From Shadows to Spotlight: Courageous Followers Shape Leaders Perceptions and Influence Followers' Job Performance

Area of Science:

• Healthcare Management
• Organizational Behavior
• Followership Theory

Background:

• Traditional healthcare leadership models overlook the active role of followers.
• Nurses significantly influence leadership, culture, and performance through their behavior.
• Courageous followership (accountability, integrity, speaking up) is crucial but underexplored in hierarchical healthcare settings.

Purpose of the Study:

• To investigate the impact of courageous followership on leaders' implicit followership theories (LIFTs).
• To examine the effect of courageous followership on followers' job performance.
• To explore LIFTs as mediating mechanisms in healthcare teams.

Main Methods:

• A cross-sectional survey design was employed with 472 healthcare professionals in Pakistan.
• Partial least squares structural equation modeling (PLS-SEM) was used to analyze data.
• Direct and mediated relationships between courageous followership dimensions, LIFTs, and job performance were tested.

Main Results:

• Four dimensions of courageous followership (assume responsibility, serve, challenge, participate in transformation) positively influenced LIFTs and job performance, with LIFTs acting as a mediator.
• "Taking moral action" showed a negative effect, indicating potential issues with ethical dissent in high power-distance environments.
• The structural model exhibited strong explanatory and predictive power (Q² for LIFT = 0.587, Q² for performance = 0.478).

Conclusions:

• This study integrates followership theory and implicit followership theories, highlighting followers' agency in shaping leadership perceptions and outcomes.
• It advocates for a relational, follower-focused understanding of healthcare leadership, moving beyond leader-centric views.
• Findings emphasize the importance of follower courage, ethics, and behavior in healthcare leadership dynamics.