Transactional Leadership and the Performance of Health Service Delivery: A Qualitative Case Study of Lira Regional Referral Hospital, Uganda
Daniel Comboni Odul, Stella Karimi and Violet Simiyu
The Catholic University of Eastern Africa, Nairobi, Kenya
Email: comboni.dc@gmail.com
Abstract: Background: Leadership shapes how health services are organized and experienced in resource-constrained public referral hospitals. Transactional leadership relies on clear expectations, supervision, accountability, rewards and corrective action; if experienced mainly as punitive control, these mechanisms may undermine staff motivation and service delivery. This study examined how transactional leadership shaped staff absenteeism and clinical shift compliance at Lira Regional Referral Hospital (LRRH), Uganda. Methods: The study adopted an interpretivist paradigm and qualitative case-study design. Twenty participants were purposively selected across four categories: five administrators and departmental heads, seven medical professionals, four support staff and four patients. Data were generated through semi-structured interviews, focus groups and documentary review, and analyzed using Braun and Clarke’s (2006) six-phase thematic analysis in NVivo 12. Trustworthiness was strengthened through triangulation, member checking, reflexivity and an audit trail. Results: Transactional leadership at LRRH operated primarily through administrative monitoring, supervision, attendance checking and disciplinary procedures that reinforced formal accountability. Frontline staff, however, often experienced this monitoring as punitive, where personal and organizational circumstances were overlooked. A gap emerged between recorded attendance and actual professional commitment: some remained beyond scheduled shifts during emergencies, while registers did not always reflect availability. Leaders addressed staffing shortages through flexible redeployment, while prolonged acting appointments in management weakened authority and accountability. Conclusion: Transactional leadership can support service delivery by clarifying expectations and strengthening accountability, but its value is limited when supervision becomes mere control and punishment.Sustainable performance requires accountability combined with supportive supervision, recognition, flexible coordination, stable leadership and adequate staffing.
