Final Arete - Volume 4, No 1 Fall Winter 2026

Αρετή (Arete) Journal of Excellence in Global Leadership | Vol. 4 No. 1 | 2026

Why Culture Is Worth Influencing: The Outcome Evidence Culture is among the strongest predictors of the outcomes that hospitals exist to achieve. Among the safety-related constructs, psychological safety has one of the most developed evidence bases. Edmondson (1999) defined it as a team’s shared sense that it is safe to take interpersonal risks. Newman et al. (2017) distinguish it from trust: trust is what one person makes of another, whereas psychological safety is what a group takes to be its norm. Their review also finds that its antecedents are spread out. Leader behavior matters, but peer relationships and the unit’s own habits matter as well, and it is this that makes the construct relevant to someone who supervises no one. Units that foster open conversation and treat improvement as routine work report better quality metrics (Braithwaite et al., 2017). Relational nursing leadership increases patient satisfaction and reduces adverse events (Wong et al., 2013). A unit’s relati onal norms correlate about as strongly with burnout, moral distress, and turnover as workload does (Laschinger & Leiter, 2006; Shanafelt & Noseworthy, 2017; West et al., 2018). Shanafelt et al. (2021) conclude that whether work remains meaningful in the face of suffering depends on institutional context and not on individual strength alone. The practices this literature identifies as protective, which involve finding meaning, reflecting ethically, and accompanying others through suffering, are practices that chaplains spend years developing and are trained to bring to others. Culture grants voice to some while denying it to others. Hierarchical culture determines who speaks up and silences non-physician voices, even when the information they hold bears on outcomes (Mannion & Davies, 2018). Moral climate shapes retention and moral capacity (Fumis et al., 2017; Pauly et al., 2009). Chaplains fit uneasily within these hierarchies. Their role lets them see across the silos that keep an organization from seeing itself whole, and it leaves them belonging to none of those silos, a trade consistent with Williams’s (2002) account of boundary -spanning competence as relational work done from outside the hierarchy. When chaplains persist in raising perspectives that hierarchical norms suppress, the effect goes beyond advocacy. Repeated year after year, the practice gradually weakens the assumption that the hierarchy is inevitable. This literature also suggests that leaders’ emphasis on vision, hope, and altruistic love affects practitioners’ experience of meaning, which in turn influences burnout and commitment (Ashmos & Duchon, 2000; Duchon & Plowman, 2005; Fry, 2003; Fry & Cohen, 2009; Gotsis & Grimani, 2017; Hunsaker, 2019; Steger et al., 2012). Spiritual leadership theory is not integrated into this article. The omission reflects a principle rather than a judgment about the value of the tradition. It is also why Schein (1990) is included even though his structure is founder-centric, and why Cunliffe and Eriksen (2011) are included even though their cases are managers. A tradition is included when its mechanism continues to function in the absence of formal position and set aside when the mechanism depends on that position. Cultural intelligence, boundary spanning, practice, and responsiveness to others all continue to work when no one has rank, so their mechanisms are integrated. Spiritual leadership claims a causal relationship grounded in the leader’s formal role, and that relationship disappears once the role is removed. The same standard applies to what this article can claim. Both Fry’s and Shanafelt’s effects are tested in people who stand in a supervisory relationship to those affected. That relationship may account for the effect.

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