The study examined the relationship between transformational leadership, empathy and its impact on quality of health care services provided to the patients. The study used two types of questionnaires: a leadership inventory index (LPI) to measure the employees and the Consumer Assessment of Healthcare Providers and Systems (CAHPS) to measure the quality of services provided to the patients at Universiti Sains Malaysia Hospital, Malaysia. The results found that there is a significant relationship between transformational leaders and empathy, but there is no significant relationship between leadership effectiveness and service quality. The study found that the patients were satisfied with the quality of the services that they received at Universiti Sains Malaysia’s hospital.

Keywords:  Empathy, Leadership, Health care, Services.

DOI: 10.20448/802.41.50.56

Citation | Wan Afezah Wan Abdul Rahman (2017). Transformational Leadership and Empathy: The Impact of Quality in the Health Care Services in Kelantan, Malaysia. International Journal of Economics, Business and Management Studies, 4(1): 50-56.

Copyright: This work is licensed under a Creative Commons Attribution 3.0 License

Funding : This research was supported by Universiti Sains Malaysia, under The Short-Term grant (Grant no. 304/PJJAUH/6313205 304/PJJAUH/6313205).

Competing Interests: The author declares that there are no conflicts of interests regarding the publication of this paper.

History : Received: 25 May 2017/ Revised: 22 June 2017/ Accepted: 30 June 2017/Published: 6 July 2017

Publisher: Online Science Publishing


Transformational leadership is a style of leadership where the leaders are believed to have a high level of emotional intelligence (Prati et al., 2003). Transformational leaders are defined as leaders with inspirational values who have the ability to nurture and identify their employees’ talents, thereby motivating them to their fullest potential (Jogulu and Wood, 2008). This style of leadership allows the leader to nurture employees and handle conflicts efficiently. In order to be able to handle conflicts efficiently, transformational leaders must have high social awareness to be able to make their employees feel important and appreciated.

Empathy skills help these leaders to nurture relationships within the organization while inspiring, empowering, and encouraging employees to achieve the organizational objectives. By providing leaders with the capability to think beyond workplace limitations, empathy helps leaders adapt to different workplace dynamics; thus, they fit better in any surroundings. In the same vein, these leaders will have the ability to accurately assess other peoples’ emotions and embrace the needed changes.

One of the changes is to provide high quality and affordable health care services. Providing high quality and affordable health care services is an increasingly difficult challenge in today’s customer driven market. In health care services, giving better services, charging economical fees, reducing mistakes and increasing patients’ satisfaction are among the factors that need to be considered in order to meet their patients’ expectations (Ramanujam, 2011).

1.1. Transformational Leadership

Transformational leadership is closely linked to empathy because transformational leaders share vision, have better communication, and have better relationships with their employees (Rosete and Ciarrochi, 2005). On top of that, transformational leaders have a strong commitment to their employees by ensuring that they have all the resources needed to perform their job and reward employees accordingly. Transformational leaders are also perceived as effective leaders who have the ability to understand and manage the emotions of others, thereby inspiring employees in the workplace. Transformational leaders nurture, inspire and encourage employees to achieve the organizational goals. Meanwhile, empathy helps these leaders understand their employees’ concerns and needs.

Gardner and Stough (2002) noted that empathy is linked to transformational leadership; their research used the Multifactor Leadership Questionnaire (MLQ) and the Swinburne University Emotional Intelligence Test (SUEIT). Results from Gardner and Stough indicated that leaders who have empathy understand the emotions as well as the views of others and thus contribute to leadership effectiveness. The results also suggested that empathy as one of the main components in emotional intelligence gives leaders the ability to handle stress, disappointment, and frustration at work. Gardner and Stough’s research provided preliminary evidence for recommending SUEIT to develop emotional intelligence in current leaders. Spears (1998) stated that in relation to emotional intelligence, transformational leadership is the best approach to life and work because transformational leaders are able to develop better strategic plans that bring the organization to higher ground (Rosete and Ciarrochi, 2005).

Rubin et al. (2005) viewed transformational leaders as leaders with sensitivity towards the needs of followers; they show their constituents empathy and help them learn how others feel. The leaders are viewed as people who tend to the emotional requirements of each individual employee; they envision the future, encourage group work, challenge the minds of their followers, set high expectations, and act as role models. In addition, transformational leadership has been associated with leadership effectiveness because transformational leaders are able to use their ability to understand others, give support, and provide encouragement in productive ways.

Transformational leaders are defined as leaders with inspirational values who have the ability to nurture and identify their employees’ talents, thereby motivating them to their fullest potential (Jogulu and Wood, 2008). By providing leaders with the capability to think beyond workplace limitations, empathy helps leaders adapt to different workplace dynamics; thus, they fit better in any surrounding.

Scholars such as Tang et al. (2010) noted that transformational leaders who are armed with empathy skills have characteristics such as better planning, encouragement, communication, trust, enthusiasm, positivity, confidence, motivation, and productiveness that contribute to leadership effectiveness. Furthermore, in countries where the culture is highly collectivist such as Taiwan, China, Korea, and Malaysia (Hofstede and Hofstede, 2005) leaders are known for their ability to act as role models to their employees, promote cooperation, and provide support. These leaders use empathy to understand their employees’ emotions and help bring about the best decisions to fit organization needs. According to Bass (1990) transformational leaders are leaders who are focused on their employees’ concerns and needs. These leaders enable their employees to look at the issues at hand in positive ways, overcome them, and work harder to achieve group goals. In addition, transformational leaders are individuals whose behaviors lead to higher employee satisfaction, higher productivity, and lower employee turnover. Bass also stated that these leaders treat their followers as individuals and spend time coaching and listening attentively to their concerns. Boseman (2008) asserts that transformational leadership has the ability to boost employees’ enthusiasm towards putting extra effort into performing their roles far above expectations; employees are thus perceived to be more satisfied, productive, optimistic, and high-spirited. Essentially, transformational leadership creates dedication to organizational goals and encourages followers to achieve these goals which translates to better performance (Stone et al., 2004).

Parolini et al. (2009) describe transformational leaders as moralistic people who inspire their followers. These leaders transform their followers’ personal interests into collaborative interests by making them see the importance of collaborative efforts. In addition, transformational leaders are ethical because they use encouragement rather than coercion to transform a follower’s personal interests into collaborative interests. Transformational leaders harness the self-interests of their followers so that the followers can further the goals of the organization; they create an atmosphere where relationships can be formed and goals shared. In the same vein, transformational leaders motivate other people and use interactive communication, thereby creating strong bonds between leaders and their followers. By approaching problems from different perspectives, these leaders stimulate their followers’ attempts to be creative, reward their followers for their innovative problem-solving abilities and ensure that their individual goals complement those of the organization.

1.2. Empathy

Goleman (1995) emphasized that empathy is pivotal for leaders because it is positively related to the innate motivation of followers. Empathy is helpful when solving problems in the workplace because it enables leaders to make immediate connections with employees, facilitates a more accurate assessment of employee performance, and yields better outcomes. The need for empathy is increasingly important in the workplace where shared vision and openness are critical factors for success. Thus, possessing empathy helps a leader to understand his/her employees, such as understanding their pain and what it is like to be in their positions. Additionally, empathy is a vital skill for successful leadership since leaders who have a high degree of empathy towards their employees are in a position to become more effective leaders.

According to Hoffman (2009) empathy is crucial because without this quality, leaders are not able to connect with their people and inspire or motivate them towards achieving a shared vision, especially during difficult times. In today’s environment and rapid globalization, research states that empathy has become increasingly important to leaders to be able to transform and adapt to the situation.  During organization expansion or relocation, in order to be effective, transformational leaders who have empathy skills need to have an open mindset and the ability to adapt quickly to the surrounding work environment (Goleman, 2000; Feng et al., 2004; Choi, 2006; Atwater and Waldman, 2008) . Goleman (1995) emphasized that empathy is a very important tool and a must-have virtue for leaders because empathy can inspire, motivate, envision, and lead others to greater effectiveness. Goleman added that empathy has an important role in leadership because empathy enables leaders to connect with their people.  Empathy also ensures that connections occur between people so that everybody is included and no employee feels left out, and as such, an empathic leader is perceived as an effective leader (Cockerell, 2009). Because of empathy, leaders have the ability to connect with employees beyond expectations, leading to effective leadership. Empathy gives leaders the ability to read and be aware of people’s emotions; thus, leaders are able to perform critical leadership activities (Mooradian et al., 2011). Previous research also showed that high level of empathy contributed significantly to effective leadership (Wan Afezah and Castelli, 2013).

1.3. Quality of Service

Quality service is reflected in today’s health care centers in a wide variety (Choi, 2006). It has been recognized as pivotal in getting, retaining and satisfying the customers’ needs (Jabnoun and Al Rasasi, 2005). Quality service in health care specifically refers to the level of outcome where patient satisfaction is the main aspect in judging by the services provided by the health providers (Gupta and Rokade, 2016). Quality service also refers to how well a delivered service satisfies the client's expectations. The services in a hospital may include clinical outcomes, services received by the patients that make a medical difference in the lives of the patients. These medical treatments can include everything from doctor’s appointments, consultations, treatments, procedures, waiting times and medications (Hughes, 2008). Service relates to what the medical staff can do to make the patients’ experience better and make them feel good. Choi et al. (2002) also noted that quality service is an important ingredient of the success of an organization based on its primary role of achieving patient satisfaction. These include communication, response, amenities, level of empathy and the quality of the care that they receive. High quality services are essential in order to promote positive behaviors, increase life expectancy, and reduce mortality in compliance with health care regulations. High quality care can be achieved through daily teamwork, collaboration and communication. Because of this, the right style of leadership is very important in the pursuit of achieving high quality health care by ensuring fewer mistakes (Hughes, 2008). Quality health care involves three aspects: the quality, cost and accessibility of health care to individuals and populations. Providing better quality of health care also results in accessible and competent pharmaceutical services.

Most of the hospitals are trying to improve the quality of their services and fulfilling the needs of the patients. In a study done by Jabnoun and Al Rasasi (2005) UAE hospitals using five dimensions of SERVQUAL such as reliability, responsiveness, tangibles, assurance and empathy found that transformational leadership has a significant relationship with quality of service and performance. The results supported previous studies that associated transformational leadership with higher performance among the employees. The study also showed that the higher the level of empathy leaders have, the better the performance they get from employees which leads to better levels in quality of services received by the patients.

Another study also showed that customers get better quality services when the employees feel motivated and have a clear vision and a bonding with the leaders (Lee et al., 2011). The study noted that the style and skills of leaders give significant impacts towards employees’ behaviors, thus leading to better team performance.


Two types of questionnaires were used in the research; the first one was a leadership inventory index (LPI) to measure the employees and the other was the Consumer Assessment of Healthcare Providers and System (CAHPS) to measure the quality of services provided to the patients. A 5-point Likert scale was used in the study. The participants are the patients and employees at Universiti Sains Malaysia Hospital, Malaysia. The data was collected by the researcher and analyzed using SPSS 22. The results from the research are presented in the findings below.


The total number of respondents is 805 and the majority of the employees who participated in the study were female (69.5%) while the majority of patients who participated in the study were also female (73.2%). Most of the employees have a college/university diploma, compared to the patients mostly had high school diplomas.

The Kaiser-Meyer-Olkin (KMO) and Bartlett’s Test of Sphericity tests were used to measure factor analysis. According to Table 1, the result for the KMO test was 0.927 and the result of Bartlett’s Test of Sphericity showed that the data did not have multicollinearity problems and the correlation between the items was sufficient to perform the factor analysis, where p < 0.05.

Table-1. KMO and Bartlett’s Test
Kaiser-Meyer-Olkin Measure of Sampling Adequacy. .927
Bartlett's Test of Sphericity Approx. Chi-Square 6769.810
  df 351
  Sig. .000
Source: Result from SPSS 22

Reliability analysis was carried out to ensure that the instruments used in the study were stable and consistent. As showed in Table 2, the alpha value was .94 for leadership and was 0. 93 for the quality of the service offered.

Table-2. Reliability Analysis
Variable Cronbach’s Alpha No. Of Items
Leadership Effectiveness .944 13
Service Quality .933 14
Source: Result from SPSS 22

Mean score and standard deviation were shown in Table 3. The score for leadership effectiveness, service quality as well as overall service quality were perceived as high by the respondents.

Table-3. Mean Scores and Standard Deviation
Variables Mean Standard Deviation Results
Leadership Effectiveness 4.24 0.545 High
Service Quality 4.31 0.550 High
Overall Score of Service Quality at HUSM 8.17 1.467 High
Source: Result from SPSS 22      

Overall, the research found that the patients were satisfied with the level of the service they received from the hospital. The research found that transformational leaders and empathy do have a significant impact towards employee behavior.


Transformational leadership enables leaders to inspire, mobilize, communicate, motivate and enhance employees’ performance to reach the organizational goal. It means great leaders with certain skills do what it takes to accomplish any goals that they set in their minds in order to improve the quality of the services for the benefit of the staff, the customers and the organization itself. Empathy helps leaders to better understand the employees and the patients in fulfilling their needs. Transformational leadership combined with empathy has a significant impact on the quality of the services performed by the employees. Good quality health care service means providing the patients with higher satisfaction, promoting and enhancing health care services, increasing efficiency and patient outcomes, and reducing mistakes and costs.

The employees observed that their leader had high leadership values in regards to treating the employees with respect and courtesy, encouraging a sense of cooperation and having a good relationship in the workplace. The study showed that the patients received high quality healthcare services from the employees in regards to professionalism and great attitudes. The patients were satisfied with the treatment given and things were explained in a way that was easily understood. The study supports the previous research where it showed that the higher the level of empathy, the better the leadership and the level of quality of health care services provided to others.


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