MANAGERIAL STYLES:'- A KEY FACTOR TO EFFECTIVE HEALTH CARE

DELIVERY IN SECONDARY HOSPITALS IN EDO STATE.

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 ABSTRACT
Management and Leadership of Health care is critical for strengthening quality and achieving
organizational performance. Through Leadership, Health care administrators are able to create a
shared vision and encourage performance. some researchers are of the opinion that the most
common problems affecting organizational performance in Nigeria including the health care
organizations is inefficiency and ineffectiveness of leaders and that organizations in Nigeria are
managed through leadership styles and behaviours that are strange to typical Nigerian culture.
The main objective of the study is to investigate how different management styles such as
transformational, transactional, autocratic, bureaucratic, and democratic affect organizational
performance in Central Hospital, Benin-City, Edo State, Nigeria. The research methods
employed in this study is descriptive survey research technique with a convenience non-
probability sampling technique used to choose the participants. The study was conducted in
Central Hospital Benin, Benin-City, Edo State, Nigeria. The data was collected using a well-
structured interview guide in which eight (8) staff were interviewed. The study showed that
there is a strong relationship between organisational performance and the management style
practiced in the organization. Transformational, Democratic and Autocratic leadership style
were found to have a positive effect on organizational performance while transactional and
Bureaucratic leadership styles have a negative effect on organizational performance. The study
recommends that Leadership style behaviours that have a strong positive relationship with
organizational performance should be put into practice. Healthcare managers should consider
formulating and implementing effective reward & recognition systems. Organizations should
focus on using the transformational and democratic leadership styles in the organizations so as
to improve the organizational performance.

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 1. INTRODUCTION
1.0 Background of the Study
Leadership is the action of leading people in an organization towards achieving goals. Leaders
do this by influencing subordinate’s behavior in several ways. Management simply relates to
getting things done through and with people. Thus, the concept of performance is central to
management. So, at the end of the day, management is reduced to " what has been achieved
(Edosa &Agbadudu, 2004). The key role of a leader is to encourage his followers to accomplish
a common goal (Northhouse, 2010). Messick and Kramer (2015) explains that the level of
leadership traits depends not only on his characteristics and personal abilities, but also it may
affect characteristics of the circumstances and culture of organization.
Leadership has generated much attention from scholars which has led to development of a
variety of leadership dimensions, ideologies and styles. These include inter alia, directive,
supportive, participative and results oriented (House and Mitchell, 1975); functional leadership
(Adair, 1983) and transformational & transactional (Bass and Avolio, 1994). These leadership
styles were a result of continued refinement of the leadership concept (Nel, et al., 2014).
Different styles of management style exist to match different situations in an organization and
each of these styles works best only if the manager has a vision of what can be achieved and
then this to others and evolve strategies for realizing the vision which will optimally lead to an
increased organization performance (Reddins, 1990).
Among the objectives of any health care organization are primarily to serve humanity, increase
health level and to maintain its status. During this process they maintain humans’ health and
provide employment, provide services, purchase equipment, drugs and other goods and services
and, therefore, contribute to increasing health status and the growth of the society and economy
at large (Khan, Bukhari and Channar, 2016). In current time, many organizations are facing
problems related to unethical practices, poor performance, etc. This may be due to the lack of
effective leadership. there is a need for effective leadership for coordinating and motivating the
employees (Vigoda-Gadot, 2012). Unfortunately, some organizations do not take account of the
leadership style adopted by their managers (Ebrahim, 2018).
Mohammed and Tanimu (2016) observed that the employees of public hospitals demonstrate
poor attitude to work which could be attributed to poor leadership style. A good leadership style
is expected to direct workers’ behaviours toward achieving organizational predetermined goals.
Hence, there is a need to investigate the leadership style that influences worker’s behaviour and
contributes to the organizational goals positively; more so, findings from previous studies on
leadership styles and organizational performance are inconsistent. There are several types of
management styles but for this study, the management styles chosen for the study are
transformational, transactional, autocratic, bureaucratic, and democratic. The reason behind
choosing these styles is the fact that they are the most practiced leadership styles throughout the
globe. From this point of view, this study was conducted to investigate the effect of
management styles adopted by healthcare leaders on the performance of health care

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organization and also contribute to researches on leadership styles and organization
performance.
1.2 Objective of the Study
The main objective of the study is to investigate how different management styles such as
transformational, transactional, autocratic, bureaucratic, and democratic affect organizational
performance in Central Hospital, Benin-City, Edo State, Nigeria.
The specific objectives are:
i. To ascertain the relationship between organizational performance and management
styles in Central Hospital, Benin-City
ii. To know how management style affects organizational performance in Central
Hospital, Benin-City
iii. To find out the management style that has more impact on organizational
performance in Central Hospital, Benin-City
iv. To determine the prominent leadership styles practiced in Central Hospital, Benin-
city
1.3 Research Questions
a) What is the relationship between organizational performance and management styles in
Central Hospital, Benin-city?
b) Does management style affect organizational performance in Central Hospital, Benin-City?
c) Which management style have more impact on organizational performance in Central
Hospital, Benin-City?
d) What prominent leadership styles is practiced in Central Hospital, Benin-city?

1.4 Significance of the Study

The study examined a contemporary understanding of the effects of leadership styles on
organizational performance in relation to health care sector. The researcher hopes that findings
of this research will be useful to future researchers, students and academicians digesting the
effects and importance of different leadership styles on employee performance. The research
also will be significant in determining the relationship between leadership style and
organizational performance, which will help the healthcare organizations to develop leadership
programmes that will see leaders acquire relevant leadership skills for effective management
and organizational performance. This study’s findings will assist different leaders in identifying
the best and the most appropriate leadership style to use in relevant situations for increased staff
and organizational productivity.

2. Literature Review and Theoretical Framework

2.1 Leadership and Leadership Style

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Although leadership has been well researched over the years, there is still lack of a definition
that is universally accepted. Stogdill (1974) puts it, “There are almost as many definitions of
leadership as there are persons who have attempted to define the concept”. Wammy and
Swammy (2014) see leadership as a social influence process in which the leader seeks the
voluntary participation of subordinates in an effort to reach organization goals and therefore a
leader is a person who delegates or influences others to act so as to carry out specified
objectives. Memon (2014) defines leadership as process by which an individual influences the
thoughts, attitudes and behaviors of others by taking responsibility for setting direction for the
firm, others to see and visualize what lies ahead and figure out how to archive it. Molero et al
(2007) described leadership style as consistent set of behaviours /patterns, proposing two
dimensions in leader’s behaviour, structure initiation which includes task oriented leaders and
consideration which includes relation oriented leaders. A well-directed employee is a focused
employee in terms of expectations and organizational goals, such individual tends to understand
product knowledge, procedures and processes, any time we develop our employees we give
them the power and the ability to produce and give their best to the organization hence
increased productivity (Hill, 2008). Sundi (2013) in his research, employee performance is very
influenced by leadership style.

2.2 Transactional leadership style and organizational performance

A leader is known as a transactional leader if he/she is always willing to give something in
return (Uchenwamgbe, 2013). Transactional leadership can be defined as the exchange of
targets and rewards between the management and the employees (Ojokuku, et al., 2012). Sofi
and Devanadhen (2015) found transactional leadership was not having a direct impact on the
performance of the organization. Bass and Avolio (2003) suggest that characteristics of
transactional leadership consist of two aspects, namely contingent reward and exception
management. Positive effect can occur when employees assess transactional leadership
positively and a negative effect can occur if employee considers that transactional leadership
styles cannot be trusted because they do not keep their promises, dishonest or not transparent.

2.3 Bureaucratic leadership style and organizational performance

Bureaucratic leaders influence the people under them to follow the policies and procedures
designed by them. The leaders are strongly committed to their processes and procedures but not
to their people. This is the reason why they appear to be aloof. This method is not very effective
as it does not lead to the development and motivation of the employees. These leaders just focus
on their tasks being completed in a systematic manner (Germano, 2010). Ojukuku et al (2012)
also stated that bureaucratic leadership has a negative impact on the organizational performance.
According to them, bureaucratic leaders do not induce the employees of their organization to
work in the expected manner which can lead to improved organizational performance (Ojokuku,
et al., 2012). Sougui et al (2015) also presented similar results which stated that the bureaucratic
leadership style does not impact the employee as well as organizational performance

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significantly. This method is beneficial only when the tasks are to be done in longer time
following a mentioned procedure (Sougui, et al., 2015).

2.4 Transformational leadership style and organizational performance

Transformational leadership style focuses on developing the followers and considering their
needs. The transformational leadership acts as a strong bridge between the followers and
leaders, to develop clear understanding associated with the motivational level, values and
interests. Bass and Avolio (1994) stated that transformational leadership demonstrates the
superior leadership performance. Wang et al (2011) found out that the transformational
leadership and individual-level follower performance are positively linked. Sofi and
Devanadhen (2015) stated that the transformational leadership has a significant impact on the
performance of the organization. Bass and Avolio, (2003). Yukl (2007) states that application of
transformational leadership style can improve performance because transformational leadership
style wants to develop knowledge and employee’s potential. Leader with transformational
leadership provides opportunity and confidence to his subordinates to carry out duties in
accordance with his mind set to achieve organizational goals. Suharto (2005) suggests that more
frequent transformational leadership behaviours implemented will bring significant positive
effect to improve psychological empowerment quality of subordinates.

2.5 Autocratic Leadership and Organizational Performance

Autocratic leaders are classic and bossy in nature. The autocratic leaders want their
subordinates to work according to them. Typically, autocratic leaders retain the decision-making
rights with them (Obiwuru, et al., 2011). Iqbal, Anwar, and Haider (2015) conducted a study to
determine the impact of leadership styles on the organizational performance. The study stated
that autocratic leadership is also known as the authoritarian leadership style. The autocratic
leadership also leads to organizational conflicts which negatively affect the overall performance
(Iqbal, et al., 2015). Bhargavi and Yaseen (2016) suggested that the autocratic leadership style
has a positive impact on the organizational performance. There is no shared vision and little
motivation beyond coercion. Commitment, creativity and innovation are typically eliminated by
autocratic leadership. In fact, most followers of autocratic leaders can be described as biding
their time, waiting for the inevitable failure this leadership produces and the removal of the
leader that follows (Michael, 2010).

2.6 Democratic leadership and organizational performance

Tannenbanum and Schmidt (1975) have defined democratic leadership as the leadership in
which the decision- making is decentralized and is shared by all the subordinates. Another big
problem associated with democratic leadership is the assumption that everyone involved has an
equal stake in the decision making with a shared level of expertise (Rukmani, et al., 2010). The
study by Elenkov (2002) indicated that the democratic leadership has a positive impact on
organizational performance. Bhargavi and Yaseen (2016) also analysed the impact of

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democratic leadership on organizational performance. Choi (2007) also stated that a democratic
leader is the one who focuses on the group discussion and group participation and as a result it
positively influences the performance of the followers. Hence, it can be stated that democratic
leadership has a positive impact on the organizational performance. (Elenkov, 2002).

2.6 Theoretical Framework

The path-goal theory of leadership
The path-goal theory is a widely recognized theoretical development from a contingency
approach which is derived from the behaviour and the expectancy framework of motivation
theory of Victor Vroom. The path-goal theory attempts to explain the impact that leader
behaviour has on associate motivation, satisfaction and performance. The early theoretical
work on the path goal theory proposed that leaders will be effective by making rewards
available to subordinates and by making those rewards contingent on the subordinates’
accomplishment of specific goals (Luthans,1998). The early path-goal work led to the
development of a theory involving four specific styles of leader behaviour (directive,
supportive, participative and achievement) and three types of subordinate attitudes (job
satisfaction, acceptance of the leader and expectations about effect, performance reward
relationships). This theory attempts to define the relationships between a leader’s behaviour
and the subordinates’ performance and work activities. Leader behaviour is acceptable to
subordinates to the degree that they see it as a source of satisfaction now or as a step toward
future satisfaction. Under this theory, each of these leadership behaviours results in different
levels of performance and subordinate’s satisfaction depending on the structure of the work
task. (Leslie and Byars 2003). Mcshane and Glinow say that path-goal theory states that
effective leaders influence employee satisfaction and performance by making their need
satisfaction contingent on effective job performance. It is on this basis that the above literatures
on leadership were reviewed.

3. RESEARCH METHOD
3.1 Study Design
The basic research design employed in this study was descriptive survey research technique.
This study utilizes qualitative approach.

3.2 Study Area

The study was conducted in Central Hospital Benin, Benin-City, Edo State, Nigeria. A
secondary health care facility.
3.3 Population of The Study
The population for the research study consisted of all the staffs of Central Hospital Benin,
Benin-city, Edo State.

3.4 Sample Size and Sampling Technique

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A convenience non-probability sampling technique sampling technique was used in this study
because it considers the availability and willingness of participants available as at the time of
data collection. An in-depth interview of eight (8) health workers in Central Hospital Benin,
Benin-city, Edo State was carried out.

3.5 Method of Data Collection

The data was collected using a well-structured interview guide which was administered on eight
(8) staffs of the institution through in-depth interview.

3.6 Validity of The Instrument

The validity of the interview guide was established through face and content validity criteria.
Each item on the instrument was examined for content clarity, scope and relevance to the study.

3.8 Ethical Consideration

The researcher presented an introductory letter to the respondents on the subject. The researcher
equally seeks the consent of the management and respondents to create a good atmosphere for
the conduct of the research. The principle of the declaration on the right of the subject was
employed for this study after approval had been sought. The researcher avoid undue violation of
privacy and assured the subjects/institutions of security and confidentiality of any answer given.
The researcher also performed her duties within the ethics of research.

4. DATA PRESENTATION AND ANALYSIS

4.1: Presentation of Data
Table 4.1.1: Respondents Age distribution
AGE (n=8) FREQUENCY PERCENT (%)
18-27 1 12.5
28-37 3 37.5
38-47 2 25
Above 47 2 25
Source: Field survey (2021)
The table 4.1.1 shows that out of the 8 respondents, 1(12.5%) were of the age bracket 18-
27years, 3 (37.5%) were of 28-37years. 2(25%) were of 38-47years while those above 47 age
bracket were 2(25%)
Table 4.1.2: Respondents sex
SEX (n=8) FREQUENCY PERCENT (%)
Male 2 25
Female 6 75
Source: Field survey (2021)
The table 4.1. shows that out of the 8 respondents, 2(25%) were of the male sex while those of
the female sex were 6 (75%)

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Table 4.1.3: Respondents highest educational level
EDUCATIONAL LEVEL (n=8) FREQUENCY PERCENT (%)
Certificate/diploma 2 12.5
Bachelor’s degree 5 62.5
Master’s degree 1 12.5
PhD 0
Source: Field survey (2021)
The table 4.1.3 shows that out of the 8 respondents, 1(12.5%) attained a school
certificate/diploma educational level, 5(62.5%) attained a Bachelor’s degree, 1 (12.5%) attained
a Master’s degree while those that attained a PhD level were 0(0%)
Table 4.1.4: Respondents highest Employment status
EMPLOYMENT STATUS (n=8) FREQUENCY PERCENT (%)
Full time 5 62.5
Part time 3 37.5
Source: Field survey (2021)
The table 4.1.4 shows that out of the 8 respondents, 5 (62.5%) were full time staffs while 3
(37.5%) were part time staffs.

4.2 ANSWERS TO RESEARCH QUESTIONS

Research Question One: What is the relationship between organizational performance
and management styles in Central Hospital, Benin-city?
From the interview conducted with the staff of Central Hospital Benin to know if there is a
relationship between the organisational performance and the management style practised,
majority of the respondents agreed that the relationship exist between the organisational
performance and management style. An administrative staff stated that the relationship could be
in two ways namely, positive and negative. Positive in the sense that the relationship can be a
productive one and negative as it can be harmful to the organisational performance. This finding
is consistent with the finding of Klien et al (2013) who proved this fact by using four factor
theory of leadership along with the data collected from 2,662 employees working in 311
organizations that organizational culture and organisational performance are related to the type
of leadership style exhibited in an organisation. Sun (2002) compared the leadership style with
the leadership performance in enterprises, and showed that the leadership style has a
significantly positive correlation with the organizational performance in both schools and
enterprises. Huang (2006) found that leadership has a positive correlation with the
organizational performance as leadership performance is identical with the organizational
performance. Elenkov (2002) research results showed that the leadership style has a
significantly positive correlation with the organizational performance. Therefore, the leadership
style should be properly and carefully used to guide and motivate subordinates.

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Research question two: Does management style affect organizational performance in
Central Hospital, Benin-City?
The responses of the staff were mixed but a majority of the staffs responded that the
management style do affect the organisational performance while some were indifferent. The
health assistant believes that the management style practised is affecting their performances as
the management are too strict on them and they are also left out in major decision making. The
nurses said that they do not get the needed support from the management and but are expected
to beat previous target. They are advised to adhere to standard procedures. This finding is inline
with performance Hartnell, Kinicki, Lambert, & Fugate (2016) that leadership practices effect is
fundamentally identified with organizational performance. Akida (2016) stated that The style of
leadership affects performance since performance cannot be achieved in the absence of a
leadership that can adapt to the changes and challenges of the environment, that knows how to
motivate the employees and that encourages them to take more ownership for their work.
Ojokuku, et al. (2012) conducted a research on the Impact of leadership Style on Organizational
Performance. the findings showed that there was positive and negative correlation between
organisational performance and leadership style when 23 percent variance of performance found
in leadership style jointly predict organizational performance. Nasir, et al. (2014) findings
concluded that leadership behaviours are interrelated and have high positive impact with
organizational performance. On the other hand, some researchers also discovered that there is
no correlation between leadership styles and organizational performance (Ejere & Abasilim,
2013).
Research question three: Which management style have more impact on organizational
performance in Central Hospital, Benin-City?
They were asked which management style have more impact on the organisational
performance. Most of the respondent stated that the bureaucratic leadership style followed by
the autocratic style do have the most negative impact on the organisational performance. Most
of the nursing staffs stated that the transformational and democratic leadership style is the best
style of management and should have the most positive impact on the organisational
performance. The finds of this study are in line with previous research studies. Wang, et al.
(2010); Obiwuru, et al., (2011) studies, such as the investigation conducted in Nigeria had built
up that while transactional leadership had significant negative effect on performance, and
transformational leadership style had positive impact on performance. Asrar-ul-Haq &
Kuchinke (2016) found that transformational leadership positively affect the performance while
transactional leadership had negative impact on performance. The study done in Kuwait by Al-
Mailam (2004) to determine whether employees working for a transformational leader perceive
their leader to be more effective than did those working for transactional leader, the study also
compared the private and public sector with regard to leadership style. The result of this study
indicated that the transformational leadership style was linked to high levels of leadership
efficacy and performance. Also the result showed that employees in private hospitals were more
likely to perceive their leaders more transformational than employees in the public hospitals.
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However, longe (2014) found that the transactional leadership also has a positive impact on
organizational performance, which contradicts the results of this study. According to the
research conducted by Sofi and Devanadhen (2015), transactional leadership was not found to
have a direct impact on the performance of the organization.
Research question Four: What prominent leadership styles is practiced in Central
Hospital, Benin-city?
Majority of the staffs made mention of the democratic leadership style as the most prominent
leadership style practised. Although some were of the opinion that autocratic leadership style
was also evident especially among the junior staffs. The finding is consistent with Capella
(2016) that the democratic leadership style has a mean of 22.2%, that it is the prominent
leadership style practiced and both authoritarian and democratic leadership style is practised
seeing that they have close average, the authoritarian leadership style has a mean of 20.4%. The
finding was not consistent with Chen (2004) who studied the relationship style between nursing
faculties’ perceptions of nursing deans’ and directors’ leadership style and faculties’ job
satisfaction level in Taiwan. He found that Taiwanese nursing deans and directors tend to
display transformational leadership more frequently than transactional leadership.

CONCLUSIONS
This study has investigated the effect of management style on organizational performance in
Central Hospital Benin. The results of this study revealed that leadership style has both positive
and negative effect on organizational performance. The study found that transformational and
democratic and autocratic leadership style, in which employees are allowed to have sense of
belonging, carry out higher responsibility with little supervision, and are helped to achieve their
needs enhance organizational performance. It is concluded that transformational and
Democratic leadership styles are the best for the management of healthcare workers to be
adopted in order for them to perform better. The study concludes that leadership style of the
organization greatly influence the healthcare performance and worker’s motivation.
Organization will function effectively when management employs a proper leadership style.
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