There are strengths in having a mixed style of leadership. One is the accommodation of various leadership preferences (Daft, 2008). Autocratic leadership is a common practice not only in government but also in private companies not only in the UAE but also in the region. Some of the local members of TAWAM may be used to or prefer this mode of leadership. Democratic leadership is common organizational practice in Western countries. JHI executives may practice or prefer democratic participation in decision-making. By practicing a mix of leadership styles, TAWAM can accommodate different leadership perspectives until the leadership capabilities of its members are fully honed to direct the leadership style or mix that serves the hospital’s mission best. Another is to provide the leadership needs (Daft, 2008) of a developing and modernizing health care institution intended to address the needs of the global market. Having a mixed style of leadership also supports the building of leadership competencies by fostering communication between frontline personnel and managers to motivate innovative ideas while at the same ensuring the acceptable mode of participation based on the cultural context.
There are also weaknesses in the mixed style of leadership at TAWAM. One is the possible resistance to the mixed system (Daft, 2008). There may be some members of the organization preferring an absolute single leadership style to be practiced. Having a mixed style also means that members of the organization need to change their perspectives and make adjustments in the way they consider the manner that things are to be done in order to accommodate the other leadership styles, to a certain degree. This involves a transition and possible difficulties for hospital personnel. Another is the uncertainty of how leadership works (Daft, 2008), on the part of managers and personnel, with the differences in the thrust of the autocratic and democratic leadership styles.
III. Management Level Leadership in TAWAM Hospital
Management level leadership at TAWAM hospital is transformational leadership. This form of leadership involves the leader taking the role of visionary and inspiring personnel to follow, usually in the direction of changes in attitudes, behavior and work practice (Jabnoun et al., 2005). This was supported by TAWAM’s organizational structure providing autonomy to the medical and nursing departments.
In the case of the nursing department, the Chief Nursing Officer or Director of Nursing heads the nursing team together with three Associate Directors. There are also Nurse Managers directly supervising registered nurses, registered midwives, nursing assistants, ward clerks and porter staff. As an autonomous department, the goals are to establish workforce practice, advance the knowledge and training of middle level managers, and develop a culture of safety and service excellence. The Director of Nursing takes the role of a visionary in initiating certain practices in support of the change needed to achieve the department goals. Opening communication lines is the key to achieving the goals. The Director of Nursing included in the responsibility of the Nursing Managers the role of encouraging initiatives on the part of frontline personnel and reporting these to the Director of Nursing. (“Position summary,” 2010) Continuous learning and training of personnel on matters related to health care service delivery and health care management are in place. These activities signal the need for greater personnel participation in improving nursing services and management. With open communication and continuous learning and training, frontline personnel should be able to develop the competencies to do well in their jobs as well as to take on leadership positions in the future. The nursing department at TAWAM takes pride in having a higher retention rate relative to other hospitals in the region.
There are strengths in a transformational leadership style in the management level at TAWAM. One is the leadership process that involves the leaders and the followers (Hall et al., 2009). This interactive form of leadership emphasize not only on the achievement of goals but also on the particular needs of hospital personnel. Transformational leadership considers the goals that need to be addressed and translates these into competency needs addressed through activities involving leaders and personnel. The outcome is beneficial to leaders, personnel and the organization as a whole. The process and the outcome are also acceptable to all parties involved. The other is the intuitive nature of the leadership style that adheres to the more common view of leadership (Hall et al., 2009). The sensitivity to changing conditions and the specific situation of personnel that happens through transformational leadership establishes the perspective of leadership as caring or nurturing. This leads to better response by personnel.
There are also weaknesses in transformational leadership at the management level. One is the difficulty of measuring outcomes (Hall et al., 2009). The outcomes of transformational leadership are both qualitative and quantitative so that not all outcomes are measurable. Retention rates and performance measures are examples of quantitative outcomes. In the case of the nursing department, it was able to determine a higher retention rate relative to other hospitals in the region as a result, in part, of its leadership style. Outcomes such as motivation, satisfaction, and service quality are more difficult to measure using absolute numbers. Difficulties in measurement open room for approximations on the impact of transformation leadership and emerging issues. The other is the possible difficulties in distinguishing transformation leadership as a style adopted at the management level and the transformational leadership personality of particular leaders (Hall et al., 2009). A change in leadership could shift perspectives on the continued application of transformational leadership.
IV. Data Collection
The fifty interviewees were the staff from the medical and nursing departments of TAWAM Hospital. Half of interviewees were from the medical department and half were from the nursing department. Within each department, the interviewees were equally selected from the sub-departments. The interviewees were selected through stratified sampling using at least three years of employment in the company as the initial selection criterion. This ensures that the interviewees have sufficient knowledge and experience of the leadership styles at TAWAM. After the initial screening, the final interviewees were selected randomly.
The interview questions reflect on three main ideas. First is the perception of personnel over leadership at the management level. Second is the effectiveness of leadership at the management level. Third covers the strengths and weaknesses of leadership at the management level. Responses to these questions not only provide answers on these three areas but also support implications on areas for improvement and recommended solutions.
V. Data Analysis
Results of Data Collection
There is a general positive perception towards leadership at the management level of TAWAM. Perceptions of the staff are determined based on the items under transformation leadership of the Multifactor Leadership Questionnaire. The items are: 1) idealized attributes, 2) idealized behaviors, 3) inspirational motivation, 4) intellectual stimulation, and 5) individualized consideration (Bass & Avolio, 2009). The perceptions of the staff in terms of these items were positive with majority of the staff responding positively to these items based on the experience of leadership at the management level. All the interviewees agreed that intellectual stimulation and inspirational motivation were positive outcomes of the transformational leadership applied at TAWAM’s management level. This was attributed to the continuous learning and training programs implemented by both medical and nursing departments. The adoption of new technology also enhanced knowledge building and practical skills. The staff interviewed also reported being more driven towards their work as a result of greater opportunities to participate in initiatives at the department level. There was lesser unanimity in the feedback over idealized attributes, idealized behavior, and individualized consideration. There were differing opinions over what constitutes idealized attributes and behavior. A number of the respondents admitted to not having previously thought about individualized considerations relative to leadership at the management level.
The leadership at the management level of TAWAM is considered to be effective in making the situation of the staff and the hospital better. Effectiveness relative to the situation of the staff was determined based on performance, satisfaction and engagement or giving more effort in the workplace more than the minimum requirements (Bass & Avolio, 2009). The respondents reported positive improvements in their work performance by being able to handle various care situations and making lesser mistakes. This is directly linked to the learning and training program at the department level. Satisfaction was average to above average for most of the staff interviewed. There were differences in the responses over engagement. The reasons cited are linked to the variances over idealized attributes and behavior to support the identification of effort beyond the minimum requirement. There were differences in perspective over what efforts fall beyond the minimum requirement or whether their individual efforts can be considered beyond the minimum requirement. Effectiveness relative to bettering the situation of the hospital is unanimously positive with the respondents commonly citing better communications, clearer direction for change, and more responsive strategies of the hospital as outcomes.
While the perspectives towards leadership at the management level and its effectiveness was positive, the responses informed on the strengths and weaknesses of transformational leadership at TAWAM’s management level. The strengths focused on outcomes while the weaknesses reflect on the process of exercising leadership.
One of the strengths is the ability to unify the staff under a clear vision of what the department and hospital should become. Making TAWAM as a world class hospital by boosting its human resource and technological competencies is the means of achieving the vision. The staff accepts and recognizes this vision as noble and sound. Another encompassing strength is influencing acceptance of change and participation to achieve change. The direction of transformational leadership at TAWAM is to boost the leadership competencies of its personnel, especially the local staff to support excellent service quality and effective leadership continuity at the hospital. The direction towards continuous learning and leadership as well as sharing of expertise through the affiliation program was a change responsive to the vision of the hospital.
Weaknesses also emerged. One is the lack of clarity over the expectations of competencies and behaviors required from leaders. At the organizational and departmental level, the expectation was for the leader to ensure the enhancement of the knowledge and skills of their work as well as develop leadership competencies. However, at the individual staff level, there is no clarity over the specific competencies expected from leaders, which affects the assessment of the form of leadership. This is shown by the lack of agreement over the perspectives of ideal leadership competencies and behavior among the staff interviewed. The other is the limited individual participation of the staff in the identification of initiatives and implementation of change. Some of the staff explained that they have never thought about individual initiatives in improving the department and the hospital. This reflects the limitations in the leadership competency to motivate action or participation at the individual level. These weaknesses comprise the areas for improvement.
Recommended Solutions for the Areas for Improvement
TAWAM can clarify the ideal competencies and behaviors of leaders at the management level by implementing leadership assessments that involve evaluations of leadership effectiveness and feedback on best leadership qualities. In this way, leaders are able to determine the expectations of the staff and use the similarities as a guide for leadership practice and the differences to anticipate possible challenges in management. At the same time, leaders should also make their decisions and actions more felt by the staff to provide an experience of good leadership and clarify the ideal expectations of the staff. Further enhancing communication and collaboration through activities such as coaching, mentoring, transparency, and leadership by example (Daft, 2008) are ways of influencing ideal expectations from leadership. These also comprise solutions to limited participation at the individual level. Improving communication and collaboration ensures that the vision of the leaders at the management level permeate down to the individual staff level and foster individual initiatives for successful implementation.
VII. Conclusion
The perception of the staff towards leadership at the management level is positive with intellectual stimulation and inspirational motivation as the unanimously recognized outcome. The leadership at the management level is also considered effective in bettering the condition of the staff and the hospital. The responses yielded strengths and weaknesses of leadership. The strengths are unification under a vision and influence change while the weaknesses are lack of clarity of leadership expectations and limited participation at the individual level. Leadership at the management level of TAWAM hospital is improved by using leadership assessments and enhancing leadership presence or visibility. Improving communication and collaboration also supports leadership expectations and limited participation at the individual level.
References
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