Institutionen för Lärande, Informatik,
Management och Etik (LIME)
Frontiers in leadership research 5 poäng
Examensarbete
Vårterminen 2007
Managerial leadership and
subordinate health, sickness
absence, and sickness attendance
Författare: Anna Nyberg
Introduction
We still have limited knowledge about what behaviours and/or characteristics in
leaders, or in the relationship between the manager and the employee, which are
health promoting, or on the other hand constitute risk factors for the employees’
health. We also know very little about the role managerial leadership plays
concerning the extent to which employees take sickness absence, or go to work
while ill.
Such knowledge could contribute to the education of managerial leaders to act in
ways that are more beneficial to the health of the organization and the individual
employee in a long term perspective.
After presenting some general aspects of leadership research, I will present a
conceptual model of organisational- and work environment factors, and
leadership in relation to subordinate health and patterns of sickness absence and
attendance. In this model, I will present what relationships are and are not
covered by research. However, the model and literature review is “under
construction” and at present without any ambition of being complete.
What is leadership?
Leadership is a general phenomena, and always an integrated part of the
conceptions of the world of each particular time and culture. (Grint, 1997).
There are several questions to be asked, when trying to understand what
leadership is, or could be (Grint, 1997).
1. Where does leadership take place? Does it take place within the leader,
between the leader and the follower, or as representations in the
followers’ minds?
2. What differs leadership from other processes of interpersonal influence?
3. How is leadership conducted, or performed? Through communication?
4. Why do we have leadership? Do we need leaders, and if so, why?
5. Who exerts the leadership? The leader, the followers, the media?
There is no one definition of leadership, agreed upon by scholars. Leadership
has been defined according to the focus of the studies conducted, in terms of
e.g. individual traits, leader behaviours, interaction patterns, or influence over
followers (Yukl, 1989).
Yukl (1989) defines leadership as influencing task objectives and strategies,
influencing commitment and compliance in task behaviour to achieve these
objectives, influencing group maintenance and identification, and influencing the
culture of an organization.
Common leadership models tested in research
Leadership research has traditionally been conducted quantitatively. Qualitative
studies became more common in the 1980’s. The instruments used in most
ii
leadership research is self-administred questionnaires, most often the Ohio State
LBDQ, Fiedler’s LPC scale, and the MLQ (Bryman, 2004).
Yukl (1989) concludes from the results of thousands of empirical studies
conducted on leadership and effectiveness as contradictory and inconclusive.
There is a disparity of approaches, a narrow focus of most researchers, and a
lack of broad theories integrating the findings from different disciplines. The
approaches are often classified according to whether they have a primary focus
on power-influence, leader behaviour, leader traits, or situational factors
interacting with behaviour, traits, or power. A short presentation of each
approach follows below.
Power-influence approach: In the leadership literature, power is defined in
different ways. It is defined either as potential influence over others, or as
enacted and realized influence. It is defined as influence over attitudes and
behaviours of people, or as influence over events. One accepted distinction is
the one between personal power, stemming from attributes of the person, and
position power, stemming from attributes of the situation. The two are,
however, not mutually exclusive. McCall (1978) proposed that it is not enough
for managers to have expertise or information; there must also be a situation in
which followers need and are dependent of these resources. In social exchange
theory (Hollander, 1978) greater status is given someone who demonstrates
loyalty to the group, and competence in solving problems and making decisions.
Leaders lose power if mistakes are made attributed to poor judgment,
irresponsibility, or asserting self-interests in front of group interests. Research on
the social exchange theory is limited, but supportive. There is some evidence in
the literature that great power can corrupt a leader to misuse it (Zaleznik, 1970;
Kipnis, 1972). It is therefore desirable to have organisational constraints on a
leader’s use of power (Yukl, 1981).
Managerial behaviour: Except for task-oriented and relationship-oriented
behaviour, researchers have not agreed upon meaningful categories of leader
behaviours. The numerous studies of these behaviours in relation to satisfaction
and performance are inconclusive in the US, except the positive relationship
between consideration (relationship-orientation) and subordinate job
satisfaction. In Japan, however, more consistent evidence shows that both taskand relationship- oriented behaviours are required for leadership effectiveness.
There is, apparently, a situational factor present. A review by Podsakoff, Todor,
Grover, and Huber (1984) concludes that positive reward behaviours increase
subordinate satisfaction and performance.
Trait approach: Trait studies were conducted in numerous amounts in the 1930´s
and 1940´s. These early attempts aimed at finding extraordinary abilities in
leaders, but failed to find any specific traits that were related to leadership
success (Stogdill, 1974). More recent trait research is however slowly finding
traits that are related to successful leadership behaviours. Traits found to relate
iii
most to managerial effectiveness is high self-confidence, energy, initiative,
emotional maturity, stress tolerance, and belief in internal locus of control (Bass,
1981; Yukl, 1989).
Situational approaches: There are several theories applicable when trying to
understand how the situation affects managerial behaviour. One of them is Role
Theory (Kahn, Wolfe, Quinn, & Snoelk, 1964). Leaders adapt to role
requirements by supervisors, peers and subordinates, and demands of the
leadership situation. Managerial effectiveness further depends on how well the
manager understands these expectations and demands, how they overcome
constraints, and how they recognize possibilities (Kotter, 1982; Stewart, 1982).
Situational theories emphasize that different behaviour or trait patterns are
effective in different situations, and studies have tried to describe which
situational factors moderate the relationship between leader behaviours and
effectiveness. However, research on the impact of situational factors has not
resulted in any conclusions about what behaviour patterns are successful in what
situations (Yukl, 1989).
Transformational leadership: An interest in charismatic and transformational
leadership arose in the 1980’s, coinciding with the need for American companies
to make major changes in order to survive increasing competition from
companies in other countries. The aim of the influence of transformational
leaders is to empower subordinates to participate in the transformational process
of the organization (Bass, 1985). Transformational leadership is therefore
enacted at different levels in the organization, and viewed as a shared process
(Burns, 1978).
Charismatic leadership involves the view of the leader as an idealized hero, in
possession of qualities almost superhuman (Bass, 1985). This also involves a
followership characterised by unquestioning acceptance and obedience (House,
1977).
Characteristic for the theories of transformational and charismatic leadership is
that they encompass traits, behaviours, power, and situational factors at the same
time. Bass (1997) summarises the research on the effects of transactional and
transformational leadership on job satisfaction and organisational outcomes in
the following way: Transformational leaders are the most successful and laissezfaire leaders the least. In between are behaviours of more “conventional”
character, such as putting demands on subordinates, rewarding and controlling
them.
In his review of qualitative research, Bryman (2004) points out that quantitative
and qualitative researchers have focused on somewhat different leader
behaviours. Recent quantitative research puts emphasis on vision, charisma, and
transformational leadership. Qualitative researchers, on the other hand, identify
being a good communicator, and being someone who can be trusted frequently,
iv
as particularly important for successful leadership. Bryman writes that another
contribution of qualitative research on leadership is that leaders are “depicted as
people who draw upon their followers’ ideas, beliefs, and values and recycle
them back to them in the form of a distinctive leadership framework”. This
aspect of leadership is not recognized in quantitative research, where there is
more of a focus on input – output, meaning what effects leadership has on
various organizational outcomes.
Managerial leadership and employee stress, health, and behaviours related to sickness absence
and sickness presenteeism
The focus of interest in this paper is leader characteristics and behaviours
creating a good working environment, healthy employees, and employees who
go to work when healthy and stay home when sick. What do we know about a
health promoting leadership?
Leadership and employee stress and health
Working life research has, surprisingly enough, been rather neglecting of the
contribution of leadership when studying work environment factors in relation
to the health of employees. The few studies conducted are to a large extent
based upon either task- and relationship oriented leadership, or transformational
and transactional leadership.
Showing consideration for subordinates is, not surprisingly, associated with
subordinates’ good health. Initiating structure is also a health promoting
behaviour unless it is combined with low consideration. Low consideration in
combination with high structure is associated with increased stress in
subordinates. However, in more stressful situations, more structure is needed
(Nyberg, Bernin & Theorell, 2005).
We also see that both transformational and transactional leadership are
associated with good health among subordinates, the associations between
transformational leadership and subordinate health being somewhat stronger.
The situations detrimental to health are when the leader exerts no leadership at
all, acts laissez-faire, or uses only transactional leadership (Nyberg, Bernin &
Theorell, 2005).
A few studies have been published recently, using other measures of leadership
behaviours than the above mentioned. Gilbreath & Benson (2004), for example,
developed a new instrument including 63 items describing leader behaviour. The
instrument was created after interviewing subordinates and leaders and reviewing
research on work, health and supervision. The questions were related to job
control (e.g. Is flexible about how I accomplish my objectives); leadership (e.g.
Makes me feel part of something useful, significant, and valuable);
communication (e.g. Encourages employees to ask questions); consideration (e.g.
Shows appreciation for a job well done); social support (e.g. Steps in when
employees need help or support); group maintenance (e.g. Fails to properly
v
monitor and manage group dynamics); organizing (e.g. Plans work to level out
the load, reduce peaks and bottlenecks); and looking out for employee well-being
(e.g. Strikes the proper balance between productivity and employee well-being).
The instrument was developed to measure the overall effect of supervisor
behaviour, rather than the effect of specific types of behaviours. The authors
found that supervisor behaviour made a significant contribution to the
prediction of GHQ (General Health Questionnaire) scores beyond the variables
age, health practices, support from other people at work, support from home,
stressful life events, and stressful work events. Fearing that their measure of
leader behaviours were confounded with social support, they reproduced
analyses without items closely related to supportive functions. They found that
other leadership dimensions also made a statistically significant contribution to
prediction of GHQ scores.
A study by Nyberg, Åkerblom, Bernin, Alderling et al (submitted 2007)
investigated leader behaviours and characteristics as measured by the GLOBE
questionnaire (Hanges & Dickson, 2004) in relation to subordinate stress/health,
and working conditions. 10 subscales from the GLOBE questionnaire were
used, exploring leadership in the hotel industry in Sweden, Poland, and Italy.
Results showed that the leadership dimensions Integrity (just, trustworthy,
sincere, and honest), and Team integrator (communicative, team-builder,
informed, integrator) were associated with better working conditions (less isostrain), which in turn were associated with more vitality and less behavioural
stress in subordinates. Malevolent leadership (irritable, hostile, dishonest,
vindictive) was directly associated with subordinate behavioural stress.
A longitudinal study of leadership and subordinate well-being, where staff in two
community trusts participated four times in a 14-month period, concluded that
leadership behaviour and subordinate responses were linked in a feedback loop,
lending support for the proposition that the relationship between leader and
subordinate is a two-way reciprocal process (van Dierendonck, Haynes, Borrill &
Stride, 2004).
Leadership and group psychology
Sy, Côté & Saavedra (2005) used an experimental design, exploring the effects on
group members of the mood of leaders. The task given to the group members
was to put up a tent, while blindfolded. The results showed that the mood of the
leaders had important consequences in the groups. Individuals with leaders in a
positive mood experienced more positive moods themselves. Leaders’ mood
also had a direct influence on group effort. This relationship did not go through
the affective tones of individual group members. Leaders’ mood also had both a
direct and indirect (through group affective tone) influence on group
coordination. The authors conclude that leaders’ moods can be powerful forces
within groups. However, it can not be excluded that the relationship is mediated
by leadership functions, meaning that leaders in positive moods could have been
more successful in conducting their influence as leaders.
vi
An explorative study at Institutet för psykoterapeutisk psykoterapi (Ohlström,
1997) examined the effect of leadership styles on the group members in a group
therapy. The researcher observed activity levels, and affective tones. Results
indicated that being a passive, vague, unclear leader can make a group insecure.
A leader who is too strict, dominant, and focused on rules, may decrease anxiety
in group members, but on the other hand not allow them to develop as much as
they possibly could. The group in which individuals seemed to function the best
(were the most trusting, reflecting, active, and self-dependent) was the one where
the leader was active, group oriented, democratic, participative, clear and fair.
Leadership and sickness absence, sickness attendance, and work attendance
There is still little research on sickness absence and sickness attendance, and to
my knowledge no robust studies putting these outcomes in relation to
managerial leadership.
A study of work place conflict resolution and the health of employees in Sweden
and Finland, showed that employees who reported that differences were
resolved through discussion were least likely to report stress, bad health and
sickness absence. Those who reported that authority was used, or that no
attempts were made to solve the problem, both reported worse health (Hyde,
Jappinen, Theorell & Oxenstierna, 2006).
Tollgerdt-Andersson (2005) studied differences in leadership in organizations
with high and low rates of sickness absence. She came to the conclusion that
managers in organizations with low rates of sickness absence had high selfesteem, felt secure as leaders, could “say no” and trust own judgements, put high
and clear demands on subordinates, had clear rules and concrete goals, could
delegate and give responsibility to subordinates, and followed up work efforts
systematically.
Dellve, Skagert & Wilhelmsson (2007) found leadership important for workplace
health promotion, and work attendance. Leaders using rewards, recognition, and
respect, were associated with higher prevalence of work attendance. A higher
proportion of employee work attendance was also seen in units whose leaders
viewed the organization or the society (rather than the individual workers) as
responsible for the high rate of sick leave.
Organizational and work environment factors in relation to employee health,
sickness absence, and sickness attendance
Organizational justice has over the past few years been extensively investigated,
and in robust studies been found related to employee health (e.g. Elovainio,
Kivimäki, & Vahtera, 2002; Kivimäki, Elovainio, Vahtera, & Ferrie, 2003). The
relationship between organizational factors and managerial leadership at lower
levels in the organization has, to my knowledge, not been investigated to the
same extent. However, Elovainio, Kivimäki, Steen, & Vahtera (2004) found
organizational justice and dicision latitude related to each other. Working
conditions, measured by the demand-control-social support-model (Karasek &
Theorell, 1990, Johnsson, 1986) have for decades been established having a
relation to employee health outcomes, such as cardiovascular disease (Johnson,
vii
Hall & Theorell, 1989), psychiatric disorders (Sanne, Mykletun, Dahl, Moen &
Tell, 2005), the metabolic syndrome (Chandola, Brunner & Marmot, 2006), and
sickness absence (Christensen, Nielsen, Regulies, Smith-Hansen & Kristensen,
2005). The effort-reward-imbalance-model (Siegrist & Peter, 2000) explains
about the same amount of ill health in subordinates, as has the demand-controlsocial support model been shown to do.
The three most commonly used models in working environment research
(demand-control, effort-reward, organizational justice) were included in a
presentation of working life research by Michael Marmot (American
Psychosomatic Society, Budapest, 2007) and summarized as explaining
approximately 30% of the ill health in the population.
This figure is a (first draft of a) conceptual model of how aspects of the
organization, the managerial leadership, and the working conditions
interplay with individuals´ affects, cognitions, stress, health, and
behaviours regarding sickness absence, and attendance.
Organization:
Justice
Clarity
…
Managerial leadership:
Integrity, Communication, Autocracy
Inspiration, Consideration, Structure, Transformational…
Individual
perceptions, interpretations,
affects, cognitions, behaviours
Working conditions:
Demands
Control
Social support
Effort-reward
…

Stress/Health
Sickness absence
Sickness attendance
There is substantial evidence of a relationship between working
conditions (demand-control-social support, effort-reward) and
subordinate health and sickness absence.
viii





There is substantial evidence of a relationship between organizational
justice and subordinate health and sickness absence.
There is a significant contribution of managerial leadership practice to
the health of subordinates, over and above other work environment
factors studied in relation to health. Studies of group psychology indicate
that subordinates are susceptible to their leaders moods and behaviours,
and that these are relevant for the level of trust within and performance
by the group.
There are few studies investigating the contribution of leadership
practice on well-known work environment factors (demand-control;
effort-reward). The results from one study indicates that leader integrity
and team-orientation contributes to a good work environment (less isostrain).
There are, to my knowledge, no studies looking at how organizational
justice is associated with managerial practices at lower levels.
There are, to my knowledge, no published studies looking specifically at
managerial leader behaviour in relation to subordinate sickness absence
and sickness attendance.
References
Bass, B.M. (1981). Handbook of leadership: Revised and expanded edition. New York:
Free Press.
Bass, B.M. (1985). Leadership and performance beyond expectations. New York: Free
Press.
Bass, B.M. (1997). Does the transactional – transformational leadership
paradigm transcend organizational and national boundaries. American Psychologist,
52:130-139.
Bryman, A. (2004). Qualitative research on leadership: A critical but appreciative
review. Leadership Quarterly. Vol 15, Issue 6, p 729.
Burns, J.M. (1978). Leadership. New York: Harper & Row.
Chandola, T., Brunner, E., & Marmot, M. (2006). Chronic stress at work and the
metabolic syndrome: prospective study. BMJ, 4;332(7540), 521-5.
Christensen, K.B., Nielsen, M.L., Rugulies, R., Smith-Hansen, L. & Kristensen,
T.S. (2005). Workplace Levels of Psychosocial Factors as Prosepective
Predictors of Registred Sickness Absence. JOEM, Vol 47: no 9.
ix
Dellve, L., Skagert, K., Vilhelmsson, R. (2007). Leadership in workplace health
promotion projects: 1- and 2- year effects on long-term work attendance.
European Journal of Public Health, 1-6.
van Dierendonck, D., Haynes, C., Borrill, C., & Stride, C. (2004). Leadership
Behavior and Subordinate Well-Being. Journal of Occupational Health Psychology,
9(2), 165-175.
Elovaino, M., Kivimäki, M., Steen, N., & Vahtera, J. (2004). Job decision latitude,
organizational justice and health: multilevel covariance structure analysis. Social
Science & Medicine 58, 1659-1669).
Elovaino, M., Kivimäki, M., & Vahtera, J. (2002). Organizational Justice:
Evidence of a New Psychosocial Predictor of Health. American Journal of Public
Health, vol 92, No. 1.
Gilbreath, B., & Benson, P.G. (2004). The contribution of Supervisor Behaviour
to Employee Psychological Well-being. Work & Stress, 18, 255-266.
Grint, K. (1997). Leadership: Classical, Contemporary and Critical Approaches. Oxford:
Oxford University Press.
Hanges, P. J. & Dickson, M. W. (2004) The Development and Validation of the
GLOBE Culture and Leadership Scales. In House, R.J., Hanges, P.J., Javidan,
M., Dorfman, P.W., Gupta, V. (Eds.): Culture, Leadership and Organization: A
GLOBE Study of 62 Societies. Thousand Oaks: Sage Publications.
Hollander, E.P. (1978). Leadership dynamics: A practical guide to effective relationships.
New York: Free Press.
Hyde, M., Jappinen, P., Theorell, T., & Oxenstierna, G. (2006). Workplace
conflict resolution and the health of employees in the Swedish and Finnish units
of an industrial company. Social Science & Medicine, 63(8), 2218-27.
House, R. J. (1977). A 1976 theory of charismatic leadership. In J.G. Hunt &
L.L. Larson (Eds), Leadership: The cutting edge (pp.189-207). Carbondale, IL:
Southern Illinois University Press.
Johnson, J.V. (1986). The impact of workplace social support, job demands, and work
control upon cardiovascular disease in Sweden. Department of Psychology. Division of
Environmental and Organisational Psychology. Stockholm: Stockholm
University.
Johnson, J., Hall, E., & Theorell, T. (1989). Combined effects of job strain and
social isolation on cardiovascular disease morbidity and mortality in a random
x
sample of the Swedish male working population. Scand J Work Environ Health,
15(4), 271-9.
Kahn, R.L., Wolfe, D.M., Quinn, P.R. & Snoek, J.D. (1964). Organizational Stress:
Studies in role conflict and ambiguity. New York: Wiley.
Karasek, R. & Theorell, T. (1990). Healthy Work: Stress, Productivity, and the
Reconstruction of Working Life. USA: Basic Books.
Kipnis, D. (1972). Does power corrupt? Journal of Personality and Social Psychology,
24, 33-41.
Kivimäki, M., Elovaino, M., Vahtera, J. & Ferrie, J.E. (2003). Organisational
Justice and health of employees: prospective cohort study. Occup Environ Med; 60:
27-34.
Kotter, J.P. (1982). The general managers. New York: Free Press.
McCall, M.W. (1978). Power, influence, and authority: The hazards of carrying a sword
(Thchnical report # 10). Greensboro, NC: Center For Creative Leadership.
Nyberg, A., Bernin, P. & Theorell, T. (2005). The impact of leadership on the
health of subordinates. SALTSA: Report No 1: 2005.
Ohlström, Ann (1997). Uttryck – intryck – avtryck – Om terapeuters påverkan
på gruppen. Observationer av fem gruppledare och deras grupper. Institutet för
Psykoterapeutisk Psykiatri.
Podsakoff, P.M., Todor, W.D., Grover, R.A., & Huber, V.L. (1984). Situational
moderators of leader reward and punishment behaviour: Fact or fiction?
Organizational Behaviour and Human Performance, 34, 21-63.
Sanne, B., Mykletun, A., Dahl, A., Moen, B., & Tell., G. (2005). Testing the Job
Demand-Control-Support model with anxiety and depression as outcomes: the
Hordaland Health Study. Occup Med (Lond), 55(6), 463-73.
Siegrist, J. & Peter, R. (2000). The effort-reward imbalance model. Occupational
Medicine, 15, 83-87.
Stewart, R. (1982). Choices for the manager: A guide to understanding managerial work.
Englewood Cliffs, NJ: Prentice-Hall.
Stogdill, R.M. (1974). Handbook of leadership: A survey of the literature. New York:
Free Press.
xi
Svensen, E., Lie, S.A., & Eriksen, H.R. (submitted) Leadership and Health. A
multilevel analysis of the relative importance of individual perception of
leadership.
Sy, T., Coté, S., & Saavedra, R. (2005). The Contagious Leader: Impact of the
Leader’s Mood on the Mood of Group Members, Group Affective Tone, and
Group Processes. Journal of Applied Psychology, 90, 295-305.
Tollgerdt-Andersson, I. (2005). Ledarskap och sjukfrånvaro. En jämförande
studie av arbetsplatser med hög respektive låg sjukfrånvaro. Göteborg: FoU i
Väst.
Yukl, G. (1989). Managerial Leadership: A review of Theory and Research.
Journal of Management, Vol. 15, No.2, 251-289.
Zaleznik, A. (1970). Power and politics in organizational life. Harward Business
Review, pp.67-78
xii