رهبری اخلاقی، مراقبان حرفه ای رفاه، و بیماران ادراکات کارکنان از کیفیت مراقبت در سرطان Ethical leadership, professional caregivers’ well-being, and patients’ perceptions of quality of care in oncology

1. Introduction For almost three decades, numerous studies have carefully built a body of knowledge about the effects of healthcare professionals’ practice environment factors and work characteristics (e.g., management at the unit level, hospital management, organizational support) on their psychological health and quality of care (Jones et al., 2013). Indeed, many work-related factors may influence quality of care. For instance, transformational leadership practices are associated with high quality of care and weak turnover intentions. Conversely, abusive leadership practices relate to poorer quality of care and strong turnover intentions in a sample of nurses working in different units (Lavoie-Tremblay et al., 2016). In the nursing context, Wong and Laschinger (2013) also showed that the more managers are seen as authentic, by emphasizing transparency, balanced processing, self-awareness, and high ethical standards, the more nurses are satisfied with their work and report higher performance. Furthermore, leaders who are able to create empowering work environments facilitate a range of positive work attitudes and behaviors among their subordinates (Bawafaa et al., 2015). Finally, ethical leadership predicts workers’ well-being (e.g., work engagement) (Chughtai et al., 2015). More generally, in the healthcare setting, the dominant approach has been to model simple sets of relationships whereby work-related factors are hypothesized to impact outcomes (e.g., well-being, quality of care) through unspecified or untested mechanisms. In addition, oncology studies on the determinants of healthcare professionals’ wellbeing (i.e., experiencing high levels of positive affective states; Van Katwyk et al., 2000) and patients’ perceptions of quality of care (i.e., patients’ response given to their health care needs and expectations; Brédart et al., 2005) have been quite rare (Brown, 2014). However, some studies, outside of the oncology setting, showed that work-related factors had a significant impact on healthcare professionals’ well-being (e.g., life satisfaction), which in turn significantly related to the patient experience and perceived quality of care (Montgomery et al., 2011). For instance, Shirom et al. (2006) showed that overload indirectly predicted poor quality of care through its effect on physicians’ burnout in a sample of specialists representing six medical specialties. Van Bogaert et al. (2014) also examined, in a sample of 1201 acute care staff nurses, the mechanisms (i.e., workload, social capital, decision latitude, and burnout) through which nurse practice environment dimensions related to nurse-assessed quality of care. The studied participants were registered nurses working in medical and surgical units, intensive care and medium care units, emergency room, operation theatre, and post anesthetic care units. Moreover, nurses’ work engagement, conceptualized as an indicator of well-being (Hakanen and Schaufeli, 2012), mediated the relationship between ward service climate and patient-centered care in a sample of nurses working in 40 wards of retirement homes (Abdelhadi and Drach-Zahavy, 2012). Despite these encouraging findings, the relationships between ethical leadership, well-being, and patients’ perceptions of quality of care have not yet been investigated. More generally, few studies sought to examine the mechanisms by which managerial practices have indirect effects on perceptions of quality of care (Westerberg and Tafvelin, 2014), especially in the oncology setting. We aimed to fill this gap in the present research and felt that this work may enhance our knowledge regarding the processes involved in delivering good quality of care. We may also identify modifiable factors that could be targets for managerial interventions.