An analysis of the influence of multilevel leadership on the effectiveness of provincial hospitals in the Kwazulu/Natal Province.
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Date
1998
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Abstract
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.
Description
Thesis (Ph.D.)-University of Natal, Durban. 1998.
Keywords
Nursing Services--South Africa--Administration., Leadership., Nurse Administrators--South Africa., Theses--Nursing.