What Mental Health Teams Want in Their Leaders

Administration and Policy in Mental HealthVol. 26, No. 2, November 1998

WHAT MENTAL HEALTH TEAMS WANTIN THEIR LEADERS

Patrick W. Corrigan, Andrew N. Garman, Chow Lam, andMatthew Leary

ABSTRACT: The authors present the findings of the first phase of a 3-year study developinga skills training curriculum for mental health team leaders. A factor model empiricallygenerated from clinical team members was compared to Bass' (1990) Multifactor Model ofLeadership. Members of mental health teams generated individual responses to questionsabout effective leaders. Results from this survey were subsequently administered to a sampleof mental health team members. Analysis of these data yielded six factors: Autocratic Lead-ership, Clear Roles and Goals, Reluctant Leadership, Vision, Diversity Issues, and Supervi-sion. Additional analyses suggest Bass' Multifactor Model offers a useful paradigm for devel-oping a curriculum specific to the needs of mental health team leaders.

Practice guidelines have prominently featured clinical teams for such dis-parate problems as eating disorders (Schechter, 1994), anxiety disorders(Dahlgern, Pollard, & Brown, 1994; Pollard, Merkel, & Obermeier, 1986),severe mental illness (Corrigan & McCracken, 1995; Yank, Barber, Har-grove, & Whitt, 1992), child residential services (Bendicsen & Carlton,1990), integrated services for children and their families (Stone, 1988),and case management tasks for community mental health (Paradis, 1987).Four factors seem to distinguish clinical teams from other work groupsor the efforts of individual clinicians (Dyer, 1995): (1) teams are char-acterized by face-to-face interaction, with members of the clinical team ac-

Patrick Corrigan, Psy.D., is Associate Professor of Psychiatry, University of Chicago Center for Psychi-atric Rehabilitation. Andrew Garman, Psy.D., and Chow Lam, Ph.D., are with the Illinois Institute ofTechnology. Matthew Leary, B.S., is with the University of Chicago Center for Psychiatric Rehabilita-tion.

This study was made possible in part by grants from the U.S. Department of Education(H263A50006) and the Illinois Department of Mental Health and Developmental Disabilities.

Address for correspondence: Patrick Corrigan, Psy.D., University of Chicago Center for PsychiatricRehabilitation, 7230 Arbor Drive, Tinley Park, IL 60477. E-mail: [email protected].

111 © 1998 Human Sciences Press, Inc.

complishing their work goals by interacting personally with colleagues; (2)team members are able to mutually influence each other when conductingthe program, in that members jointly develop and implement treatmentplans; (3) workers on a team perceive they are members of that team—infact, work identity is frequently entwined with membership on a particularteam; (4) members of a team share common goals and tasks while workingwith peers to implement a variety of clinical skills that comprise their pro-gram.

Competent leadership is a fifth characteristic of effective teams; teammembers look to their leader to help them set the agenda and work welltogether (Sluyter, 1995; Wilcoxon, 1989). Although much has been writtenanecdotally about qualities of competent teams and their leaders, few care-fully controlled studies have been completed on leadership for mentalhealth services. The March 1991 issue of Administration and Policy in MentalHealth reviewed leadership models for top level, mental health administra-tors. To our knowledge, however, little has been written about effectiveleadership of the mental health team.

In contrast, team leadership in business and military organizations hasbeen studied extensively. Organizational psychologists have examined per-sonality traits that distinguish leaders from followers (Stogdill, 1974), be-havioral characteristics of leadership (Hemphill & Coons, 1957; Likert,1967), task-oriented versus relationship-oriented leadership styles (Fiedler,1964), and situationally defined models of leadership (Hersey & Blanchard,1982).

A particularly useful theory to arise out of this research is Bass' Multifac-tor Model of Leadership (Bass & Avolio, 1993). Bass (Bass, 1985; Bass,1990a; Bass & Yammarino, 1991; Hater & Bass, 1988; Yammarino & Bass,1990) identified and validated three factors that correspond with effectiveleadership:

(1) Transformational leadership—effective leaders help team memberstransform clinical programs to meet the ever-evolving needs of theirclientele. Transformational leaders do this by inspiring team mem-bers, stimulating them intellectually to rethink their work goals, andconsidering the interests and strengths of each team member.

(2) Transactional leadership—effective leaders also pay attention to theday-to-day tasks that need to be completed to operate the programsmoothly. Transactional leadership comprises two subfactors: Con-tingent Reward, in which team members are reinforced for suc-cessful completion of objectives, and Management by Exception,in which team members are reprimanded for errors in their work(Fulk & Wendler, 1982; Podsakoff, Todor, & Skov, 1982). Contin-gent reward is viewed as a useful leadership skill while Managementby exception can be problematic (Bass, 1990a).

112 Administration and Policy in Mental Health

Patrick W. Corrigan, Andrew N. Garman, Chow Lam, and Matthew Leary

(3) Nonleadership—effective leaders eschew a laissez faire style wherebyleaders assume little responsibility for the day-to-day supervision ofthe team or operation of the program.

The present study reports the first phase of a 3-year research projectdesigned to develop curricula for training leaders of mental health teams.The goal for phase one is to identify factors that team members seek intheir leaders. As part of this phase, we examine the applicability of Bass'leadership model to mental health settings. On the one hand, the funda-mental goals and tasks that define mental health settings are very differentfrom the industrial and military systems used to develop Bass' Multifac-tor Model. Therefore, one might expect that leadership needs of mentalhealth teams would not parallel Bass' Multifactor Model. However, othershave argued that the structures and rules that describe the interactions ofa clinical team are essentially similar to all work teams (Dyer, 1995). If thisassertion is correct, we expect clinical team members' responses will gener-ate factors similar to those of Bass' Multifactor Model.

Both qualitative and quantitative research strategies were adopted to testthis hypothesis. In earlier studies (Corrigan et al., 1994b; Garman et al.,1997), we used a qualitative survey strategy to identify staff concerns andperceptions about effective training and burnout. Focusing on staff con-cerns, rather than their perceptions about ideals, seems to be an effectivemethod for provoking participants to generate an exhaustive list of rele-vant issues. The same strategy was adopted in this study to obtain an inde-pendently validated sample of items representing concerns about effectiveleaders of the clinical team. Subsequent items were administered to men-tal health team members to identify common factors. These factors werethen correlated with Bass and Avolio's (1993) Multifactor Leadership Ques-tionnaire to determine the relationship between Bass' factors and the lead-ership factors obtained in this study.

Other studies have suggested that burnout of team members with effec-tive leaders is significantly lower than teams with relatively poor leaders(Seltzer, Numeroff, & Bass, 1989; Wilcoxon, 1989). A second goal of thisresearch was to determine the association between leadership factorsfound in this study and the burnout of team members. We expected toreplicate earlier findings and show burnout to be associated with less effec-tive leadership.

METHODS

Qualitative Survey

To examine mental health team members' perceptions of leadership, alist of items that represent staff concerns needed to be developed. Existing

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leadership measures were developed in business and military settings; gen-eralizability to clinical settings seemed questionable. Therefore, 389 staffmembers who provided team-based clinical or rehabilitative services to per-sons with severe mental illness were asked to complete a survey about teamleadership. This group was drawn from 62 agencies (Table 1).

Participants were instructed to complete a pencil-and-paper survey thatincluded five open-ended questions about problems which occur in theabsence of effective leaders and teamwork. Questions addressed issuessuch as conflict between supervisors and staff, conflict within the servicedelivery team, types of changes that are most difficult for the team, andareas of staff diversity that help or hinder teamwork. Specific questionswere taken from a list of 15, which members of four focus groups agreedwere important concerning leadership on the mental health team. Fourindependent experts ranked the 15 questions and the five with highestpriority were included in the survey.

Survey participants generated 3,563 responses to these items, whichwere transcribed into a computer database. Redundant items were thenremoved by computer sort according to 91 key words. Additional items

TABLE 1Demographic Characteristics of Staff Samples

Sample sizeAge

GenderEthnicity

Education

Years of experience

nMSDFemaleAfr. AmerAsianCaucasianLatinoOtherHigh schoolSome collegeAssociate'sBachelor'sMaster'sDoctorateM.D.MSD

QualitativeSurvey

38945.29.5

65.0%19.14.0

68.85.52.66.9%

13.39.7

23.241.2

2.23.6

11.38.8

QuantitativeSurvey

34643.710.964.020.72.9

71.43.91.18.8

26.115.323.821.5

1.62.9

10.58.3


were removed by consensus of two independent raters who judged itemsfor importance and relevance to leadership and the mental health team aswell as generalizability across clinical settings. This process yielded 60items, hereafter referred to as the Team and Leadership Questionnaire(TLQ).

Quantitative Analysis

A second sample of team members (N= 346) was administered the TLQ.They were instructed to rate the degree to which each item was a problemfor the team on an 8-point Likert scale (8 = always a problem). Thisgroup is described in Table 1 alongside the sample who completed thequalitative survey.

Factor Correlates

A subset of team members (n = 80) completing the TLQ was adminis-tered three additional measures to investigate correlates of factors foundin a factor analysis of the TLQ. These team members completed the Cham-pions of Psychiatric Rehabilitation Scale (CPRS). "Champions" are infor-mal leaders who initiate specific work projects (Howell & Higgins, 1990;Tushman & Nadler, 1986). Champions of psychiatric rehabilitation, then,are informal leaders who assume responsibility for developing innovativeprograms for persons with severe mental illness. The CPRS contains 39items describing qualities of champions on a 7-point Likert scale of agree-ment (7 = highly agree). The test has been shown to have satisfactorycontent validity, reliability, and internal consistency (Corrigan & Garman,1996). Responses were summed to yield a total CPRS score, which wasbelieved to correlate with general factors representing leadership.

Team members also completed the Multifactor Leadership Question-naire (MLQ) to examine correlations among Bass' factors (1993) and TLQfactors. As used in this study, participants were instructed to rate theirteam leader on 44 items that represent the leader's skills. The MLQ hasbeen widely investigated and shown to have excellent internal consistency,test-retest reliability, and construct validity. Results of factor analyses haveshown the test yields nine reliable indices. These indices are interrcorre-lated and combine into groups that correspond with the three central con-structs of Bass' Multifactor Model: transformational leadership, transac-tional leadership, and nonleadership.

As mentioned earlier, research has shown an inverse relationshipbetween burnout and transformational leadership (Seltzer, Numeroff, &Bass, 1989; Wilcoxon, 1989). Team members in this study reported theirlevel of burnout using the Maslach Burnout Inventory (MBI), a 22-itemself-report measure that assesses burnout in the helping professions (Mas-lach & Jackson, 1986). Research participants rated the frequency with

115

which they experience job-related stressors on a 7-point Likert Scale (7 =highly agree). Prior analysis of the MBI has uncovered three reliable andvalid factors that are included in this study: emotional exhaustion (e.g., "Ifeel emotionally drained from work"), depersonalization (e.g., "I feel Itreat some of the consumers as if they were impersonal objects"), and per-sonal accomplishment (e.g., "I feel exhilarated after working closely withmy consumers").

RESULTS

To obtain reliable factor structures, data from the TLQ were analyzedusing principal components analysis with an oblique rotation; this is therecommended method for this type of survey due to the intercorrelationof leadership factors (Bass, 1990a). Factors comprised of items with signifi-cant loadings are summarized in Table 2.

Six factors with eigenvalues greater than or equal to 3.0 emerged fromthe analyses. A conservative factor loading (>.500) was used to identifyitems that comprised each factor. Two experts independently analyzed theset of composite items for each factor and showed notable convergence indescription and definition of each factor.

Factor 1, Autocratic Leadership, represents team members' displeasurewith leaders who manage by making unilateral decisions for subordinates.Items on this factor suggest an over-reliance on corrective measures, talk-ing down to team members, managing team members too tightly, and notresponding well to feedback. The content of this factor is similar to Bassand Avolio's (1994) management by exception. Factor 2, Clear Roles andGoals, comprised items suggesting that aspects of respondents' teamworkwere not clearly delineated. Bass (1994) describes contingent reward in asimilar manner. Factor 3, Reluctant Leadership, contained items concern-ing the need for leaders to address team problems proactively and fairly,and not to shrink away from the tough decisions. This factor seemed tooverlap with Bass' nonleadership factor. Factor 4, Communicating the Vi-sion, seemed to capture the spirit of transformational leadership most closely.These items suggested that providing tasks and goals to team members isnot enough; team members also want the rationale for how individualtasks promote the vision of the agency. Factor 5, Diversity Issues, com-prised items pertaining to diversity-related team conflicts, including issuesof ethnicity, age, and gender. Factor 6, Supervision, contained items sug-gesting team members' needs for supervision, training, and attention fromtheir leaders.


Patrick W. Corrigan, Andrew N. Garman, Chow Lam, and Matthew Leary 117

TABLE 2Results of the Factor Analysis

Factor

AUTOCRATICLEADERSHIP

CLEAR ROLES/GOALS

RELUCTANTLEADERSHIP

COMMUNICATINGTHE VISION

ItemCorrelations

.735

.675

.656

.621

.590

.585

.700

.682

.665

.623

.517

.509

.591

.504

.504

.663

.643

.642

.587

Items

Leaders manage the staff with tootight control

Staff fear getting into trouble whenthey make a mistake

Leaders rely on punishment morethan praise

Leaders talk down to staffLeaders do not treat staff as individ-

ualsLeaders are not open to feedback

from staff

Team members do not know roles —who is responsible for what

Team members have conflicts overroles and responsibilities

Team members lack common goalsTeam members have difficulty coor-

dinating how they deliver servicesTeam meetings lack structureEducational backgrounds divide staff

Leaders often give in to staff who getangry or emotional

Leaders do not discipline staff fairlySome staff are not held accountable

for their work by team leadersLeaders implement new policies with-

out orienting staffLeaders do not let staff know what is

going on in the agencyNew policies/procedures are imple-

mented without staff knowing whyNot everyone is informed of changes

at the same time


Correlations with Other Constructs

Pearson Product Moment Correlations examined the relationship amongfactors derived from the Team and Leadership Questionnaire (TLQ), theChampions of Psychiatric Rehabilitation Scale (CPRS), the MultifactorLeadership Questionnaire (MLQ), and Maslach's Burnout Inventory (MBI);corresponding correlation coefficients are summarized in Table 3. Substan-tial factor intercorrelation was found on the TLQ coefficients ranged from.28 to .50. The high intercorrelation suggests there is a general leadershipfactor that accounts for common variance in the six TLQ factors. Thisassertion is evident in Table 3. Note that the six factors from the TLQ areall highly correlated with the total score from the CPRS. Moreover, Trans-formational, Transactional, and Nonleadership scores from the MLQ areall significantly associated with the six factors obtained in this study.

To determine whether relationships between specific TLQ Factors andMLQ Factors are unique, a correlation between Factor 1 and TransactionalLeadership was determined after the CPRS score was partialled out; theCPRS was selected as a measure of general leadership. The resulting par-tial correlation was significant (r = .31). Similar partial correlations weredetermined for Factors 2 through 4 and their corresponding MLQ factors.Nonleadership on the MLQ was found to be significantly associated withFactor 3 after the CPRS score was partialled out (r = -.28). A nonsignifi-cant trend described the partial correlation between Factor 2 and Transac-

Factor

DIVERSITYISSUES

SUPERVISION

TABLE

ItemCorrelations

.887

.713

.679

.678

.647

.634

.567

2 (Continued)

Items

Some caucasion staff will not acceptdirectives from a minority leader

Team members tend to segregatethemselves according to ethnicity

Staff do not always accept directivesfrom leaders of opposite sex

Leaders discriminate against staffbased on ethnic background

Leaders are not assertive enoughStaff do not get enough supervision

from their leaderLeaders do not provide enough train-

ing and in-services

Patrick W. Corrigan, Andrew N. Garman, Chow Lam, and Matthew Leary 119

Administration and Policy in Mental Health

tional Leadership (r = .20). The partial correlation between Factor 4 andTransformational Leadership was not significant (r = .10).

The relationship between burnout and the six leadership factors identi-fied in this study is also summarized in Table 3. Results validate earlierresearch findings; effective leadership is inversely associated with staffburnout. This relationship appears strongest in relation to Emotional Ex-haustion, particularly for the Reluctant Leadership subfactor (Factor 3).

DISCUSSION

The primary goal of this study was to identify what team members per-ceive to be problems and skills that define effective leadership of mentalhealth teams. This information was gathered to develop a curriculum formental health team leaders. Analysis of 346 mental health staff surveysyielded six factors, five of which appeared to overlap with the MultifactorLeadership Model. Factor 1—Autocratic Leadership—echoed Bass' man-agement by exception factor. Team members dislike leaders who regularlypunish or belittle them. Team members do not want a leader who commu-nicates with them only when they make mistakes.

Clear Roles and Goals, Factor 2 in this study, seemed to replicate contin-gent reward, another subfactor of transactional leadership. Team memberswant their leaders to clearly define the goals of the team as well as theindividual roles needed to accomplish these goals. Team members havedifficulty coordinating their efforts with colleagues if their leader does notprovide them with suitable guidelines. Goal-setting programs, which have along track record of research success (Calpin, Edelstein, & Redmon, 1988;Locke & Latham, 1990) may help to ameliorate such problems in mentalhealth teams.

The third factor identified in the factor analysis was Reluctant Leader-ship, which appeared to be similar to Bass' nonleadership factor. Team mem-bers reported dissatisfaction with leaders who could not make difficultdecisions or control obstreperous colleagues. Team members are clearlycalling for leaders who assume responsibility and make appropriate deci-sions. In fact, team members in this study were likely to report emotionalexhaustion and feelings of depersonalization when supervised by a Reluc-tant Leader.

Factor 4, Vision, seemed to parallel Bass' transformational leadership factor.Team members do not want to carry out their job blindly. Rather, theywant to understand the rationale for their work in terms of some higherorder goal or vision provided by the leader. This is consistent with Bass'model; transformational leadership helps team members transcend the nor-mal limits of their job so that they have a greater sense of accomplishment

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at work. A leader can develop vision by learning skills such as establishing asense of mission, inspiring staff, and team-building (Bass, 1990a; Bass &Avolio, 1994). Even qualities such as charisma, once thought to be untrain-able, have been examined from a skills training perspective (Conger &Kanungo, 1988).

Factor 5, Diversity Issues, suggests that team members view managing ademographically diverse team as a discrete task for the leader. Team mem-bers were concerned that leaders from minority groups are not respectedby colleagues, nor will leaders representing the majority understand teambehaviors that reflect minority groups. Interestingly, problems with leader-ship in this area were rated as more significant by persons of minor-ity ethnic groups. Leaders can learn to handle diversity-related conflictsthrough the use of structured conflict resolution approaches (Fisher &Ury, 1981; Pedersen, 1993). Factor 6, Supervision, draws attention to theleader's role in staff development. Apparently, this vital leadership func-tion can get lost in the competing demands placed upon leaders.

Additional research is necessary to further validate the Multifactor Lead-ership Model for mental health teams. These studies are needed not onlyto replicate the findings reported in this paper, but also to look for factorsthat interact with leadership. Future investigations should look into whe-ther these findings generalize to other groups of clinicians, e.g., teams thatwork with children or persons with developmental disabilities. Research isalso needed to identify other variables that correspond with individualcharacteristics of the team. For example, perceptions of collegial supporthave been shown to be related to burnout (Corrigan, Holmes, & Luchins,1995; Corrigan, Holmes, Luchins, Parks, & Basit, 1994a). Future researchshould determine whether perceptions about collegial support improvewith more competent leadership as outlined in this study.

Finally, research needs to examine how improved leadership affects thequality of care. One might hypothesize that consumers of mental healthservices receive better care from teams with competent leaders. If this hy-pothesis is supported in subsequent research, then one might concludethat training team leaders on appropriate leadership skills is an importantmethod for improving the quality of mental health services.

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What Mental Health Teams Want in Their Leaders