The Research Of The Effectiveness And Mechanism Of Leader Humility In Hospital Context

The complexity of environment and the diversity of knowledge constantly urge managers to take the bottom-up leadership and to express humility,and the patient-centered and integrated primary care practices also call for humble leadership.As a new leadership theory,humble leadership has shown its positive effect on enterprise employees and teams,but a systematic investigation of the effectiveness and mechanism of humble leadership in the hospital context is rare.However,in order to improve healthcare quality and safety,and to realize innovation,effective leadership for hospitals in China is warranted.As such,it is particularly timely to explore the effectiveness and mechanism of humble leadership in Chinese hospital context.In view of this,based on the literature review of leadership in healthcare settings and humble leadership,focusing on healthcare quality and safety and medical innovation,this study examined the effect and mechanism of humble leadership on quality of care,speaking up and silence about patient safety,and innovative behavior.We conducted four studies to test our hypothesis.The purpose of study 1 was to test the psychometric properties and measurement invariance of the Expressed Humility Scale among healthcare workers.In a sample of 532Chinese healthcare workers(N nurse=292,N doctor=240),Cronbach's?met the measurement standard(>0.70);and the confirmatory factor analysis revealed the structure of the Expressed Humility Scale fitted the data well(?2=200.95,df=24,CFI=0.96,TLI=0.95,SRMR=0.03,SABIC=9429.50).A multigroup confirmatory factor analysis provided evidence for configural,metric,and scalar invariance of the Expressed Humility Scale between nurses and doctors(?CFI<0.01,?TLI<0.01).These findings suggest that the Expressed Humility Scale had sound psychometric properties in Chinese hospital context.The study 2 aimed to explore the effect of humble leadership on quality of care,and the dual mediating effect of work engagement and burnout.In this study,80 nursing units(80 head nurses,579 nurses)were obtained from a tertiary hospital.The results of correlation analysis showed that there was a significant correlation between humble leadership and quality of care assessed by nurses(r=0.46,P<0.01),but no significant correlation between humble leadership and quality of care assessed by head nurses(r=0.09,P>0.05).Multilevel analysis showed that humble leadership can positively affect quality of care assessed by nurses(?=0.40,P<0.01),and work engagement(indirect effect=0.13,95%CI:[0.06,0.22])and burnout(indirect effect=0.07,95%CI:[0.02,0.15])played dual mediating roles in this relationship.These findings suggest that humble leadership can promote the quality of care by improving work engagement and reducing burnout.The aims of study 3 were to examine the effect of humble leadership on speaking up and silence about patient safety,and the mediating effect of encouraging environment on team level and psychological safety on individual level.The first part is the validation of the Chinese version of the speaking up about patient safety questionnaire.The questionnaire was translated using the back-translation procedure,and then 532 healthcare workers from a tertiary hospital completed the questionnaire(the same sample as the study1).The results showed that Cronbach's?met the measurement standard(>0.70).And the confirmatory factor analysis revealed the structure of the speaking up-related climate scale fitted the data well(?2=200.95,df=24,CFI=0.96,TLI=0.95,SRMR=0.03,SABIC=9429.50),and the structure of the speaking up-related behavior scale fitted the data well(?2=85.46,df=41,CFI=0.98,TLI=0.97,SRMR=0.04,SABIC=13634.92).Multigroup confirmatory factor analyses provided evidence for configural,metric,and scalar invariance of the Chinese version of the speaking up about patient safety questionnaire between nurses and doctors(?CFI<0.01,?TLI<0.01).The second part aimed to test the whole theoretical model using a field study.In this study,1104 healthcare workers(N nurse=755,N doctor=349)were obtained from three tertiary hospitals.The results of correlation analysis showed that there was a significant correlation between humble leadership and silence(r=-0.24,P<0.01),but no significant correlation between humble leadership and speaking up(r=-0.00,P>0.05).Multilevel analysis showed that humble leadership can positively affect speaking up about patient safety via encouraging environment on team level(indirect effect=0.09,95%CI:[0.01,0.19])and psychological safety on individual level(indirect effect=0.05,95%CI:[0.01,0.10]);at the same time,humble leadership can negatively affect silence(?=-0.18,p<0.01)via encouraging environment on team level(indirect effect=-0.06,95%CI:[-0.12,-0.01)and psychological safety on individual level(indirect effect=-0.14,95%CI:[-0.14,-0.06]).In the third part,the effect of humble leadership on promotive and prohibitive voice was verified by using scenario-based experiment and 2 X 2 mixed experiment design.115medical students from a university participated in this study.The manipulation checks revealed that the manipulation of the humble leadership was successful(t=-22.29,p<0.01,Cohen's d=-4.21).The results of repeated measures analysis of variance(r ANOVA)indicated that humble leadership had a positive effect on promotive voice(F_(1,113)=46.53,p<0.01,?²_p=0.29)and prohibitive voice(F_(1,113)=23.89,p<0.01,?_p²=0.18).The study 4 aimed to explore the effect of humble leadership on innovative behavior,and the serial mediating effect of creative role identity and creative self-efficacy.In this study,data were obtained from 1104 healthcare workers of three tertiary hospitals(the same sample as the second part of study 3).The results of correlation analysis showed that there was a significant correlation between humble leadership and innovative behavior(r=0.35,P<0.01).Multilevel analysis showed that humble leadership can positively affect innovative behavior(?=0.39,P<0.01).In addition,creative role identity and creative self-efficacy played a serial mediating role in the relationship between humble leadership and innovative behavior(indirect effect=0.43,95%CI:[0.20,0.73]).These findings suggest that humble leadership can positively stimulate the innovative behavior of healthcare workers by activating the creative role identity and promoting the creative self-efficacy.Taken together,humble leadership played a positive role in improving healthcare quality,ensuring patient safety and stimulating innovation.Hospital managers should a)pay attention to leadership training and cultivation in order to improve healthcare quality and safety;b)provide managers with training of humble leader behaviors to systematically upgrade the scientific management of the hospital;c)attach importance to healthcare workers'self-initiated and change-oriented behaviors,which could bring great benefits to healthcare quality and safety.