Leadership & Organization Development Journal

Investigating the impact of ethical leadership on aspects of burnout

Afokoghene Z. Okpozo, Tao Gong, Michele Campbell Ennis, Babafemi Adenuga,
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Afokoghene Z. Okpozo, Tao Gong, Michele Campbell Ennis, Babafemi Adenuga, (2017)
"Investigating the impact of ethical leadership on aspects of burnout", Leadership & Organization
Development Journal, Vol. 38 Issue: 8, pp.1128-1143, https://doi.org/10.1108/LODJ-09-2016-0224
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LODJ
38,8 Investigating the impact of ethical
leadership on aspects of burnout
Afokoghene Z. Okpozo
Duquesne University, Pittsburgh, Pennsylvania, USA
1128
Tao Gong
Received 17 September 2016 University of Maryland Eastern Shore, Princess Anne, Maryland, USA
Revised 6 February 2017
1 May 2017
Michele Campbell Ennis
Accepted 16 May 2017 Wicomico County Department of Human Resources, Salisbury,
Maryland, USA, and
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Babafemi Adenuga
Howard University Hospital, Washington, District of Columbia, USA

Abstract
Purpose – The purpose of this paper is to investigate the effect of ethical leadership on the burnout process
among resident physicians, and the mediating roles of general self-efficacy and perceived supervisor support
(PSS) in the relationship between ethical leadership behavior and various aspects of burnout.
Design/methodology/approach – A total of 203 residents of three teaching hospitals in the South Atlantic
Division of the USA completed the Maslach Burnout Inventory-Human Services Survey, the General
Self-Efficacy Scale, and Survey of Perceived Supervisor Support and rated the ethical leadership of their
supervising attending physicians on the Ethical Leadership Scale. Confirmatory factor analysis and path
analysis were conducted to test the measurement and hypothesized structural models.
Findings – The results showed that ethical leadership had a negative indirect effect on emotional exhaustion
through PSS and a positive indirect effect on personal accomplishment through general self-efficacy.
However, PSS and general self-efficacy did not mediate the relationship between ethical leadership and
depersonalization.
Originality/value – This study adds to the body of knowledge on the impact of ethical leadership on three
aspects of burnout syndrome, i.e., emotional exhaustion, depersonalization and personal accomplishment.
Moreover, this is the first study to consider PSS and general self-efficacy as intervening variables to the
ethical leadership-burnout relationship.
Keywords Burnout, Ethical leadership, General self-efficacy, Perceived supervisor support,
Resident physicians
Paper type Research paper

1. Introduction
Burnout is a psychological and pathological syndrome of emotional exhaustion (the feelings of
exhaustion by one’s work), depersonalization (an impersonal response toward recipients of
one’s services) and reduced personal accomplishment (the feelings of competence and
successful achievements in one’s work with people). Burnout has been associated with
impaired job performance, poor mental and physical health and deterioration in relationships
with family and friends (Becker et al., 2006). Stress-related symptoms, increased substance
abuse, the increased risk of anxiety, depression and lowered self-esteem are other negative
physical and mental health outcomes associated with burnout (Maslach et al., 2001).
A review of the literature revealed that there is a high prevalence of burnout syndrome
among resident physicians who are medical school graduates during residency training in a
specialized area of medicine (Dyrbye et al., 2010; IsHak et al., 2009). Residency is considered a
Leadership & Organization
Development Journal stressful and overwhelming period for the reason that residents work long hours, and the
Vol. 38 No. 8, 2017
pp. 1128-1143
lives of others depend on them as they increase their medical knowledge base exponentially
© Emerald Publishing Limited
0143-7739
(Thomas, 2004). Residents have the license to practice medicine, but they are not
DOI 10.1108/LODJ-09-2016-0224 autonomous in patient care (Coats and Burd, 2002). Residents depend on the knowledge and
 support of attending physicians or faculty who are medical doctors that have completed an Impact
accredited residency program, and usually would have obtained specialty board of ethical
certification in order to improve on their medical skills as their education progresses. leadership
The high dependency on the evaluations of attending physicians to start, continue and
successfully finish their education would further contribute to stress in residency
(Geurts et al., 1999). Geurts et al. (1999) suggested that residents had limited control over
their tasks and conduct during the work day, as their activities were highly supervised, 1129
evaluated and judged by superiors. This did not necessarily imply that the residents
experienced a supportive relationship with superiors. In fact, high dependency on a superior
who continuously evaluates and judges the activities of residents was likely to be
experienced as troublesome. These were considered as some of the situations that set the
stage for residents to develop burnout (Thomas, 2004).
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Previous studies have linked supervisory leadership to the occurrence or prevention

of burnout. For example, some studies considered the relationship between burnout
and multidimensional leadership (Hetland et al., 2007), transformational leadership
(Gong et al., 2013; Kanste et al., 2007; Stordeur et al., 2001) and authentic leadership theories
(Laschinger et al., 2012). In these studies, researchers demonstrated significant linkages and
predictions between leadership behaviors on some, or all of the burnout constructs.
However, most of these studies were narrowly focused on the impacts that transformational
and authentic leadership behaviors have on burnout symptoms without considering
the moral impact leaders tend to have on the conduct of subordinates in organizations
(Aronson, 2001; De Hoogh and Den Hartog, 2008; Treviño et al., 2003).
The perceptions of the leader’s personal traits, character and altruistic motivation
represents the moral person aspect of ethical leadership (Treviño et al., 2003). The reputation
of organizational leaders depends on their morality beliefs as persons, managers or
executives. Attributes of the ethical leader such as trustworthiness, fairness, integrity and
the ability to make fair and balanced principles was the rationale for selecting this form of
leadership in addressing burnout in this study. Ethics is concerned with the kinds of values
and morals an individual or society considers desirable or appropriate. In regards to
leadership, ethics expresses what leaders do and who leaders are (Northouse, 2013). Ethical
leaders are socially responsible and care about the ethical standards of the organization.
They are concerned about multiple stakeholders, the common good, the community and
society (Bass, 2008). Social responsibility of leaders includes their moral-legal standard of
conduct, internal obligation, concern for others, concern about consequences and
self-judgment (Dehoogh and Den Hartog, 2008). Based on their study, DeHoogh and
Den Hartog (2008) found a significant positive relationship between social responsibility
and the combined scale for ethical leadership, as well as underlying components of ethical
leadership, namely morality, fairness and role clarification. The values, moral development,
conscious intentions, freedom of choice, use of ethical and unethical behavior and types of
influence used are some criteria relevant for judging leaders (Yukl, 2006).
Ethical leadership is uniquely important because this form of leadership is to promote
ethical conduct at work and set and communicate ethical standards of the organization
(Brown and Mitchell, 2010). Ethical leaders engage in open communication, clarification of
expectations and responsibilities, so that employees are clear on what the organization and
society expects of them (Brown et al., 2005), and the residents who are the supervised by
such leaders may develop no or less burnout syndrome. As many studies have shown,
ethical leadership has significant positive relationship with important follower outcomes,
such as employees’ job satisfaction, organizational commitment, organizational
identification, willingness to report problems to supervisors, optimism about future,
self-efficacy and employee performance (Brown et al., 2005; DeHoogh and Den Hartog, 2008;
Kalshoven et al., 2011; Walumbwa et al., 2011), and significant negative relationships with
 LODJ work-related stress, emotional exhaustion, employee well-being and turnover intentions
38,8 (Elçi et al., 2012; Yang, 2014; Zheng et al., 2015). Thus, the purpose of this study was to add
to the budding literature on ethical leadership by examining the relationship between ethical
leadership and burnout in post graduate medical education and the mechanism through
which ethical leadership relates to the various aspects of burnout.

1130 2. Theory and hypothesis development

2.1 Ethical leadership
Brown et al. (2005) defined ethical leadership as “the demonstration of normatively
appropriate conduct through personal actions and interpersonal relationship, and the
promotion of such conducts to followers through two-way communication, reinforcement
and decision-making” (p. 120). They suggested two major constructs of ethical leadership;
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a moral person and a moral manager. Such a leader is approachable and shows concern for
others (Brown and Mitchell, 2010). Ethical leaders are consistently moral in both their
personal and professional lives, and as moral managers, they use the tools of their position
of leadership to promote ethical conduct at work (Brown and Mitchell, 2010). They are firm
and communicate ethical standards of the organization, by utilizing reward and
punishments as tools to ensure these standards are followed.
2.1.1 Ethical leadership and burnout. According to Maslach and Goldberg (1998),
burnout was described as an important social problem that is a type of prolonged response
to chronic emotional and interpersonal stressors on the job. The researchers described
burnout as an individual stress experience embedded in a context of complex social
relationships, and it involves the person’s conception of both self and others. Though prior
work on ethical leadership suggested a direct influence of ethical leadership on positive
employee outcomes such as motivation, follower’s satisfaction and organizational
commitment (Brown and Treviño, 2006), studies on the direct effect of ethical leadership
on the aspects of burnout are scarce. Elçi et al. (2012) found a significant negative
relationship between ethical leadership and work-related stress. Leaders perceived as ethical
were able to reduce work-related stress, because they were supportive, created a structured
pleasurable work environment, engaged in open communication with employees, and
ensured job expectations and responsibilities were clear to employees. Zheng et al.’s (2015)
study found the relationship between ethical leadership and emotional exhaustion was both
direct and indirect through team cohesion using a sample of 338 military personnel.
The results revealed high levels of ethical behavior provided subordinates with certain
resources that protected them from emotional exhaustion. However their study focused only
on emotional exhaustion without considering the other two aspects of burnout,
depersonalization and personal accomplishment. Interestingly, Mo and Shi’s (2017) study
suggested no direct impact of ethical leadership on employee burnout using data from
45 team leaders and 247 employees in a pharmaceutical retail chain company. They considered
burnout as a one-dimensional construct and employee’s trust in leaders and surface acting as
mediators in the relationship between ethical leadership and employee burnout.
A relevant study by Yang (2014) hypothesized a positive but found a significantly negative
relationship between ethical leadership and employee well-being using two alumni samples
from the same college in Taiwan. The study’s explanation for this unexpected finding was that
the higher levels of ethical conducts that ethical leaders display at work could induce pressure
which causes employees to develop distress in workplace.
Ethical leaders are attractive and credible role models that stress moral values in their
decision making, and verbally persuade their followers by clarifying responsibilities, expectations
and showing them how their efforts and tasks will significantly contribute to meeting
organizational goals (DeHoogh and Den Hartog, 2008). Additionally, through social exchange,
 they show interest in the well-being of their followers, and listen to their ideas and concerns, Impact
thereby creating a positive and psychologically safe work environment (Walumbwa et al., 2011). of ethical
Hence, we proposed: leadership
H1a. Ethical leadership behaviors of attending physicians will lead to lower levels of
emotional exhaustion among residents.
H1b. Ethical leadership behaviors of attending physicians will lead to lower levels of 1131
depersonalization among residents.
H1c. Ethical leadership behaviors of attending physicians will lead to higher levels of
personal accomplishments among residents.
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2.2 Ethical leadership and self-efficacy

According to Schwarzer and Hallum (2008), general sense of self-efficacy refers to “global
confidence in one’s coping ability across a wide range of demanding or novel situations”
(Schwarzer and Hallum, 2008, p. 154). By means of general self-efficacy, individuals can have a
stable sense of personal competence to deal effectively with a variety of stressful situations.
Residents should possess a sense of general self-efficacy as they constantly attend to diverse,
unpredictable medical conditions. In organizations, highly self-efficacious people tend to
possess the ability to invest more effort and persist longer in their job-related tasks than those
low in self-efficacy (Schwarzer and Hallum, 2008). Self-efficacy beliefs are enhanced from four
sources of information: enactive mastery experiences (personal attainment), vicarious
experiences (modeling), verbal persuasion and physiological or affective states
(Bandura, 1977).
Ethical leaders fosters confidence and autonomy among subordinates; thereby boosting
subordinates’ self-efficacy levels which will in turn reduce the incidence or levels of
burnout in organizations. We based this assumption leaning on the social learning theory
(Bandura, 1977) and social cognitive theory (Bandura, 1997), as suggested by
Walumbwa et al. (2011). By means of the social learning perspective, ethical leaders
through direct modeling help employees to be more confident in their behavioral and
motivational patterns. Notably, ethical leaders demonstrate a power-sharing behavior which
gives followers more control and makes them less dependent on leaders, thereby,
strengthening their efficacy beliefs. Such leaders are capable of reducing the risk of burnout
in the work environment as they provide training opportunities, and place employees in
situations that facilitate growth and confidence in their job-related skills through
observation or verbal persuasion (Walumbwa et al., 2011). Such leaders also demonstrate
directive behaviors that generate simple compliance behaviors in followers to help such
followers to either gain rewards or avoid punishment. In other cases, followers learn from
leaders modeling ethical behaviors, by observing behaviors that are determined by the
followers as the right way to act or the right way to be.
Research indicates that ethical leadership has a significant positive relationship with
self-efficacy (Chughtai, 2015; Walumbwa et al., 2011). Hence, we expected ethical leadership
to have a significant positive relationship with general self-efficacy in this study:
H2. Ethical leadership is positively related to general self-efficacy.

2.3 Ethical leadership and perceived supervisor support (PSS)

Supervisors support which stems from the organizational support theory has been
thoroughly researched, and seen to be the most influential of all organizational sources of
support in preventing burnout (Greenglass et al., 1996; Halbesleben, 2006; Rhoades and
Eisenberger, 2002). Other sources of organizational support include administrative support
 LODJ and co-worker support (peer support). Supervisor support is the degree to which employees
38,8 perceive that supervisors offer assistance, encouragement and concern (Burke et al., 1992).
Supervisors act as the agents of the organization, they have a responsibility to direct and
evaluate subordinates’ performance. Just as employees form global perceptions concerning
their evaluation by the organization, they develop general views concerning the degree to
which supervisors value their contribution and care about their well-being (Kottke and
1132 Sharafinski, 1988; Rhoades and Eisenberger, 2002). Employees view their supervisor’s
favorable or unfavorable orientation toward them as indicative of the organization’s support
(Eisenberger et al., 1986, 2002).
Dimensions of ethical leadership endorse such leaders as supportive in the workplace.
An influential theory for explaining this is the social exchange theory. Interactions within
social exchange theory are usually seen as interdependent and contingent on the actions of
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another person (Blau, 1964). Interdependence refers to the outcomes that are based on a
combination of parties’ efforts, and it is considered a defining characteristic of this theory.
Social exchange theory emphasizes that these interdependent transactions have the
tendency to generate high-quality relationships that evolve overtime into trusting, loyal and
mutual commitments (Cropanzano and Mitchell, 2005). The people-oriented, fairness and
role clarification dimensions of ethical leadership portrays such leaders as supportive.
For the most part, ethical leaders are people oriented and they genuinely respect,
support and care for subordinates to ensure that their needs are met (Kalshoven et al., 2011;
Treviño et al., 2003). When employees are given a voice in the evaluation process, treated
fairly in the allocation of rewards, and supported, a level of trust is developed for the leader
which will produce positive employee outcomes (DeConinck, 2010). Based on these
assertions, we hypothesized:
H3. Ethical leadership is positively related to PSS.

2.4 Mediating effect of general self-efficacy and PSS

Though we proposed a direct relationship between ethical leadership and burnout
constructs, we considered general self-efficacy and PSS as likely psychological and social
factors that would mediate this relationship. Self-efficacy is an important element that
ameliorates the burnout process in organizations. As a critical stress resource factor,
self-efficacy is effective in mitigating levels of burnout in employees (Brown, 2012).
Considering self-efficacy in the burnout process, low levels of self-efficacy is recognized as
a cause of burnout. Low self-efficacy represents inadequate coping responses to
challenging or stressful situations, which may eventually lead to emotional exhaustion
(Schwarzer and Hallum, 2008). Bandura (2000) observed that followers with low
self-efficacy in organizations experienced increased vulnerability to physical and
emotional exhaustion, depersonalization, lack of personal accomplishment and
occupational disengagement.
Ethical leadership was seen to enhance safety compliance and participation among 179
full-time medical doctors working in public sector hospitals in Pakistan (Chughtai, 2015).
The findings from this study indicated that ethical leaders inspired their subordinates to
comply with safety regulations and take extra measures to make the workplace safe by
empowering them and by levitating their self-efficacy. In another study conducted by
Chughtai et al. (2015), ethical leaders demonstrated positive and beneficial actions that
gained the trust of their employees. In such a high-quality relationship, followers were likely
to feel confident when they encountered job-related difficulties and this strengthened their
efficacy beliefs. Based on the research by Xanthopoulou et al. (2007), a strong sense of
self-efficacy makes employees less susceptible to emotional exhaustion, by off-setting the
health-impairing effects of job demands. Therefore, promoting ethical leadership is a useful
 strategy for reducing emotional exhaustion in the workplace, and enhancing the general Impact
self-efficacy of the subordinates is a critical means required to achieve this: of ethical
H4a. General self-efficacy will mediate the relationship between ethical leadership and leadership
emotional exhaustion.
H4b. General self-efficacy will mediate the relationship between ethical leadership and
depersonalization. 1133
H4c. General self-efficacy will mediate the relationship between ethical leadership and
personal accomplishment.
Observations made in residency have shown inadequate supervisory support correlated
substantially with occupational stress, burnout and medical errors made by health
professionals (Postgraduate Medical Education and Training Board, 2008; Prins et al., 2007).
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Researchers are beginning to scrutinize the importance of PSS on burnout among residents.
Supervisor support has been significantly associated with the emotional exhaustion,
depersonalization and work place reduced personal accomplishment constructs of burnout
among resident doctors (Prins et al., 2007; Sochos et al., 2012). Similarly, the rate of burnout
among residents within the USA in a cross-sectional study was significantly higher among
the residents who were dissatisfied with their clinical faculty (Martini et al., 2004).
Ethical leadership promotes positive work attitudes through support, which will in turn
lead to reduced burnout levels in followers. Ethical leaders offer support to subordinates by
role clarification and providing feedback, as a means of preventing adverse situations
dealing with job expectations, and uncertainties that tend to predispose subordinates to
burnout. Also, ethical leadership is a successful means for building and improving
communication with subordinates, as they depend on the feedback from their leaders to
become more effective in their tasks. For example, Chen and Hou (2016) found that followers
of ethical leaders are willing to provide suggestions and opinions which enhanced their
individual creativity in organizational operations. This is possible because ethical leaders
make their followers comfortable and provide a healthy work environment that followers
can voice in the decision-making process. In accordance, we proposed:
H5a. PSS will mediate the relationship between ethical leadership and emotional exhaustion.
H5b. PSS will mediate the relationship between ethical leadership and depersonalization.
H5c. PSS will mediate the relationship between ethical leadership and personal
accomplishment.

3. Method
3.1 Research participants and procedure
Research participants were resident physicians from seven departments, i.e., anesthesiology,
psychiatry, internal medicine, emergency medicine, obstetrics and gynecology, surgery and
family medicine, of three teaching hospitals in a state and district of the South Atlantic
Division in the USA. All participants were qualified graduates from an accredited medical
school. Prior to their involvement in the study, these residents were informed of the purpose
and voluntary nature of the study. A total of 214 responses were obtained of which 203 of the
surveys were usable (response rate of 36 percent). Male respondents (51.7 percent) slightly
outnumbered the female respondents (48.3 percent). A large number of the group had two
years of postgraduate training (33 percent), followed by those who had three years
(29.6 percent) and at least one year of postgraduate training (23.6 percent). Considering
the department representation, majority were from internal medicine (30.1 percent), surgery
(21.2 percent) and anesthesiology departments (16.7 percent).
 LODJ 3.2 Measures
38,8 3.2.1 Ethical leadership. Residents assessed the ethical leadership behavior of supervising
attendants using the ten-item Ethical Leadership Scale (ELS) (α ¼ 0.92) developed by
Brown et al. (2005). Sample survey items include “My leader listens to what employees have
to say” and “Sets an example on how to do things the right way in terms of ethics.” The ELS
is a six-point Likert scale ranging from (1) strongly disagree to (6) strongly agree.
1134 3.2.2 General self-efficacy. The General Self-Efficacy Scale (GSES) (α ¼ 0.90) consists of
ten items that measure optimistic self-beliefs used to cope with variety demands in life
(Schwarzer and Jerusalem, 1995). Sample items on the scale are “I can always manage to
solve difficult problems if I try hard enough” and “I can usually handle whatever comes my
way.” Each item is rated on a four-point Likert scale ranging from (1) not at all true to (4)
exactly true of which higher scores in the GSES generally indicate stronger self-efficacy.
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3.2.3 PSS. The levels of residents’ perceived support received from attending
physicians were assessed using the Survey of Perceived Supervisor Support (SPOS)
(α ¼ 0.88) designed by Eisenberger et al. (1986). The SPOS measures the global beliefs
regarding the extent to which their organizations care about the well-being of employees
and value their contributions. By substituting the word “supervisor” for “organization,”
the scale measures similar beliefs employees may have about their respective supervisors.
A sample item in the six-item scale includes “My supervisor shows little concern for me.”
Each item is rated on a six-point Likert scale ranging from (1 ¼ strongly disagree,
6 ¼ strongly agree).
3.2.4 Burnout. Levels of burnout were assessed using the Maslach Burnout
Inventory-Human Services Survey (MBI-HSS) (Maslach and Jackson, 1981) which
contains three subscales that assess the three aspects of the burnout syndrome (emotional
exhaustion (α ¼ 0.90), depersonalization (α ¼ 0.71) and personal accomplishment
(α ¼ 0.74)). Burnout is not considered as a dichotomous but a continuous variable
spanning from low to moderate to high degrees of experienced feelings. The instrument
includes 22 questions of which nine measures emotional exhaustion, five measures
depersonalization and eight measures lack of personal accomplishment. Sample items on
the MBI are “I feel frustrated by my job” for emotional exhaustion subscale, “I feel I treat
some recipients as if they were inanimate objects” for depersonalization subscale, and
“I have accomplished many worthwhile things in this job” for the personal
accomplishment subscale. Each question is rated on a seven-point Likert scale with
ranges from (0) never to (6) daily.

4. Results
Table I presents the means, standard deviations, correlations and internal consistencies
among the study variables. The Pearson correlational coefficients indicated that ethical
leadership had significant correlations with emotional exhaustion, depersonalization and

Variable M SD 1 2 3 4 5 6

1. Ethical leadership 4.74 0.82 (0.92)

2. Supervisor support 4.67 0.84 0.70** (0.88)
3. Self-efficacy 3.15 0.43 0.32** 0.31** (0.90)
4. Emotional exhaustion 3.38 1.17 −0.35** −0.38** −0.21** (0.90)
Table I. 5. Depersonalization 2.23 1.08 −0.19** −0.20** −0.13 0.54** (0.71)
Descriptive statistics, 6. Personal accomplishment 4.65 0.71 0.23** 0.23** 0.34** −0.16* −0.26** (0.74)
correlations and scale Notes: n ¼ 203. The internal consistency Cronbach’s α coefficients are reported in diagonal. *p o0.05;
internal consistencies **p o 0.001 (two-tailed)
 personal accomplishment. More than half of the residents experienced emotional exhaustion Impact
and depersonalization at least a few times a month and personal achievement at least once of ethical
a week. leadership
Prior to examining the hypothesized structural model (Figure 1), confirmatory factor
analysis was implemented to validate the measurement model of latent constructs. Based on
the fit criteria recommended by Bagozzi and Yi (1988) that factor loadings should not be
smaller than 0.5, seven items were removed from the MBI due to low loadings to achieve a 1135
satisfactory fit. In particular, four items were removed from the emotional exhaustion
construct, two items from depersonalization and one item from personal accomplishment
constructs of the scale. Each of the remaining items for burnout, ethical leadership, supervisor
support and general self-efficacy constructs was significantly loaded to their respective
latent variable. Analysis results indicated the measurement model has an adequate fit,
χ2 (840) ¼ 1,209.692, po0.001, RMSEA ¼ 0.047, CFI ¼ 0.919 and SRMR ¼ 0.041.
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The hypothesized structural model, as well as two alternative models, was analyzed.
The model fit results are presented in Table II. Model I refers to the hypothesized structural
model where PSS and general self-efficacy mediate the relationship between ethical
leadership and the three burnout syndromes. We allowed the disturbance terms for
emotional exhaustion, depersonalization and personal accomplishment to covary in order to
account for the systematic statistical correlations among the three dimensions of burnout.
Model II dropped the direct paths from ethical leadership to emotional exhaustion,
depersonalization and personal achievement. Model III dropped the direct paths from ethical
leadership to PSS and general self-efficacy, regarding these two mediators as exogenous.
Inspection of the fit indices across models indicates that Model II fit the data best, χ2 ¼ 6.75,
df ¼ 5, p ¼ 0.240, RMSEA ¼ 0.042 less than 0.05, CFI ¼ 0.994 greater than 0.95, and
SRMR ¼ 0.031 less than 0.05. Dropping the direct paths from ethical leadership to emotional

Perceived –0.35* Emotional

supervisor exhaustion
–0.
support 18
**
0*
0.7

0.1
4

Depersonalization
Ethical
.10

leadership
–0

07
0.

–0.
32

General Personal Figure 1.

**
*

self-efficacy 0.30***
accomplishment Standardized
estimates for
the best model
Significant path Insignificant path

Model χ2 df Δχ2 Δdf CFI RMSEA SRMR AIC

1. Model I (hypothesized model) 3.59 2 0.995 0.063 0.023 41.585

2. Model II (no direct paths from ethical
leadership to three burnout dimensions) 6.75 5 3.16 3 0.994 0.042 0.031 38.745
3. Model III (no direct paths from ethical Table II.
leadership to perceived supervisor support Comparison of
and general self-efficacy) 161.03** 4 157.44 7 0.461 0.441 0.198 195.03 fit indexes for
Note: **p o0.001 (two-tailed) alternative models
 LODJ exhaustion, depersonalization and personal achievement did not fit the data significantly
38,8 worse than the hypothesized model (Δχ2 ¼ 3.16, Δdf ¼ 3, p W0.05), thus the more
parsimonious model is preferred (df ¼ 5 in Model II).
Based on these results, H1a-c that ethical leadership leads to lower levels of emotional
exhaustion and depersonalization and higher levels of personal accomplishment among
residents were rejected. Pictorial representation of significant and insignificant paths for the
1136 best model is illustrated in Figure 1.
As shown in Figure 1, H2 and H3 were supported as ethical leadership was found to be a
significant predictor of general self-efficacy ( β ¼ 0.32, po0.001) and PSS ( β ¼ 0.70, po0.001).
General self-efficacy was a significant positive predictor of personal accomplishment
( β ¼ 0.30, po0.001), but not emotional exhaustion and depersonalization. Furthermore, PSS
was a significant negative predictor of emotional exhaustion ( β ¼ −0.35, po0.05), and not a
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significant predictor of depersonalization and personal accomplishment.

To test for H4, the indirect effects of ethical leadership on the burnout constructs
through general self-efficacy and their significance levels were calculated and reported
in Table III. The results suggested that the indirect effect of ethical leadership through
general self-efficacy was significant for only personal accomplishment, p ¼ 0.004,
95 percent CI (0.106, 0.304), hence H4c was supported. Similarly, the results in Table IV
suggested that the indirect effect of ethical leadership through PSS was significant for
only emotional exhaustion, p ¼ 0.029, 95 percent CI (−0.271, −0.057), hence H5a
was supported.

5. Discussion
Ethical leadership behaviors demonstrated by attending physicians have an indirect effect
via PSS and general self-efficacy on burnout among residents in this study. Specifically,
perceived supervisor’s support mediated the relationships between ethical leadership and
emotional exhaustion and general self-efficacy mediated the relationship between ethical
leadership and personal accomplishment. However, ethical leadership did not have an
indirect effect on depersonalization among residents.

95 percent confidence interval

Effect Point estimate SE LB UB p-value

ELS → GSE → EE (H4a) −0.162 0.129 −0.220 0.047 0.213

Table III.
Exclusive indirect ELS → GSE → DP (H4b) −0.064 0.072 −0.108 0.036 0.356
effect of ethical ELS → GSE → PA (H4c) 0.338 0.080 0.106 0.304 0.004**
leadership through Notes: LB, lower bound; UB, upper bound; ELS, ethical leadership scale; GSE, general self-efficacy;
general self-efficacy EE, emotional exhaustion; DP, depersonalization; PA, personal accomplishment. **p o0.01 (two-tailed)

95 percent confidence interval

Effect Point estimate SE LB UB p-value

ELS → PSS → EE (H5a) −0.304 0.110 −0.271 −0.057 0.029*

Table IV.
Exclusive indirect effect ELS → PSS → DP (H5b) −0.079 0.062 −0.097 0.014 0.153
of ethical leadership ELS → PSS → PA (H5c) 0.077 0.068 −0.016 0.132 0.232
through perceived Notes: LB, lower bound; UB, upper bound; ELS, ethical leadership scale; PSS, perceived supervisor support;
supervisor support EE, emotional exhaustion; DP, depersonalization; PA, personal accomplishment. *p o0.05 (two-tailed)
 5.1 Theoretical implications Impact
Discussion on ethics is quite popular due to numerous scandals that occur in organizations, of ethical
and breaches in ethics can be grave or costly. Beyond the influence of ethical leadership on leadership
ethical related outcomes, employee attitude and performance, this leadership theory is
instrumental in the prevention of burnout. This adds to the body of knowledge on the ethical
leadership theory by investigating a significant outcome (burnout constructs), that have
been proposed to have consequential implications among employees of diverse 1137
organizations. Based on the call for future studies on ethical leadership by Brown and
Treviño (2006), and the test for more mechanism through which ethical leadership relates to
employee outcomes (Walumbwa et al., 2011), two mediators were examined in this study.
This was the first study to consider PSS and general self-efficacy as intervening variables to
the ethical leadership-burnout relationship. Ethical leadership was instrumental in
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preventing emotional exhaustion by increased level of perceived support from leaders.

Furthermore, ethical leadership enhanced the personal accomplishment of followers by
strengthening their coping skills through high levels of self-efficacy, in diverse medical
training situations.
The findings of this study indicated that attending physicians who demonstrated ethical
leadership behaviors boosted the general self-efficacy of the residents under their charge.
Ethical leaders enhance followers’ self-efficacy by monitoring, and guiding them in the work
process. Such leaders view the developmental needs of their followers as paramount, and
place them in situations that encourage their advancement and confidence at work
(Zhu et al., 2004). Furthermore, attending physicians who demonstrated ethical leadership
behaviors, gave residents a voice in decision making, and listened to what residents had to
say. Through the verbal persuasion technique of social cognitive theory, the attending
physicians perceived as ethical were able to strengthen the residents’ efficacy beliefs in their
capabilities, especially by providing feedback. In addition, the power-sharing dimension of
ethical leadership was a possible strategy utilized by attendants to increase residents’
self-efficacy beliefs.
This study finds that ethical leadership influenced the degree of personal
accomplishment of residents through its impact on their general self-efficacy. Typically,
individuals with high self-efficacy are more likely to undertake pro-active approach
when faced with stressful situations at work than those with low self-efficacy
(Nielsen et al., 2009). Feelings of reduced personal accomplishment may be due to inability
to cope with the job. It can be aggravated by the lack of opportunities to develop
professionally. Ethical leaders have the ability to raise employees’ confidence levels,
thereby encouraging the employees to exert more effort at work (Walumbwa et al., 2011),
which eventually leads to improved performance at work. This is possible because ethical
leadership is positively related to employees’ satisfaction with leader and willingness to
give in an extra effort (Brown et al., 2005).
Ethical leadership was a significant predictor of PSS. Hence, when the attending
physicians demonstrated ethical leadership behaviors, resident perceived them as being
supportive. Ethical leaders are considered supportive because they are people oriented, they
treat followers fairly, they respect their followers, care for them and ensure their needs are
met (Kalshoven et al., 2011; Treviño et al., 2003). Ethical leadership is a valuable means for
developing and improving communication with subordinates, whereby they depend on the
feedback from such leaders to become more effective in their tasks. Furthermore, Mulki et al.
(2007) affirmed when employees know that their actions are guided by rules and procedures,
they find the work more meaningful, and display positive behaviors in the organization.
Fair treatment of followers by ethical leaders includes the allocation of rewards or
punishment when necessary. Such leaders create a positive work environment when clearly
communicated ethical standards, and expectations are incorporated into the reward system
 LODJ and are upheld. Followers of ethical leaders consider themselves in a social exchange
38,8 relationship with their leaders whom they trust because of the fair and supportive treatment
they receive from them.
Our findings supported theoretical predictions that high levels of supervisor support is
tied to low levels of emotional exhaustion (Halbesleben, 2006; Prins et al., 2007; Sochos et al.,
2012). Support provided by supervisors is considered an essential work-related factor that
1138 produces a relatively powerful coping strategy in counteracting burnout among health
workers (Balogun et al., 2002). Support supervisors provide for residents may include
emotional support, informative support and appreciative support (Sochos et al., 2012). When
people receive positive and supportive messages from others it may help them exert more
effort and reduce anxiety in the workplace (Mulki et al., 2007). The demonstration of ethical
leadership by attending physicians was perceived as supportive and such behaviors
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ameliorated the effects of emotional exhaustion among residents.

Depersonalization is a defensive mechanism that depicts negative callous behaviors and
detachment from clients (Maslach and Goldberg, 1998). Our findings did not provide
support for the mediating effect of general self-efficacy and PSS on the relationship between
ethical leadership and depersonalization. Generally, it is assumed that physicians build
relationships with their patients as they attend to their medical needs. Based on the results
from this study, we propose that residents are more interested in addressing the health
issues of their clients, build up their medical knowledge and improve their clinical skills,
rather than establishing relationships with patients. Their general self-efficacy was
probably more channeled toward their medical training and not their relationship with the
patients. Perhaps, there was no reason for detachment or negative callous behaviors toward
patients, if there was no attachment in the first place. In addition, that support demonstrated
by ethical leaders did not contribute to the depersonalization of residents. This may
probably have been because the attending physicians, who demonstrated ethical leadership,
only considered it their responsibility to train residents and to provide clinical guidance.
The support they provide for residents beyond diagnosing diseases and administering
treatments to patients, was not centered on establishing connections or with handling
negative callous tendencies or detachment from patients.

5.2 Practical implications

This study suggests that promotion of ethical leadership behavior will be an intervention
aimed at reducing burnout among resident physicians. Qualities of such leaders include
people orientation, fairness toward employees, implementing punishment or rewards to
endorse ethical conducts or standards, providing followers with a voice, placing followers in
situations that build their confidence, and showing concern for the well-being of followers.
Also, the results from the current study suggest that role modeling in terms of high moral
standards and the communication of expectations by ethical leaders are important in the
prevention of burnout.
This study provides the potential advantage of ethical leadership in imparting ethical
guidance and sustainability in residency training programs. Some studies have reported ethical
issues in residency training programs (Baldwin and Daugherty, 2008; Hillard et al., 2007;
Li et al., 2008). Recently, ethical leadership behavior is advocated in organizations to ensure
followers act ethically and also to influence more general social norms about how people can
relate to one another in supportive, respectful, fair and reasonable ways (Mayer et al., 2012).
Some suggested faculty characteristics for assessing the quality of residency training include:
faculty stability, faculty supervision, faculty’s ability to provide feedback and resident
evaluation regularly, faculty teaching commitment and ability to meet program goals
(Klessig et al., 2000). These expectations are aligned to the ethical leadership theory, putting
into consideration the constructs and dimensions of ethical leadership. Consequently, human
 resource practices should be utilized to advocate ethical leadership among attending Impact
physicians and others in positions of authority in residency programs. This can be achieved by of ethical
administering ethical leadership training, not only because it is normatively appropriate, but leadership
because of its positive influence on employees and organization outcomes. Successful
leadership training programs are currently being administered to health physicians by some
successful organizations, some healthcare institutions, medical schools, and business schools
(Stoller, 2013). Physicians traditionally assume leadership positions based on their academic or 1139
clinical scientific prowess. Although these accomplishments are imperative, they do not
guarantee leadership success. Effective training on ethical leadership is critical in optimizing
the quality of health of the residents, as well as the quality of health provided for patients.
Residency programs of medical institutions can use the ethical leadership-burnout
model of this study to better understand some underlying factors that are necessary in
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mitigating the burnout process. Building on the levels of confidence, competence and
coping skills of residents through ethical leadership is valuable in increasing the
accomplishment of residents. Additionally, this study extends research on the importance
of general self-efficacy in residency programs, and should be considered as a crucial factor
in the residency training process.
This research proposes that the resident survey utilized by the Accreditation Council
for Graduate Medical Education to evaluate the quality of residency training, or human
services practices can incorporate questions on the self-efficacy beliefs of residents, due to
its impact on their performance expectations and prevention of burnout. Also this study
provides support for past literature in healthcare that confirmed perceived support
provided by leaders, was an essential resource for reducing emotional exhaustion
among residents.

6. Recommendations for future research

The authenticity of these findings can be established by increasing the number of
participants, additional studies in other health institutions, as well as any other diverse
organization. In this study, general self-efficacy and PSS were not significant mediators
between ethical leadership and depersonalization. Future studies utilizing a mixed-methods
approach can be informative in explaining these non-significant relationships. Studies can
consider other mediators in the relationship of ethical leadership and burnout constructs
such as role ambiguity, trust in leader, task significance, psychological safety and job
demand. Role ambiguity is the degree to which employees are uncertain about their job
expectations and responsibilities. One of the dimensions of ethical leadership discussed in
this study was role clarification. Thus, role ambiguity may be considered as a potential
mediator to the same relationship. A positive outcome of ethical leadership behavior is
trust in the leader. Trust in ethical leaders should also be considered as a potential mediator
between ethical leadership and the constructs of burnout. Beyond regional variations
in hospitals, findings may also vary in terms of departments. Thus, findings from this
study can be expanded by including moderators such as departments and institutions,
where the study was conducted as well as demographic characteristic such as years of
postgraduate education.

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Further reading
Harshman, C.L. and Harshman, E.F. (2008), “The Gordian knot of ethics: understanding leadership
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Yu, M., Lin, C. and Hsu, S. (2009), “Stressors and burnout: the role of employee assistance programs
and self-efficacy”, Social Behavior and Personality, Vol. 37 No. 3, pp. 365-378, doi: 10.2224/
sbp.2009.37.3.365.

Corresponding author
Tao Gong can be contacted at: [email protected]

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