An analysis of the influence of multilevel leadership on the effectiveness of provincial hospitals in the Kwazulu/Natal Province.
The purpose of this study was to describe and identify the leadership style that prevails in health care institutions, in order to establish the influence of multilevelleadershipon the effeciveness of hospitals in KwaZulu-Natal. Hunt's extended multilevel leadership Model was used as a conceptual framework. Six institutions were selected by random sampling, categorised into three sizes i.e. large institutions with number of beds above 400, midddle sized between 200-400 and smaller institutions with a bed state below 200. Three categories of leaders were as top, middle and operational leadership. The 8 leaders included the chief medical superintendent, the hospital secretary, the chief nurse manager, two area nurse managers and the three operational nurse managers in each of the six institutions. A total of 48 MLQ instruments designed by Bass and Avolio (1989) focused on leadership style was used to identify transformational, transactional and nonleadership styles. 121 Questionnaires were distributed to staff and community to measure hospital effectiveness. Interviews were carried out on patients and visitors to establish patients' satisfaction. The effectiveness of health care services was described by goal attainment, level of support and system's achievement. The instruments to measure goal attainment and level of support were designed by the researcher. The 6 institutions were measured for system's achievement by using the instrument designed by Beattie, Rispel and Cabral (1995). The criteria used to assess infrastructure, access to the institution, management of personnel, management of resources, patient satisfaction, community outreach programmes and the process of care, was based on the criteria developed by Beattie, Rispel, and Cabral (1995). A correlation was done to establish the relationship between leadership style and hospital effectiveness. Findings; the area manager exhibited the leadership style that is predominantly Transformational, the other four categories identified in the study, revealed a leadership style that was predominently Transactional. Of the six institutions two revealed a transfomational leadership style and three revealed a transactional leadership style. One institution reflected a Laissez-Faire leadership style. The overall leadership style was transactional. On comparing the three effectiveness criteria goal attainment was identified as the most effective area of achievement followed by system's achievement and the least being level of support. A MANOVA multivarate analysis of variance revealed that the relationship between leadership style and goal attainment was not significant. The relationship between leadership style and level of support was significant. On further analysis using the Shetre test, it was found that the level of support was significantly related to transformational leadership. The relationship between leadership style and stystem's achievement was not established, because the sample size of six institutions was too small. The overall relationships between leadership style and hospital effectiveness was significant at p-< 0.01 level. Recommendations; included that all all categoties of leadership at institutions are to increase their diagnostic level of awareness of their leadership styles. Rigorous education and training on leadership and support were essential. A further recommendation was that the methodology used in this study to measure hospital effectiveness be used more widely as a management tool. A common instrument used to evaluate acceptable standards of health care assessment should be used to ensure comparison between and within institutions in KwaZulu- Natal There was a need for further research to establish the influence of leadership style on hospital effectiveness in order to ensure quality care by health care providers and to increase professional efficiency and effectiveness in the hospitals of KwaZulu-Natal.