2.1 Positive leadership and self-efficacy.
Recent studies had shown that positive leadership may influence self-efficacy. Bandura et al. mentioned that self-efficacy reflects the belief and confidence that an individual can accomplish challenges with their abilities [25]. For instance, study in Dutch demonstrated that nurses supported by positive leadership have better self-efficacy and health outcomes [26]. A Korean study showed that leadership stress caused by overload of work contributes to burnout among nurses, which affects their self-efficacy [27]. A Canadian study suggested that nursing managers with positive leadership may increase their subordinate’s self-efficacy [28]. In addition, Mazzetti and Schaufel proposed that dedicated leaders have an indirect positive impact on members' levels of job engagement [29]. Chiocchio et al. argued that the actions guided by positive leadership, such as providing healthcare training or project management training, can positively influence employees' self-efficacy [30].
Integrating these findings, positive leadership may have a positive effect on the self-efficacy of IPC. Therefore,the following hypotheses are proposed by this study:
Hypothesis 1
Positive leadership has a positive impact on self-efficacy.
2.2 The mediating roles of career identity between positive leadership and self-efficacy.
Recent researchs had suggested that positive leadership may influence career identity. Career identity refers to the affirmative evaluation of medical staff about the profession they practice and the attitudes, values, knowledge, beliefs and skills they share [31, 32]. For instance, in a Dutch study, the motivation of leaders influenced the career identity of medical staff [33]. Meanwhile, Adler et al. proposed that by promoting healthy leadership, leaders can alleviate burnout among medical staff, thereby enhancing their career identity [34].
In addition, career identity is positively related to self-efficacy. Career identity can increase the initiative, perseverance, and self-efficacy of medical staff. For example, Mei et al. mentioned that career identity was positively associated with indicators reflecting self-efficacy, such as students' mental health, clinical performance and care quality [35]. Furthermore, a Chinese study showed that strengthening career identity improves nurses' job satisfaction and reduces their willingness to leave, thereby improving the self-efficacy of medical staff [36].
Integrating these findings, positive leadership may have a positive effect on the self-efficacy of IPC through career identity. As a result, the following hypotheses are proposed by this study:
Hypothesis 2
Positive leadership has a positive impact on career identity.
Hypothesis 3
Career identity has a positive effect on self-efficacy.
2.3 The mediating roles of achievement motivation between positive leadership and self-efficacy.
Achievement motivation of medical staff refers to the desire of medical staff to achieve significant results and success during the service delivery process [37]. Prior research had suggested that the style and form of positive leadership determine the achievement motivation of medical staff. For instance, according to an Iranian survey, ethical leadership in nursing not only enhances the accountability of nurses at work but also promotes the entire team’s achievement motivation [38]. Evidence from a US study found that mentoring, as an aspect of leadership, has a positive effect on psychological capital. In other words, work resources given by leaders can influence the achievement motivation of subordinates [39].
In addition, there is evidence that achievement motivation has an impact on self-efficacy. Previous studies proved that, people with high achievement motivation are promoted faster, and achieve goals more firmly. For instance, a Cairo study demonstrated that nursing students' self-efficacy in clinical teaching practice is strongly associated with teaching programs that improve achievement motivation [40]. People with high achievement motivation pursue self-improvement, tend to seize opportunities in the external social environment, use their resources effectively and have a higher sense of self-efficacy throughout the process, according to a Chinese study [41]. Evidence from an Ethiopian study suggested that higher achievement motivation affects levels of ambition, goal setting, perseverance in the face of difficulty [42].
Meanwhile, there are also studies proving that career identity can promote achievement motivation. For instance, a Chinese study by Ge et al. revealed that the understanding and recognition of the profession influences the level of goal setting [43], and stimulates the motivation to develop the career of general practitioners. Li indicated that nurses' recognition of their profession promoted their sense of achievement and the value of nursing [44]. Zhang et al. found that career identity is strongly correlated with the job engagement of medical staff, which laterally reflects the influence of career identity on achievement motivation [45].
Given these findings, positive leadership may have a positive effect on self-efficacy through achievement motivation, and such a positive effect may also occur through distal mediating effects of career identity and achievement motivation. As a result, the following hypotheses are proposed by this study:
Hypothesis 4
Positive leadership has a positive impact on achievement motivation.
Hypothesis 5
Achievement motivation has a positive effect on self-efficacy.
Hypothesis 6
Career identity has a positive effect on achievement motivation.
2.4 The moderating role of culture
Culture refers to concepts that bind members of an organization, such as beliefs, symbols, consciousness, and faith, and it can change over time [46]. Lee and Jang suggested that in healthcare, culture affects the relationship between positive leadership and career identity [20]. For example, a U.S. study showed that in an environment that promotes a "personalized, proactive and patient-driven" culture of care, medical staff are able to share authority and responsibility, thereby enhancing career identity [47]. According to Mannion and Davies, the initiatives taken by the leadership team to create an culture lead to career identity and psychological safety for medical staff [48]. In addition, a study in Canadian, UK and US hospitals found that hospital culture management through informal interpersonal relationships improved employee performance in terms of loyalty and commitment, thereby enhancing their career identity [49].
Integrating these findings, we suggest that culture shapes the environment for positive leadership to take hold. Therefore, culture might further enhance the positive relationship between positive leadership and career identity.
In this research, we first examined the effects of positive leadership on intrinsic motivation—career identity, achievement motivation, and self-efficacy of IPC among medical staff, including direct and indirect effects. Then, we also examined the moderating effects of culture on the links between positive leadership and career identity. The hypothesized model is illustrated in Fig. 1.