Navigating the Tension between Being a Transformational Leader and an Efficient Leader?


  • Meghan Richardson
  • Sherry Dahlke


Since its introduction in 2014, the quadruple aim of optimizing healthcare performance by reducing costs and improving population health, patient experience, and healthcare team well-being has not been realized. Lean, a formal quality improvement model aimed at eliminating waste, improving flow and quality of care, and increasing efficiency, has been inconsistently successful in healthcare due to poor implementation and organizational understanding. This discussion paper explores the potential for transformational leaders to support the use of lean through empowering clinical leaders. Transformational leadership is a relational style of leadership found to motivate followers by soliciting their perspectives on problem-solving while supporting each individual to reach their full potential. Although transformational leaders can foster the development of clinical leaders to influence and coordinate care, they must navigate the tension between supporting clinical leaders and the organizational demands for improved efficiency. The gains of supporting the use of lean by clinical leaders could be meaningful development of strategies aimed at the quadruple aim by supporting the daily efforts of front-line nurses and their leaders to improve the delivery of quality care.