Table 3

The perspectives of staff on the leadership and management practices

NHMH	EJMH	RKMH	SMBA
CEO 1 (2007– 2013) *Transactional leadership* Conformity to rules and procedures, role model. Improved staff working conditions. Staff perspective Strong perceived leader support, which catalysed the quality culture. CEO 2 (2014– 2016) *Transformational leadership* Clear communication of his vision. Genuine concern for staff needs. Enhanced staff mission valence. *Distributed leadership* Stimulated network formation, ‘kind heart actions’ Staff perspective Responsiveness to their basic psychological needs Reinforced existing clan culture. Positive organisational climate (mutual trust and team work). This led to increased organisational commitment and extra role performance. In 2016, the hospital won the second price in the national quality contest). CEO 3 (July 2016–Sep 2017): Laissez-faire leadership Passive attitude. Reliance on administrative correspondence. Poor communication with staff. Hierchical line not enforced. Staff perspective Role ambiguity, high job stressors. Unresponsiveness to staff needs. Deteriorating working conditions. Perceived organisational politics. Demotivation, conflicts and tensions with unions. CEO 4 (Oct 2017–March 2018) Transactional leadership Reinforcing the hierarchical line. Building alliance with informal leaders. Staff perspective Distant leader. Reduced perceived autonomy support. Improved working conditions. Clarifying goals reduced role ambiguity and job pressures for admin. staff. Reduced interaction between health units.	CEO 1 (2012– 2015) Transactional leadership Power-assertive attitude. Overemphasis on compliance with rules and procedures. Staff perspective Perceived distant leader. Low perceived autonomy support. Decreased organisational commitment. Mistrust, conflicts and tensions with unions. CEO 2 (2015– 2018) *Transformational leadership* Good communication of vision and objectives. Genuine concern for the needs of staff. *Distributed leadership* Constructive dialogue to resolve professional issues. Catalysing role of mid-level managers. Participative decision-making. In 2016, the hospital won the first price of the quality contest. Staff perspective High perceived autonomy support. Good congruence with professional and public service motives. Trust relationship between staff and management team. Reduced tensions with unions.	CEO 1 (2010– 2012) *Transactional leadership* Strict application of administrative procedures. Staff perspective Appreciated by administrators and close collaborators. Increased extrinsic motivation of staff. Nurses and doctors resisting to his overcontrolling behaviour engaging in conflicts and strikes. CEO2 (2012– 2018) Laissez-faire leadership Often absent. Chief nursing officer overwhelmed by day-to-day operational management duties. Staff perspective Appreciated by administrators and close collaborators. Nurses and doctors unhappy about lack of responsiveness to their needs and the poor working conditions. Conflictual organisational climate, characterised by high job pressure and role ambiguity. Perceived organisational politics (nepotism and clientelism), contributing to perceived unfairness.	CEO 1 (2007– 2010) *Transactional leadership* Enforcement of hierarchy. Emphasis on conformity with rules and procedures. Audit and clinical supervision. High moral standards. Staff perspective Highly appreciated by close collaborators and administrative staff. Nurses and doctors perceived a lack of participative decision-making and reduced perceived autonomy support. CEO 2 (2010– 2013) *Transactional leadership* Enforcing conformity with rules and regulations. Close supervision, administrative sanctions. Staff perspective Well appreciated by administrators and close collaborators. Perceived unresponsiveness to nurses’ needs. CEO 3 (2014– 2018) *Laissez-faire leadership* Hierarchical line not respected. No meetings, no clinical supervision. No inter-unit interaction. Staff perspective Decreased organisational commitment Inadequate working conditions and supply of consumables. Low perceive organisational support. High role ambiguity and job pressure. High level of perceived organisational politics.