The Relationship between Transformational
   Leadership and Service Quality
   Tanuja Agarwala  (  prof.tanuja.agarwala@outlook.com )
    Manipal University, Dubai, UAE
   Mohammed Alwan 
    Manipal University, Dubai, UAE
   Research Article
   Keywords: transformational leadership, services quality transactional leadership, healthcare, United Arab
   Emirates
   DOI: https://doi.org/10.21203/rs.3.rs-2371054/v1
   License:   This work is licensed under a Creative Commons Attribution 4.0 International License.  
   Read Full License
          The Relationship between Transformational Leadership and Service Quality 
           
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                          Tanuja Agarwala and Mohammed Alwan  
                                         
                  1.  School of Business Administration, Manipal University, Dubai, UAE 
                       Correspondence: prof.tanuja.agarwala@outlook.com 
                                        
           
           
           
           
          This paper investigates the relationship between transformational leadership and service quality in 
          UAE hospitals. The paper first determined the level of satisfaction of patients with the service 
          quality they received. The paper also analyzed how hospital employees perceived the dimensions 
          of transformational and transactional leadership of their leaders. Finally, the relationship between 
          the dimensions of service quality and those of transformational and transactional leadership was 
          investigated. Two questionnaires were administered. The first questionnaire addressed service 
          quality  using  an  adapted  SERVQUAL.  The  second  one  addressed  transformational  and 
          transactional leadership using the multi-level leadership questionnaire. The first questionnaire was 
          distributed  to  patients  of  six  major  UAE  hospitals  while  the  second  one  was  distributed  to 
          employees of the same hospitals. Data were collected and analyzed using SPSS. The paper found 
          that UAE patients were generally satisfied with the service quality rendered by their hospitals. It 
          however  found  that  hospital  employees  had  a  low  rating  of  their  leaders  in  terms  of  the 
          transformational  leadership  and  contingent  reward.  Finally,  service  quality  was  found  to  be 
          positively related to all dimension of transformational leadership and the transactional leadership 
          dimension of contingent reward. The two dimensions of active exception and passive avoidant 
          leadership were negatively related to service quality. This paper bridged an important gap in the 
          literature by addressing the relationship between service quality and transformational leadership. 
          It provided important guidelines for managers on the dimensions of leadership that needed to be 
          enhanced in order to improve service quality. 
           
          Keywords:  transformational  leadership,  services  quality  transactional  leadership,  healthcare, 
          United Arab Emirates  
           
          Introduction  
           
          Many authors have stressed the importance of leadership in driving quality initiatives forward 
          (Cole et al., 1993; Ebrahimpour, 1985; Lascelles and Dale, 1989). But not much has been done to 
          learn about the kinds of leadership that promote high-quality implementation. However, some 
          research suggests that transformational leadership is necessary for a high-quality implementation 
          to be successful (Waldman, 1993; Jabnoun, 2002). In the last twenty years, researchers have 
          focused extensively on the phenomenon of transformational leadership. A large body of literature 
          has established that transformational leadership improves employee morale and output (Bass, 
          1999).  However,  studies  on  transformational  leadership  have  concentrated  on  objective 
          performance measures like sales volume, profit margin, and stock product performance (Geyer 
          and  Steyer,  1998;  Howell  and  Avolio,  1993)  in  addition  to  employee  satisfaction  and 
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      organizational  commitment  (Barling  et  al.  2000).  No  research  has  examined  the  effect  of 
      transformational leadership on service quality. In this paper, we look into how transformational 
      leadership affects service quality in hospitals across the United Arab Emirates. 
       
      Literature review 
       
      Service quality 
       
      The importance of providing high-quality service to clients has long been acknowledged (Spreng 
      et al., 1996). It follows that service providers looking to gain an edge in the market should focus 
      more on raising the bar for customer satisfaction (Khassawneh et al., 2022; Jun et al., 1998). 
      Quality of service is now understood to be a multi-factor phenomenon. Originally, ten service-
      industry-wide factors were identified by Parasuraman et al. (1985). Material goods, timeliness, 
      courtesy, expertise, credibility, security, ease of access, clarity of communication, and awareness 
      of the client's needs were also considered important factors. Later, in 1988, Parasuraman et al. 
      created the 22-item SERVQUAL instrument, which is now the de facto standard for measuring 
      service quality. The five dimensions represented by the instruments are as follows: We'll start with 
      that all-important one: dependability. Dependability and precision in delivering the service are key 
      aspects to consider along this axis. Two, quickness to react. The willingness to aid customers and 
      provide timely service is the focus of this dimension. Material things, third. In this respect, we're 
      talking about things like building design, hardware, and employee uniforms. Fourthly, confidence. 
      In this respect, we're talking about a staff's expertise, friendliness, and ability to inspire confidence. 
      Five) Feeling for other people. The level of concern and personalized service given to each 
      customer is one indicator of quality along this axis.  
       
      The hotel, dental, travel, higher education, real estate, accounting, architectural, hospital, and 
      construction service industries are just some of the many that have benefited from implementing 
      SERVQUAL (Parasuraman et al., 1988). Service quality has emerged as a competitive factor in 
      the health care industry, just as it has in others. Now more than ever, the medical community is 
      eager to upgrade their facilities and provide better care. SERVQUAL is the standard for measuring 
      the quality of health care services (Lim and Tang, 2000; Sewell, 1997; Anderson, 1995). Patient 
      service requirements were analyzed by Reidenbach and Sandifer-Smallwood (1990), who looked 
      at how people's perceptions of hospitals' emergency care, inpatient care, and outpatient care varied. 
      Their primary concern was how these impressions affected patients' overall definitions of service 
      quality, their level of satisfaction with their care, and their propensity to recommend the hospital 
      to family and friends. They created a tool that borrows heavily from the original Parasuraman et 
      al. ten-factor questionnaire (1985). Factor analysis using orthogonal rotation with varimax was 
      performed on data collected via telephone survey from 300 patients. The seven factors that 
      emerged from this examination were trustworthiness (among patients), business acumen (among 
      staff),  treatment  quality  (among  treatments),  supportive  services  (among  patients),  hospital 
      ambience (among visitors), wait times (among visitors), and empathy (among staff). The results 
      showed that the effects varied across the three types of hospital settings studied. Patient satisfaction 
      was found to be influenced by the confidence of the patient in each of the three contexts. Patients' 
      intentions to recommend the hospital were found to be influenced by the dimension of treatment 
      quality both for outpatients and ER visitors. Patient satisfaction surveys and emergency room 
      evaluations  of  care  are  both  affected  by  patients'  impressions  of  staff  members'  outward 
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      appearance.  Using  a  modified  SERVQUAL  with  25  items  representing  six  dimensions 
      (accessibility, affordability, tangibles, reliability, assurance, responsiveness, empathy, and so on), 
      Lim and Tang (2000) sought to understand patients' expectations and perceptions in Singapore 
      hospitals.  An  examination  of  252  cases  reveals  a  discrepancy  between  patients'  reported 
      experiences and their expectations regarding the quality of care they received. There should have 
      been enhancements in all six areas. Patients were surveyed by Sewell (1997) to determine which 
      aspects of care quality were most important to them in the National Health Service. The results 
      indicated that reliability was the most crucial factor, followed closely by confidence. Tactiles were 
      deemed to be the least important factor, while empathy and responsiveness were ranked nearly 
      equally. When comparing the quality of inpatient care provided by public and private hospitals in 
      the UAE, Jabnoun and Chaker (2003) used a modified version of the SERVQUAL instrument. 
      Public hospital inpatients reported higher levels of satisfaction with the quality of care received 
      compared to their private hospital counterparts. 
       
      Transformational leadership 
       
      Burns  (1978)  defined  transformational  leadership  as  a  way  for  leaders  to  modify  followers' 
      behavior. Transformational leaders boost confidence, create interest in the group or organization, 
      and shift employees' focus to achievement and progress rather than existence (Bass, 1985). They 
      emphasize effectiveness over efficiency and explore new ways of functioning (Lowe et al., 1996). 
      Transformational leaders guide subordinates to exceed standards and goals, stressing employee 
      empowerment over dependence (Mohammad and Khassawneh, 2022; Yammarino and Dubinsky, 
      1994; Bass and Avolio, 1994, 1995; Hartog et al., 1997). Transactional leaders rely on transactions 
      to meet subordinates' needs (reward for performance, mutual support and bilateral exchanges). 
      Bass  (1985)  defines  a  transactional  leader  as  one  who  favours  a  leader-member  exchange 
      relationship, in which the leader fulfills the followers' needs in exchange for their performance in 
      meeting basic expectations. A transactional leader avoids risk and builds subordinates' confidence 
      to  achieve  goals  (Khassawneh  and  Abaker,  2022;  Yammarino  et  al.,  1993).  Transactional 
      leadership ensures people meet expectations, whereas transformational leadership exceeds them 
      (Masi and Cooke, 2000). Bass developed the MLQ to measure transformative and transactional 
      leadership  (1985).  The  MLQ  originally  included  charm,  inspirational  leadership,  intellectual 
      stimulation, customized consideration, contingent compensation, management by exception, and 
      laissez-faire leadership. The first two factors weren't differentiated empirically (Bass 1988). This 
      leads to six considerations. The MLQ was amended (Bass and Avolio, 1989, 1991, 1993) to 
      address researchers' concerns and recommendations (Khassawneh and Mohammad, 2022a; Hunt, 
      1991; Bycio et al., 1995). Avolio et al. (1999) recently revised the MLQ using a larger, more 
      heterogeneous  sample.  This  reexamination  identified  six  factors:  charisma,  intellectual 
      stimulation, customized consideration, contingent reward, active management by exception, and 
      passive-avoidant leadership. Summarize the six factors: (1) Charisma comprises the capacity to 
      inspire  followers  and  give  them  a  clear  sense  of  purpose,  modeling  ethical  behavior,  and 
      developing identification with the leader and his goal. (2) Intellectual stimulation that encourages 
      workers to challenge tried problem-solving strategies. (3) Individualized consideration, including 
      understanding each employee's needs and trying to maximize their potential. (4) Contingent 
      reward clarifies what's required of followers and what they'll get if they do. (5) Active management 
      by exception monitors task execution and corrects faults to preserve performance. (6) Passive-
      avoidant leadership reacts only when situations are significant and avoids decisions. 
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