on patient outcomes and patient safety, health service power and corporate culture were determined [3]. However, Cummings [10] stated that most styles can be grouped under relational leadership or task-focused leadership. Relational leadership styles focus on people and relationships. It includes transformational, emotional intelligence, resonance, and participatory leadership. These styles are positively associated with staff satisfaction, organizational commitment, improved staff health welfare, stress reduction, job satisfaction, productivity increase, effective study, and positive patient outcomes. However, task-focused leadership is focused on completion of works, deadlines, and directives. Task-focused leadership styles include operational, autocratic, and laissez-faire leadership [10].
Relational leadership styles focus on people and relationships and include transformational, emotional intelligence, resonance, and participatory leadership [11]. These leadership styles are associated with increased employee satisfaction, organizational commitment, improved staff health and well-being, stress reduction, job satisfaction, increased productivity, effective work, and positive patient outcomes [10].
Transformational leadership is considered the gold standard of leadership [11]. Transformational leadership is at the center of nursing because it has an impact on patient outcomes, employee satisfaction, and safety culture. Transformational nurse leaders first perform nursing, communicate effectively with their audiences, and become effective role models [12]. Such leaders are motivated and empowering, encouraging and following their audience for organizational goals and individual goals [13, 20]. In addition, it is explained how the transformational leaders have four characteristics that affect their audience. These characteristics are charisma, inspirational, intellectual thinking, and individual attention [42].
It is thought that the transformational leaders fascinate their audience with the charisma feature. This fascination is sometimes associated with the physical characteristics of the leader as well as communication skills and vision. The inspiring character of transformational leaders supports and motivates their followers with encouraging speeches in case of hard work and crises [14].
Transformational leaders, with their intellectual characteristics, encourage their followers to think innovatively and to think about how we can do it better. At the same time, these leaders do not prefer their followers to accept their thoughts as they are [14]. Finally, the transformational leaders, who are interested in their followers individually, advise them in line with their individual needs. In addition, leaders appreciate their followers within the team.
When considered with a general assessment, transformational leaders think that their followers should be evaluated individually and the needs and characteristics of the followers may change with the influence of the leader. Therefore, with the mentoring of the leader, the development of the followers increases at the same rate.
Resonance leadership is based on emotional intelligence and awareness, including being open and sensitive to judgment [15]. Resonance leaders have emotional intelligence features. These are self-awareness, self-management, social awareness, and relationship management [16]. According to these characteristics, resonance leaders are effective in managing and solving conflict, democratic, collaborative, and can find solutions to problems.
Emotional intelligence was first described as a feature of transformational and resonant leadership in the 1980s. Leaders with emotional intelligence have four important structures: self-awareness, self-management, social awareness, and social skills. Emotionally intelligent leaders are sensitive to the well-being, emotions, and emotional health of themselves and their followers, and develop effective personal relationships while directing followers to common business goals. Emotionally intelligent leaders manage and reflect their emotions, making rational decisions to ensure teamwork and collaboration. Emotionally intelligent leaders are also effective in conflict resolution because they have the ability to see the situation from others’ perspective and manage work stress [11].
In participatory leadership, the views of individuals and groups are taken into consideration. Knowledge, experience, skills, and innovation are of great importance in the decision-making process, with a wide range of expertise and participation in engagement. In 2016, WHO called for participatory leadership to replace hierarchical leadership models of health leadership, suggesting that inclusiveness and the involvement of various stakeholders would strengthen health services [17].
The task-focused leadership style involves planning business activities, clarifying roles within a team or a group of people, as well as a set of objectives, and continuous monitoring of processes and performance. Task-focused leaders focus on completion of jobs, deadlines, and directives [10]. Task-focused leadership is significantly associated with high-level patient satisfaction [18].
“Do it now!”
This concept, which is referred to as “transactional leadership” in English literature, is used as “interactionist,” “operational,” or “transactional” leadership in different sources. Transactional leadership is a leadership style that provides short-term goals and motivates viewers through the fulfillment of individual needs in exchange for high performance toward organizational goals [19]. Leaders in transactional leadership act as exchanges managers by exchanging followers who lead to improvement in production, and are interested in processes rather than shared values with forward-thinking ideas [18, 20].
Transactional leadership style emerges in two basic forms as “management with exceptions” and “conditional rewarding” [21, 22]. The form management with exceptions is divided into two as active and passive. The active leader monitors the performance of the team followers and intervenes to correct these errors when he/she detects errors. The passive leader expects the followers’ mistakes to draw their attention before giving negative feedback or any warning [23]. In conditional rewarding, transactional leaders clearly explain to their followers what their duties are, how they will be made, and how they will be rewarded if the desired tasks are fulfilled satisfactorily [21, 24].
Transactional leaders are cultural carriers who maintain the existing order and act in line with traditions and past [25]. In crises where an explicit orientation is required, the transactional leadership approach is an effective style. Transactional leadership can be the best leadership style for the direction of critical events [18, 26]. This leadership style can be effective in emergency situations such as cardiac arrest, by enabling nurses to focus on the task as a whole on the patient [27].
In the literature, transactional leadership and transformational leadership are explained together and comparisons are made. Besides, unlike the transformational leadership, leaders who adopt an interactive approach want to maintain the same things instead of changing the future, and they are less concerned with the creative and innovative aspects and focus on concepts such as efficiency and quality [28]. Bass emphasizes the use of interactive leadership as a conditionally rewarding performance, especially among followers and leaders [29]. While transformational leadership results in a performance beyond expected, interactive leadership focuses on the expected results [30]. According to the transactional leadership, leadership is seen as a simple mutual exchange between leaders and followers based on economic or political reasons, while transformational leadership states that leaders and followers influence each other in order to achieve higher levels of motivation and morale [31].
Another type of transactional leadership is autocratic leadership. Autocratic leaders are defined as directives, controlling, power-oriented, and closed-minded. The leader describes the “what, when, why, and how” of the task. He/she emphasizes obedience, loyalty, and strict adherence to the rules. Followers do what the autocratic leader says [32]. The autocratic leadership style can be considered ideal in emergencies because he or she takes all decisions himself/herself, regardless of the views of the leading staff [3]. Because information is seen as power, critical information can be hidden from the team. Mistakes are not tolerated and individuals are accused rather than erroneous operations. Rewards are given for compliance, but disobedience is punished [18, 32]. In addition, autocratic leaders can create fear among staff and often make decisions without consulting the team [32]. These leaders motivate their subordinates by using their “legal powers,” “rewarding powers,” and “coercive forces.” Autocratic leaders may not be welcome by their team, but this can be transformed into appreciation and devotion when the positive results of their leadership emerge. Although staff do not like autocratic leaders, they often work well on their orders [18, 32]. This leadership approach can be useful at the moment when it is necessary to make quick decisions or to mobilize uneducated and less-motivated followers in the short term by pressure and fear [6, 33, 34]. The positive aspect of this style is that it works perfectly in emergencies or chaotic situations with little time for discussion.
Schoel et al. found that very popular leaders were perceived as ineffective, while unpopular leaders could be perceived as effective [35]. According to the results of Uysal et al., the perception of the behavior of hospital managers as autocratic by followers decreases the productivity of the work [6], because autocratic leadership is perceived negatively by the followers; the reason is that the authoritarian attitude does not give the employee the right to speak, and that the awards and punishments are precise and clear.
The style of leadership recognizing full freedom is also referred to as “laissez-faire” in the literature and is expressed as “let them do it.” This kind of a leader advises the process by not participating in the process, encourages followers to generate ideas, offers suggestions when asked by followers, and declares opinions. [31]. Leadership that recognizes full freedom is a style in which the leader provides little or no orientation or control, and prefers a practical approach. Fully free leadership style includes a leader who does not decide, and acts without staffing or supervision [3]. The main task of the leader is to provide resources. Such leaders dissipate responsibilities and retreat and refrain from taking decisions [31]. The leader only gives his/her opinion when asked about his/her opinion on any subject, but this view is not binding on his/her followers [36].
Leadership that recognizes full freedom is an authoritative, task-focused leadership style, because it involves the regulation of tasks in times of crisis, so it shows reactive leadership. This style of leadership is often used by inexperienced leaders or those who are about to vacate their leadership positions, who prefer to give up their followers or others to change their positions, such as those who would like to give up their job [18]. The leader leaves the followers on their own. Followers do what they think is the best. Followers are trained to find the best solution to their problems. Whenever he/she sees it necessary, a person can form a group with whom he/she wants to solve problems, try new ideas, and make the decisions that he/she thinks are most appropriate for him/her [37, 38].
There are positive and negative aspects of the leadership style that gives full freedom. The first positive aspect of this leadership style is the determination and implementation of the goals, plans, and policies of employees or members of the organization, and it mobilizes the creativity of each member or employee [39]. The second positive aspect is that employees are motivated to train themselves and find the most appropriate solution to the problems. When the individual deems it necessary, he/she creates a group with the people he/she wants, solves the problems, tries new ideas, and reaches the most appropriate decisions [40]. The negative aspects of leadership, which gives full freedom, are the emergence of turmoil within the organization and the fact that everyone leads to the targets he/she wants and even toward opposing targets. Another disadvantage is the significant decrease in organizational success, independent of personal achievements.
Skogstad et al. state that the type of leadership recognizing full liberty reinforces the role conflict and role ambiguity experienced by the individual, and increases the conflicts with colleagues [40]. Hinkin et al. also state that leadership behaviors that recognize full liberty harm the punitive and rewarding roles of the leader and decrease leaders’ effectiveness [41]. Chaudhry and Javed state that fully free leadership has no effect on the motivation of the followers compared to other types of leadership [42]. Şentürk et al. reveals that fully free leadership does not have a reinforcing effect on innovative behaviors but rather reduces it [31]. According to the results of Uysal et al., the perception of the behavior of hospital managers as autocratic by followers decreases the productivity of the work [6]. Because autocratic leadership is perceived negatively by the followers. The reason is that the authoritarian attitude does not give the employee the right to speak, and that the awards and punishments are precise and clear.
Instrumental leadership focuses on choosing an appropriate strategy along with appropriate resources to achieve business goals, and it is vital for sustainable corporate performance [43, 44]. This leadership style is part of the spectrum of transformational and interactive leadership styles. Instrumental leaders can be effective managers because they ensure efficiency protection. Thus, jobs are completed in line with the resources, strategic vision, and time constraints of the health facility [45]. In current leadership approaches, the strategy and task-focused developmental functions of the leaders are not taken into account; however, strategy and task-focused functions, which are instrumental forms of leadership, are essential for organizations and followers to ensure sustainable performance. Instrumental leadership is based on neither ideals nor swap relationships. Instrumental leadership includes ensuring harmony between the organization and the environment, developing strategies, preparing task and strategy tables, using resources effectively, and providing performance feedback [44]. The most prominent feature of the instrumental leadership type is the determination of the subordinates’ path by the leader [34]. The instrumental leader is mainly concerned with the timely completion of the work related to the desired goal; it focuses on functions such as setting goals, organizing group members, setting up the communication system, and determining work-related times [46]. Akyurt et al. found that instrumental and interactive leadership have a statistically significant and positive effect on job satisfaction and organizational commitment [21]. Tengilimoglu and Yigit, in their study on 355 state hospital workers in order to determine the effect of leadership behavior in hospitals on job satisfaction of the employees, found that the leadership style with the highest job satisfaction were participatory, instrumental, success-oriented, and supporting leadership, respectively [34].
As the health sector is in a process of change, new leadership approaches need to be implemented to effectively manage this new structure [46]. Developments in the field of management-organization and organizational behavior and new concepts have also led to the emergence of new leadership styles in leadership [4]. Leadership is important for every organization as well as for health organizations, because the success of an organization is a good leader [47]. For effective leadership, it is important to focus on the dynamic relationships between guidance, leadership values, culture, talent, and organizational context [48]. Effective leaders in health care services consider safe, qualified, and friendly care as the top priority. Effective leadership is critical to facilitate quality care, patient safety, and positive staff development. Leaders make the voice of patients continuous; they continuously monitor their patient experiences, concerns, needs, and feedback [49]. Nurses, the largest workforce in a health institution and a dynamic profession, play an important role in health leadership and policy-making, while maintaining their traditional care skills [50]. The leadership style of executive nurses plays an important role in the provision of job satisfaction and motivation of nurses, development of institutional commitment, and effective management of conflicts [51, 52, 53]. In addition, effective leadership styles can increase the quality of health care outcomes. In addition, leadership in health facilities is considered as an important factor in ensuring quality health services, patient satisfaction, and financial performance.
Nurses are responsible for guiding the community because of their responsibilities in health care. Patient care and education, effective communication, and clinical management are the most important tasks. These tasks are closely related to leadership behavior. Nurses who exhibit leadership behavior will be pioneers in bringing the profession to a professional level. The goal of future health care institutions should be to influence the quality of patient care through a good nursing leadership. Future research should focus on the development, applicability, and implementation of robust leadership style models in different health environments. These studies should include multidisciplinary professional teams; strengthen the role of nurses and other health professionals; and address organizational parameters and individual wishes, preferences, and expectations for quality of life and health care.
We thank everyone who provided scientific guidance.
The authors declare no conflict of interest.
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