Objectives: The Bureau of National Health Insurance put an expenditure cap on primary care clinics as well as on dialysis clinics in 2003 as a result of global budgeting. This policy contributed to a high level competitiveness among dialysis facilities as they strived to control costs in order to achieve performance goals. Few studies have addressed the correlations between leadership styles and operational performance in dialysis facilities; therefore, the aim of this survey was to investigate the correlations between the leadership styles of nurse managers in dialysis facilities and operational performance in those facilities.Methods: The survey questionnaire, sent to the head nurses of dialysis facilities nationwide, explored their perceptions of leadership style. Of 418 questionnaires sent out, 114 valid responses were returned. Leadership style was measured by the Multifactor Leadership Questionnaire and Data Envelopment Analysis was employed for the assessment of operational performance. Results: The one-way ANOVA showed that there was no significant difference in operational performance among the four leadership styles. However, an in-depth exploration showed that the low-transformational-but-high-transactional leadership style had significantly better effects on operational performance than did high-transformational-but-low-transactional leadership (p= 0.049).Conclusions: Our findings suggested that providing tangible rewards and paying attention to the behavior of subordinates might contribute to better performance than inspiring motivation and intangible encouragement would.