Background and purpose: Organizations in the health care sector in Turkey parallel to the world are undergoing broad structural reforms. As with most broad reforms employee commitment and support from hospital staff members are need to successfully implement these changes. Our claim is that hospital managers who seek commitment rather compliance are required to meet these challenges. We tested this claim by studying the relationship of charismatic leadership which is thought to emerge in times of stress and crisis, and is an antecedent of follower performance-stimulation and follower initiative-oriented behaviors. Since charisma is also thought influence followers' discretionary behavior in organizations as it creates sense of self efficacy and confidence coupled with performance-stimulation we examined if employee' job autonomy and stress in the workplace enhanced followers' initiative-oriented behavior.