transformational and transactional leadership skills for mental health teams

q 1999 Human Sciences Press, Inc.301

Community Mental Health Journal, Vol. 35, No. 4, August 1999

ADMINISTRATIVE UPDATE

Transformational and TransactionalLeadership Skills forMental Health Teams

Patrick W. Corrigan, Psy.D.Andrew N. Garman, Psy.D.

ABSTRACT: Many treatments for persons with severe mental illness are provided bymental health teams. Team members work better when led by effective leaders. Re-search conducted by organizational psychologists, and validated on mental healthteams, have identified a variety of skills that are useful for these leaders. Bass (1990,1997) identified two sets of especially important skills related to transformational andtransactional leadership. Leaders using transformational skills help team members toview their work from more elevated perspectives and develop innovative ways to dealwith work-related problems. Skills related to transformational leadership promote in-spiration, intellectual stimulation, individual consideration, participative decisionmaking, and elective delegation. Mental health and rehabilitation teams must notonly develop creative and innovative programs, they must maintain them over time asa series of leader-team member transactions. Transactional leadership skills includegoal-setting, feedback, and reinforcement strategies which help team members main-tain effective programs.

This study was made possible in part by grants from the U. S. Department of Education(H263A50006) and the Illinois Office of Human Services.

Patrick W. Corrigan is affiliated with the University of Chicago Center for Psychiatric Reha-bilitation. Andrew N. Garman is affiliated with the Illinois Institute of Technology.

Address correspondence to Patrick Corrigan, University of Chicago Center for Psychiatric Re-habilitation, 7230 Arbor Drive, Tinley Park, IL 60477; e-mail pcorriga6mcis.bsd.uchicago.edu.

Anyone wishing to have manuscripts reviewed in the areas of administration, managementquality assurance, managed care, and standards of care should contact Paul S. Sherman, Ph.D.,Editor, Administrative Update, 4530 S. Independence Trail, Evergreen, Colorado 80439 or sub-mit the material to David L. Cutler, M.D., Dept. of Psychiatry, 3181 Sam Jackson Park Road,Portland, Oregon 97201-3098.

302 Community Mental Health Journal

Mental health and psychiatric rehabilitation programs have a signif-icant impact on the lives of persons with severe and persistent mentalillness (Bachrach, 1992; International Association of Psychosocial Re-habilitation Services, 1994; Liberman, 1992). These programs rely oninterdisciplinary teams of professionals, paraprofessionals, and pros-umers.1 Teams that work well together provide better quality servicesto their clientele. Members are able to form a more cohesive teamwhen they are led by supervisors possessing appropriate leadershipskills.

Experts in business management and organizational psychologyhave developed a variety of paradigms for leaders in business and in-dustry. Recent research suggests that many of these paradigms areapplicable to mental health and psychiatric rehabilitation teams (Cor-rigan, Garman, Lam, & Leary, in press; Corrigan, Garman, Canar, &Lam, 1998). This paper reviews skills which help leaders with theirmental health teams. The role of the team in the provision of reha-bilitation services is described before reviewing specific leadershipskills.

THE ROLE OF THE TEAM

Mental health and psychiatric rehabilitation services for persons withsevere mental illness are typically carried out by a team of providers.Experts in management and organizational psychology have definedfour characteristics of generic work teams that differentiate them fromother groups (Dyer, 1995). Mental health teams show each of thesecharacteristics: (1) The work of teams rests on face-to-face interactions.Members of the rehabilitation team accomplish work goals by interact-ing personally with colleagues. (2) Members of a work team mutuallyinfluence each other. Staff on a rehabilitation team are not carryingout treatment plans dictated by the team leader. Rather, team mem-bers and the leader develop and implement individual rehabilitationplans with the consumer as a partner. Implementing the plan requiresthe joint efforts of all.

(3) Workers on a team perceive they are members of that team. Infact, work identity is closely tied to one’s membership on a particularteam. Members of the rehabilitation team frequently distinguish their

1Prosumers are persons with severe mental illness, who have consumed or are currently usingrehabilitation and mental health services and, who now provide these services in some capacity.

Patrick W. Corrigan, Psy.D. and Andrew N. Garman, Psy.D. 303

role from that of other treatment providers. (4) Members of a workteam share common goals and tasks. Staff members on mental healthand psychiatric rehabilitation teams work with their peers to carry outa variety of services that comprise their program.

Team Leadership

Factors affecting a team’s ability to work together and function effec-tively include burnout (Corrigan, Holmes, & Luchins, 1995; Corrigan,Luchins, Malan, & Harris, 1994); commitment to the team (McGrath,1984; Schein, 1992); support from agency administrators (Liberman,1983); ability to communicate and problem solve (Hirokawa, 1990;Hirokawa, Erbert, & Hurst, 1996); and SKILLS OF THE TEAMLEADER. Research suggests having a skilled leader who convenes acohesive team is a priority of many team members (Garman et al.,1997). However, many graduate programs in the various mentalhealth disciplines fail to provide basic courses in leadership (Garman,Blaney, & Corrigan, 1996). Fortunately, organizational research hasidentified skills that assist leaders in their task (Fiedler, 1964; Hemp-hill & Coons, 1957; Likert, 1967).

A particularly useful theory to arise out of this research is Bass’ (1993)multifactor model of leadership. Bass (1985, 1990; 1997; Bass & Yam-marino, 1991; Hater & Bass, 1988; Yammarino & Bass, 1990;) distin-guished two sets of skills relevant to effective leadership: (1) transfor-mational skills: effective leaders help team members transform programsto meet the ever-evolving needs of their clientele and (2) transactionalleadership skills: effective leaders attend to the day-to-day tasks whichneed to be completed to operate the program smoothly.

Subsequent studies examined whether leadership models developedin business and military settings are relevant for mental health andrehabilitation teams (Corrigan, Garman, Lam, & Leary, in press; Cor-rigan, Garman, Canar, & Lam, 1998). Findings from research withmore than 1000 participants showed that independent groups of men-tal health (Corrigan, Garman, Lam, & Leary, in press) and rehabilita-tion staff (Corrigan, Garman, Canar, & Lam, 1998) identified leader-ship factors that paralleled Bass’ distinction between transformationaland transactional leadership. Findings from these studies were thendiscussed with eight focus groups comprising team members and leadersto develop a mental health team leader curriculum (Garman & Corri-gan, 1995). The curriculum includes specific skills that promote trans-formational and transactional leadership.


TRANSFORMATIONAL LEADERSHIP SKILLS

The needs of persons with severe mental illness are constantly chang-ing; in like manner, services to address these needs are also changing.Mental health and rehabilitation programs must continually evolveand include the latest service innovations to appropriately serve theirclients. Leaders adopting transformational skills stimulate the reha-bilitation team to think creatively about program development andmeet consumer needs. With these skills, leaders encourage their col-leagues to take a critical look at the program and identify its strengthsand limitations. Leaders then inspire team members to pose ways inwhich the program may be improved given these limitations. Success-ful program transformation rests on two goals (Bass, 1990). First, theleader needs to build a close working relationship among colleagues onthe team. Then leaders use team cohesiveness to improve task effec-tiveness.

Facilitating Team Cohesion

Members of a cohesive team are able to look beyond their own self-interest and work harder to serve the team and consumers. Cohesiveteam members are able to view their own work environment frommore elevated perspectives; e.g., proactively examining how specificcomponents of a service address the overall mission of the programrather than reactively focusing on client problems as discrete phenom-ena. Bass (1990, 1997) identified three factors that facilitate team co-hesion: inspiration and charisma, intellectual stimulation, and individ-ualized consideration.

Inspiration and Charisma. Inspiration and charisma are embodiedin the sense of mission that drives a program (Bass, 1985, 1990). Abroader sense of the program’s purpose helps team members becomecritical of individual components of the program and work on changingthose components to meet identified shortfalls. Team members whobelieve that their team is accomplishing important goals are motivatedto provide a quality program. Inspiration and charisma are facilitatedby leaders that work alongside colleagues, demonstrating that thelofty goals of the mission are attainable.

Mission statements are one vehicle for inspiring team members andinclude three parts. First, missions include a statement about how theteam’s program is special and exceeds the status quo. The mission


statement lists how the program addresses unique challenges posed bypsychiatric disability. The mission statement of many rehabilitationprograms include the hope and power suggested by recovery models ofsevere mental illness (Anthony, 1993; Deegan, 1988).

Second, mission statements are enhanced by symbols and metaphor.For example, one program used the Statue of Liberty to assert its mis-sion: ª We take all consumers; the downtrodden, the low of heart . . . weturn no one away from our doors.º This statement compels the team tonot discount individuals who fail to neatly fit into intake criteria. Thethird aspect of a mission statement is to charge colleagues to highergoals; each team member is responsible for realizing the program’smission. One way to keep the mission relevant and alive is for theleader to choose a ª keeper of the missionº each month. This person,selected from among team members, comes to meetings during thatmonth with a short quote, poem, or inspirational passage that cap-tures the spirit of the mission.

Intellectual Stimulation. Transformational leaders encourage allstaff members to think critically about the rehabilitation program(Bass, 1985, 1990; Bass & Avolio, 1993). The assumption is that teammembers, when asked, are capable of providing intelligent recommen-dations about the program. This charge to think about the programmotivates team members to be more involved in it. Intellectual stimu-lation also builds cohesion among team members when they respect-fully discuss aspects of the program with each other.

Intellectual stimulation may be fostered by journal clubs whereteam members are assigned opportunities to lead a discussion about aspecific article. Periodicals like the Psychiatric Rehabilitation Journalpublished by the Boston University Center for Psychiatric Rehabilita-tion, Psychiatric Rehabilitation Skills by the University of ChicagoCenter for Psychiatric Rehabilitation, and the Journal by the Califor-nia Alliance for the Mentally Ill present practitioner-oriented articlesthat do not require a strong research background to discuss. A seniormember of the team may coach more hesitant colleagues about how tolead a discussion in the journal club. This process sends the explicitmessage that intellectual consideration of the program is the respon-sibility of all staff.

Group evaluation projects provide another way for the leader to in-volve team members in thinking critically about the program. Leadersempower colleagues on the team to evaluate some aspect of their pro-gram in a manner similar to a research project. The first step is to


identify a problem to be examined in their evaluation. Problems areworded as questions; for example, how do some persons who abusealcohol quit? The team then poses ways which the problem might beresolved. For example, the mental health team might develop skillstraining modules for dual-disabilities. These solutions act as hypoth-eses for the evaluation project. Team members then develop ways tomeasure the impact of these interventions. For example, do measuresof sobriety track the impact of the new, dual-disability groups? Finally,team members decide who will carry out the evaluation project; e.g.,which team members will implement the dual-disability program andwho will collect outcome data on it. Group evaluation projects serveseveral goals: they empower team members to resolve program prob-lems; they lead to concrete changes in the program; and they provideuseful evaluation data that track the impact of these changes.

Individualized Consideration. Bass (1990, 1997) noted that inter-ests and skills vary across team members as a function of disciplin-ary background and other individual differences. Team members aremore invested in teams and programs that exercise their interestsand provide opportunities to use their skills. Leaders explicitly needto support team members in pursuing their professional interests bymatching staff with program duties that complement their skills andinterests. Leaders may promote individualized consideration throughstaff development plans, training and study opportunities, and jobrotations that reflect team member interests. In addition, leadershipstrategies that promote task effectiveness include an appreciation ofthe individual differences of staff. These strategies are reviewed be-low.

Improving Task Effectiveness

Two leadership skills help the cohesive team complete program devel-opment and implementation tasks more effectively: participative deci-sion making and elective delegation (Leana, 1987; Schriesheim &Neider, 1989). In participative decision making, leaders and teammembers join together to determine changes in overall program for-mat as well as specific services to consumers. Participative decisionmaking is a cognitive task: collecting information and deciding a spe-cific direction for change. For example, during participative decisionmaking, team members, who consider ways of improving services forsubstance abuse, might choose specific assessment strategies and


skills training modules. Elective delegation is the behavioral effect ofthese decisions. Team members distribute responsibilities for decided-upon-changes to the program. The team in the example above deter-mined which staff members will carry out the assessments strategiesand who would implement the skills training modules. These decisionsare made by team members and leaders based on individual staff in-terest and resource availability.

As outlined in Table 1, participative decision making and electivedelegation vary in level of leaders’ involvement (Bass, 1990; Vroom &Jago, 1978; Vroom & Yetton, 1973). At the most involved level, leadershave complete authority over participative decision making and elec-tive delegation with team members limited to providing data that in-form decisions and assignments. At the least involved level, leadersturn the process over to team members entirely and only monitor prog-ress. A variety of factors affect the leader’s selection of the level ofparticipative decision making and elective delegation. Team leadersare more likely to exert control over these tasks when agency adminis-

TABLE 1

Levels of Participative Decision Making and ElectiveDelegation

Level Participative Decision Making Elective Delegation

Level 1 Leaders make decisionsalone based on informa-tion provided by teammembers.

Leaders provide decision op-tions and preferred deci-sion. Final decision andcompletion of task restswith team.

Level 2 Leaders make decisionsbased on team members’suggestions.

Leaders’ input are limited toinformation. Final decisionand completion of taskrests with the team.

Level 3 Leaders share decision mak-ing with team members.

Final decision and comple-tion of task rests with theteam; no input is providedby the leader.

Level 4 Leaders turn over decisionmaking to team members.


trators are holding them personally accountable for decisions. Exter-nal quality requirements (such as those imposed by accrediting bodies)are also likely to require greater involvement by leaders. Conversely,leaders are likely to hand over decision making and responsibility as-signment to the team when team acceptance of the action is crucial.Cohesion tends to be facilitated by team control over decisions andassignments.

TRANSACTIONAL LEADERSHIP SKILLS

From a transactional perspective, rehabilitation and treatment teamsare viewed as a kind of marketplace where team members trade theirservices for a variety of rewards provided by the work place (Bass,1990). The prototype reward is a paycheck. However, other factors,such as social recognition and pride in a job well-done, are also power-ful motivators. Transactional leaders capitalize on these motivators tohelp team members work better and feel more satisfied with the job.In keeping with the analogy of the marketplace, transactional leader-ship focuses on the here-and-now. Rather than emphasizing futurechangeÐ the goal of transformational leadershipÐ transactionalleaders address questions like, ª What must I do to keep this programrunning smoothly today?º

Leaders using transactional skills focus on three goals: (1) clarifyingexpectations: helping team members to better understand their work-related responsibilities by providing clear goals; (2) motivating im-provement: challenging team members to continuously improve theirperformance; and (3) recognizing achievements: creating opportunitiesfor the efforts of team members to be recognized and rewarded. A vari-ety of skills facilitate the objectives of transactional leadership includ-ing goal setting, performance feedback, and contingent reinforcement.

Goal Setting

Often, work performance can be increased by clarifying program goalsand individual staff responsibilities vis-a-vis these goals (Locke, 1968).Program goals and staff responsibilities have been broadly spelled outin the transformational efforts described above. Goal setting helps in-dividual team members understand how their duties relate to programgoals. Explicit goals also provide a standard by which team membersgauge the quality of their accomplishments.


Effective goal setting has several characteristics. Goal setting needsto be an interactive process between leader and team members (Corri-gan & McCracken, 1997). Dictated goals will cause team members tolose interest in day-to-day efforts (Erez, Earley, & Hulin, 1985). Effec-tive goals are specific. They include target levels of performance anddates by when targets should be achieved. Effective goals are challeng-ing yet realistic. Easy or simple goals are unlikely to motivate teammembers. Conversely, team members become frustrated with goalsthat require overwhelming effort. Goals are stated in the positive; i.e.,in terms of what team members should do (e.g., come to work on timeeach day), rather than what they should not do (don’t come to worklate). Finally, goals reflect benefits to the consumer in particular andthe rehabilitation program in general (Sluyter & Mukherjee, 1993).

Performance Feedback

Feedback is particularly useful when given soon after performance ofthe work skill (Kolodny & Kiggundu, 1980); leaders can do this bysetting up regular supervision sessions with their staff. Feedback isalso effective when it is positive and reflects a staff member’s effortrather than critical and focuses on mistakes (Prince, 1988). When mis-takes are addressed, corrective feedback includes specific opportuni-ties for change. In this way, team members understand what they cando to more effectively accomplish their goals.

Feedback that describes directly observable behaviors is more usefulthan general feedback (Beer, 1981). Similarly, giving a team memberfeedback about a single concern is more effective than hitting col-leagues with multiple and unrelated feedback all at once. Individualfeedback sessions should end upbeat. If feedback was positive, leadersencourage the worker to `keep up the good work.’ If feedback had toinclude some critiques, leaders express confidence in the team mem-ber’s ability to overcome the problem.

Contingent Reinforcement

Team members who are rewarded for accomplishing their goals aremore likely to repeat these efforts in the future. Both external rewards(e.g., bonus paycheck, extra day off, or special parking place) and in-ternal reinforcers (e.g., the personal satisfaction and recognition for ajob well done) can positively affect team members’ behavior (Eisen-berger & Cameron, 1996). Rewards are most effective when they are


personally meaningful to the recipient. Team surveys can help theleader identify a range of meaningful reinforcers. Rewards also havegreater effect when connected to specific behaviors rather than vagueimpressions and when received soon after goals are met (Beer, 1981;Prince, 1988). Team meetings provide a public venue for recognitionand reinforcement of individual staff.

Rewards are more effective when linked to goals team membershave accomplished, rather than bad behaviors they have avoided.Moreover, reinforcement of positive work behavior has much greaterinfluence over team activities than punishment of mistakes (Podsakoff& Todor, 1985). Ironically, punishing leaders’ tend to have waning ef-fects over staff. Team members who are frequently criticized and oth-erwise punished by their leaders learn to avoid them.

SUMMARY

Clinical and rehabilitation researchers have identified a range of psy-chosocial treatments that help persons with severe mental illness ad-dress their disabilities. The challenge now falls to the mental healthand psychiatric rehabilitation team to incorporate these psychosocialtreatments into vital and effective programs. The team leader is anessential resource for helping the team accomplish these goals. Orga-nizational researchers have identified a range of skills that enhanceleadership. Subsequent studies have shown that models of transforma-tional and transactional leadership are especially relevant to teamsthat serve severe mental illness.

Transformational leadership skills are essential for building a cohe-sive and motivated team. These skills improve the team’s abilities tothink critically about the program. Transactional leadership skillshelp the team maintain effective programs. Leaders who learn to in-corporate these skills will produce a better functioning team. The qual-ity of services provided to consumers of this team will improve in turn.

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