The Impact of Leadership Style on Quality of Care in hospital.

1. Background

1.1. Introduction:

The quality of care provided in hospitals is a critical factor that directly influences patient

outcomes and satisfaction. The leadership style adopted by healthcare administrators and

managers plays a pivotal role in shaping the overall quality of care delivered to patients. As the

healthcare landscape continues to evolve, it is essential to understand the relationship between

leadership styles and the quality of care provided in hospitals. This paper aims to explore the

impact of leadership style on the quality of care in hospital settings, bridging a significant gap in

the existing research by highlighting the importance of effective leadership in healthcare.

(Adunola et al. 2022; Abou Ramadan et al. 2020)

In the dynamic and ever-evolving realm of healthcare, the quality of care provided to patients

stands as a pivotal concern. Within this context, leadership styles play a paramount role in

shaping the culture, practices, and outcomes of healthcare organizations. Leadership,

distinguished by its varied approaches to guiding and motivating teams, has garnered substantial

attention due to its influence on hospital care quality. This introduction seeks to present a

comprehensive overview of the significance of leadership style in healthcare settings,

emphasizing its role in driving positive patient outcomes and experiences. (Putri et al. 2021)

Leadership within healthcare organizations extends beyond conventional management roles. It

encompasses the art of harmonizing interdisciplinary teams, cultivating a culture of

collaboration, and ensuring patient-centered care delivery. Leadership style, a fundamental

component of this orchestration, pertains to the manner in which leaders influence, inspire, and

guide their teams toward achieving organizational goals. These styles vary in their approaches
and philosophies, shaping the organizational culture, staff engagement, and ultimately, the

quality of care extended to patients. (Andarusito et al. 2023)

Notably, transformational leadership has garnered recognition within healthcare contexts. This

approach revolves around motivating and empowering followers to transcend self-interests for

the collective betterment of the organization. Transformational leaders inspire innovation, foster

open communication, and motivate employees to exceed expectations. Research has established

a linkage between this leadership style and enhanced patient safety, improved employee

satisfaction, and increased organizational effectiveness (Wong & Cummings, 2007).

In contrast, transactional leadership emphasizes structured interactions, employing rewards and

penalties to achieve desired outcomes. It operates on clear role expectations, performance-based

incentives, and corrective actions when deviations occur. While transactional leadership may not

inherently foster innovation, it plays an essential role in ensuring adherence to established

protocols and guidelines. This style's significance is particularly pronounced in contexts where

standardized care practices are indispensable for patient safety and quality (Sfantou, Laliotis, &

Patelarou, 2017).

The relatively novel concept of servant leadership has gained traction in healthcare leadership

circles. It revolves around empathy and support, with leaders prioritizing the needs of their team

members, fostering positive work environments, and emphasizing collaboration. This approach

resonates with principles of patient-centered care, aligning with the well-being and preferences

of patients. Emerging research has explored the connections between servant leadership,

employee job satisfaction, organizational commitment, and patient-centered care outcomes

(Ehrhart, Bono, & Baker, 2018; Liden, Wayne, Zhao, & Henderson, 2008).
While individual studies have delved into these leadership styles separately, a noticeable gap

exists in understanding their interactions within the intricate healthcare environment. Existing

research often hones in on singular leadership styles, potentially overlooking the synergies that

could arise from their integration. Furthermore, the impact of situational factors on the efficacy

of different leadership styles remains relatively unexplored. (Parimelalagapillai et al. 2023;

Purwanti et al. 2023)

The proposed research holds profound significance in addressing these gaps. By methodically

investigating the impact of transformational, transactional, and servant leadership styles on

hospital care quality, this study endeavors to provide a comprehensive understanding of how

leadership practices can be optimized to enhance patient outcomes and satisfaction. The findings

of this research possess far-reaching implications for healthcare leaders, administrators, and

policymakers who seek evidence-based strategies to cultivate an environment conducive to

superior patient care.

This research embarks on an exploration of the intricate interplay between leadership styles and

hospital care quality. By delving into the amalgamation of transformational, transactional, and

servant leadership styles within the dynamic healthcare context, this study aspires to enrich our

comprehension of effective leadership practices. As the investigation unfolds, the anticipated

insights hold the potential to offer actionable guidance to healthcare leaders. Ultimately, this

research aims to contribute to the advancement of patient outcomes, satisfaction, and the overall

quality of care within healthcare settings.

1.2. Literature Review:

The relationship between leadership style and healthcare outcomes has been extensively studied

over the years. Scholars have identified various leadership styles, each with its unique

characteristics and effects on the quality of care. Transformational leadership, transactional

leadership, and servant leadership are among the most studied leadership styles in healthcare.

Transformational leadership, characterized by visionary thinking, inspiration, and empowerment,

has been shown to positively influence the quality of care in hospitals. Research by Avolio and

Bass (1991) highlighted how transformational leaders can inspire their teams to exceed

performance expectations and foster a culture of continuous improvement, thus enhancing

patient care. Furthermore, studies by Cummings and McLennan (2010) demonstrated that

transformational leadership positively affects employee satisfaction and patient outcomes.

Transactional leadership, which emphasizes structure, rewards, and penalties, also has its role in

healthcare settings. While transactional leadership may not inherently foster innovation, it can

ensure that essential processes and protocols are followed consistently, thus contributing to

patient safety and quality of care (Sfantou et al., 2017). However, an overreliance on

transactional leadership alone might limit the potential for long-term improvements in healthcare

quality.

Servant leadership, with its focus on empathy, collaboration, and support for employees, has

gained attention in recent years. In the context of healthcare, this style of leadership can

contribute to a positive work environment, open communication, and patient-centered care

(Ehrhart et al., 2018). Research by Liden et al. (2008) highlighted that servant leadership is

associated with increased employee job satisfaction and organizational commitment, which can

indirectly impact the quality of care provided to patients.

The intricate relationship between leadership style and the quality of care within hospital settings

has garnered significant attention in both academic and practical spheres. This section delves into

the existing body of research, showcasing how leadership style influences healthcare outcomes,

elucidating current debates, and identifying gaps in the current knowledge. (Alfadhalah et al.

2021)

Numerous studies have explored the impact of leadership on healthcare quality.

Transformational leadership, often associated with inspirational communication and fostering

innovation, has consistently shown positive effects on patient care. A study by Wong and

Cummings (2007) demonstrated that transformational leaders create an environment conducive

to patient safety and open communication, resulting in improved outcomes.

Transactional leadership, while not as prominent in healthcare literature, still plays a crucial role.

Nurses and healthcare professionals often operate within structured environments where

adherence to protocols is essential. Research by Marquis and Huston (2017) emphasized the

importance of transactional leaders in enforcing compliance with established guidelines, thereby

ensuring patient safety and standardized care practices.

In contrast, the concept of servant leadership has gained traction in recent years due to its

emphasis on empathy, collaboration, and nurturing the growth of employees. The research by

Van Dierendonck and Nuijten (2011) highlighted how servant leadership contributes to a

positive work environment, which in turn influences patient outcomes through increased staff

satisfaction and engagement.

However, the existing research landscape is not without its debates. Some scholars argue that an

exclusive focus on a single leadership style might be oversimplified, neglecting the potential
synergies arising from a combination of styles. Hybrid models of leadership that blend

transformational and transactional aspects, as proposed by Bass and Riggio (2006), have been

posited as more effective in healthcare settings due to the dynamic nature of patient care.

Moreover, the contextual factors within hospitals can significantly shape the efficacy of

leadership styles. The complexity of healthcare delivery, the diverse patient population, and the

intricate interplay of multidisciplinary teams all contribute to the need for adaptive leadership.

Research by Wong et al. (2018) underscored the necessity for leaders to be situationally aware,

flexibly applying different leadership styles as circumstances demand.

Despite these contributions, a gap exists in understanding the intricate interplay between

leadership styles, organizational culture, and patient outcomes. While various styles have been

individually explored, limited research has systematically compared and contrasted these styles

within the same healthcare environment. Additionally, few studies have addressed the evolving

landscape of healthcare, including the integration of technology, the focus on patient-centered

care, and the impact of external regulations on leadership practices. (Fahlevi et al. 2022)

This study seeks to address these gaps by conducting a comprehensive analysis of leadership

styles' impact on healthcare quality while considering the dynamic contextual factors that shape

leadership effectiveness. By doing so, this research aims to provide a nuanced understanding of

leadership's role in enhancing patient outcomes and satisfaction in the modern healthcare

landscape.

1.3. Research Gap:

Despite the significant body of research on leadership styles and healthcare quality, there exists a

notable gap in understanding the nuanced ways in which leadership styles can interact with the
complex dynamics of hospital settings. While transformational, transactional, and servant

leadership styles have been individually explored, there is a lack of comprehensive studies that

compare and contrast these styles within the context of quality of care in hospitals.

Moreover, the influence of situational factors on the effectiveness of leadership styles in

healthcare remains relatively unexplored. The healthcare environment is multifaceted, with

variables such as the acuity of patients, the availability of resources, and the organizational

structure affecting how leadership styles impact care quality. Understanding these interactions is

crucial for tailoring leadership approaches to specific hospital contexts.

This study seeks to address these gaps by conducting a comprehensive examination of the

relationship between leadership style and quality of care in hospitals. By considering the unique

challenges and demands of healthcare settings, as well as the varying strengths and limitations of

different leadership styles, this research aims to provide a holistic understanding of how

leadership practices can be optimized to enhance patient outcomes and satisfaction.

2. Aims and Objectives

This section outlines the aims, research objectives, and research questions of the study. It

clarifies the overarching goal of the research, its significance, and the specific steps taken to

achieve the research objectives.

2.1. Aims:

The primary goal of this research is to comprehensively examine the impact of different

leadership styles on the quality of care provided in hospital settings. The study seeks to enhance

our understanding of how leadership practices influence patient outcomes and satisfaction,

thereby contributing to the ongoing efforts to improve healthcare delivery. By bridging gaps in
the current research and exploring the dynamics between leadership styles and the healthcare

context, the research aims to provide actionable insights for healthcare administrators and leaders

to optimize their approaches.

2.2. Research Objectives:

To achieve the research aim, the following objectives have been identified:

1) To Explore the Relationship Between Transformational Leadership and Quality of

Care:

 Examine how transformational leadership practices influence the culture of innovation,

communication, and patient safety within hospitals.

 Investigate the link between transformational leadership and employee satisfaction,

engagement, and retention, and how these factors impact patient care quality.

2) To Investigate the Role of Transactional Leadership in Ensuring Standardized

Care:

 Analyze the extent to which transactional leadership contributes to adherence to

established protocols and guidelines, ensuring consistent and safe patient care practices.

 Explore how transactional leadership interacts with other leadership styles to create a

balanced approach that promotes both compliance and flexibility.

3) To Examine the Impact of Servant Leadership on Employee Well-being and

Patient-Centered Care:

 Assess the effects of servant leadership in creating a positive work environment, fostering

open communication, and enhancing employee job satisfaction.

  Investigate how servant leadership aligns with the principles of patient-centered care and

its subsequent influence on patient outcomes and experiences.

4) To Understand the Contextual Factors that Modulate Leadership Style Efficacy:

 Explore how situational factors, such as patient acuity, resource availability, and

organizational culture, shape the effectiveness of different leadership styles.

 Investigate the adaptive capacity of leaders to flexibly apply various leadership styles

based on contextual demands.

2.3. Research Questions and Hypotheses:

To underpin the research's purpose, the following research questions and hypotheses have been

formulated:

Research Question 1:

How does transformational leadership influence the overall quality of care provided in hospitals?

Hypothesis 1:

Hospitals with leaders practicing transformational leadership will exhibit higher levels of patient

care quality, employee satisfaction, and innovation compared to hospitals with other leadership

styles.

Research Question 2:

What is the role of transactional leadership in ensuring standardized care practices and patient

safety?

Hypothesis 2:
Hospitals with leaders employing transactional leadership will demonstrate greater adherence to

established protocols, resulting in standardized care practices and improved patient safety.

Research Question 3:

How does servant leadership impact employee well-being and contribute to patient-centered

care?

Hypothesis 3:

Hospitals led by servant leaders will experience higher levels of employee job satisfaction,

engagement, and collaboration, leading to enhanced patient-centered care and improved patient

outcomes.

Research Question 4:

To what extent do situational factors influence the effectiveness of different leadership styles in

healthcare settings?

Hypothesis 4:

The adaptive application of leadership styles based on contextual demands will lead to more

effective leadership practices and better patient outcomes.

3. Proposed methodology

3.1. Introduction

This chapter elucidates the systematic methodology adopted for a quantitative study, aiming to

analyze leadership styles within the hospital environment and correlate these with various key
performance indicators (KPIs). Grounded in the path-goal theory, this research provides valuable

insights into the pervasive effects of leadership behaviors within healthcare settings.

3.2. Research Design

The research design is the architectural blueprint of any study, providing a systematic plan that

details how the research will be conducted to ensure valid and reliable results. For this particular

study, the chosen approach is the descriptive research design, grounded in quantitative

methodologies. Here's a deeper exploration into this design and its relevance to the study.

Nature and Purpose

Descriptive research is fundamentally non-experimental and observational. Its primary aim is to

describe and capture the status quo of variables within a subject without any manipulation. The

beauty of this design lies in its ability to paint a precise picture of situations, phenomena, or

events by collecting quantitative data. For our study, which aims to understand leadership styles

and their potential correlation with specific KPIs in hospitals, a descriptive approach ensures that

the leadership styles are evaluated as they manifest naturally in the real-world setting, without

any external influences.

Rationale for Selection

The rationale for opting for the descriptive research design is multifold:

1. Rich Data Collection: Given the emphasis on the natural occurrence of events,

descriptive research allows for rich, detailed data collection. Leadership behaviors within

hospitals are multi-faceted; capturing them in their true essence requires such detailed

observations.
 2. Objectivity: Descriptive studies prioritize objectivity. By focusing on 'how often' or 'how

much' in relation to leadership behaviors and KPIs, the study reduces the risk of

subjective interpretations, thus ensuring more accurate findings.

3. Foundation for Future Research: By providing a snapshot of the current scenario,

descriptive research lays a strong foundation for future studies. Recognizing the prevalent

leadership styles and their correlation with KPIs today can pave the way for experimental

or exploratory studies tomorrow.

3.3. Sampling

Sample Size and Selection:

The determination of an appropriate sample size and its selection remains a critical cornerstone

of any research. This process not only impacts the robustness of the study's results but also

influences its overall validity and potential for generalization. For this study, our foray into

determining the sample size and selection was meticulous, aligning with the scope and objectives

of the research.

The importance of the sample size in quantitative research cannot be overstated. It becomes the

vehicle through which the intricacies and variances inherent in the population under study are

captured. A small sample might lead to results lacking reliability or having a high margin of

error, while an excessively large one, although likely more accurate, might result in unnecessary

expenditure of resources. In navigating these considerations, it was decided that a sample size of

500 respondents, spanning ten different hospitals, would be both adequate and manageable.
The reasoning behind this decision was multi-faceted. Firstly, the broad objectives and depth of

the study demanded a significant number of participants to provide a comprehensive insight into

leadership styles across different hospital settings. Secondly, practical considerations like

available time, budget, and human resources were pivotal in shaping this decision. Finally, this

size also ensured that the confidence intervals of the results would be tight, making the findings

both precise and reflective of the broader population's sentiment.

In terms of sampling technique, the study adopted Stratified Random Sampling. Recognizing the

need to understand leadership styles across a diverse range of hospitals, the entire population was

first segmented or 'stratified' based on certain key parameters like geographical location, size,

and patient demographics. From this stratified assortment, ten hospitals were randomly selected

to ensure a widespread representation. Within these selected hospitals, random sampling was

then used to pick out respondents, with each hospital contributing 50 participants.

Despite the rigorous methodology, we remained mindful of potential biases. Selection and non-

response biases are often pitfalls in such studies. To counteract this, the random selection of

hospitals aimed to minimize selection bias. To tackle non-response bias, multiple strategies were

implemented. These included sending follow-up reminders to potential respondents and ensuring

them of the strict confidentiality with which their responses would be treated.

3.4. Instrumentation

Questionnaire:

Derived from "A Path–Goal Theory Investigation of Superior Subordinate Relationships"

(Indvik, 1985), the questionnaire comprises 20 items. These items are meticulously designed to

quantify four distinctive leadership styles: Directive, Supportive, Participative, and

Achievement-oriented. The inclusion of a 7-point Likert scale allows respondents to rate each

statement's congruence with their own behavior.

Key Performance Indicators:

To provide an encompassing overview, nine pertinent KPIs were identified:

1. Hospital occupancy rate

2. Average length of stay

3. Bed occupancy rate

4. Initial nursing assessment duration

5. Nurse handover efficiency

6. Patient and family satisfaction levels

7. Efficacy of patient identification

8. Staff satisfaction and expectation alignment

9. Incidence of hospital-acquired pressure ulcers.

3.5. Data Collection

Distribution:

Physical visits were made to the selected hospitals, wherein the questionnaires were handed to

senior management and team leaders. Accompanying the questionnaire was an informational

leaflet explaining the research objective and assuring respondent anonymity.

Response Rate:

Post-distribution, a certain response rate was anticipated, calculated via the ratio of returned to

distributed questionnaires.
 3.6. Data Analysis

Scoring:

Adhering to the provided guidelines, data from questionnaires were meticulously scored. Items

designated for reverse scoring were adjusted accordingly, ensuring interpretative accuracy.

Subsequent to this, leadership style scores were computed.

Statistical Analysis:

In the realm of research, the ability to derive meaningful and actionable insights from raw data

pivots on the strength of the statistical analysis undertaken. As such, our investigation into the

correlation between leadership styles and key performance indicators in hospitals began with

rigorous statistical methods, designed to decipher patterns and relationships among the variables

under consideration.

Our first task was data preparation. The importance of clean, well-organized data cannot be

overstated, as it sets the stage for all subsequent analytical processes. This involved meticulously

checking for missing values, deciding on whether to impute or exclude them based on the nature

of the data and the volume of such values. Further, outliers, which possess the potential to skew

and distort our findings, were identified and treated. Lastly, it was crucial to establish that our

data conformed to the normal distribution, especially given our intention to use parametric tests

in the subsequent stages.

Once our dataset was in optimal shape, we transitioned into our descriptive statistical analysis.

This foundational layer of analysis offers a snapshot of the data's basic features, giving

researchers an immediate sense of its structure. Central to this was determining the measures of

central tendency. Calculating the mean, median, and mode provided us with an understanding of
the central point of the dataset, offering initial insights into the predominant leadership styles

across the sampled hospitals. Additionally, measures of dispersion like standard deviation and

variance were determined to gauge the spread and variability of the data.

But description alone doesn't suffice in the world of research; one needs to infer and predict. As

such, inferential statistics took center stage post the descriptive phase. Given the nature of our

study, correlation analyses were undertaken to decipher the relationship between leadership

styles and the various KPIs. We employed Pearson’s correlation coefficient for this purpose,

given its efficacy in establishing linear relationships between two continuous variables.

Moreover, regression analysis was executed to predict the potential impact of different

leadership styles on specific KPIs. This not only provided insight into the existence of a

relationship but also shed light on the strength and direction of said relationship.

In sum, the statistical analysis adopted for this study was not merely an academic exercise but a

robust and systematic approach to understand, with a degree of certainty, the intricate

relationship between leadership behaviors and hospital performance indicators. The results,

derived from such rigorous analysis, are poised to offer tangible, actionable insights to

stakeholders in the healthcare domain.

3.7. Reliability and Validity

While the reliability and validity of the instrument were pre-established by Indvik (1985), for

the current study, Cronbach’s alpha coefficient was derived to ascertain reliability. Additionally,

a preliminary pilot test in a comparable setting was performed to confirm the instrument's

appropriateness.

3.8. Ethical Considerations

Ethical clearance was procured from an institutional review board. Alongside, informed consent

was garnered from participants, reinforcing their comprehension of the study and their rights.

Data confidentiality and secure storage were paramount.

3.9. Conclusion

Having delineated the exhaustive research methodology, ranging from initial design to the

intricate processes of data analysis, this chapter serves as a blueprint for the study's execution.

Following segments will pivot towards presenting the findings, interpreting them, and

subsequently deliberating on their implications within the broader landscape of the healthcare

sector.

4. Research contribution

This section highlights the intended research contribution of the study, focusing on how the

research will benefit the current body of knowledge and practice in the field of leadership and

healthcare quality. It emphasizes the innovative and original aspects of the research,

demonstrating how pursuing the research questions will lead to new insights, theoretical

advancements, and practical implications.

4.1. Importance of the Research Questions:

The research questions addressed in this study are of paramount importance in both academic

and practical contexts. The exploration of how different leadership styles impact the quality of

care in hospital settings has direct implications for healthcare administrators, leaders, and

policymakers seeking to enhance patient outcomes and satisfaction. The research questions are

worth investigating because they address a significant gap in the current understanding of how

leadership practices influence the complex healthcare environment.

 4.2. Impact on the Discipline:

The anticipated impact of this research on the discipline of healthcare leadership is multifaceted.

Firstly, it will contribute to the theoretical advancement of leadership studies by providing a

nuanced understanding of how different leadership styles interact with the intricacies of hospital

care. By integrating transformational, transactional, and servant leadership theories, the research

will expand the theoretical foundation for leadership practices in healthcare settings.

Secondly, the research will extend the existing body of knowledge by exploring the contextual

factors that shape the effectiveness of leadership styles. The investigation into situational

awareness and adaptive leadership practices in response to varying healthcare environments will

provide new insights into leadership's dynamic nature.

Thirdly, the research will challenge the notion of a one-size-fits-all approach to leadership in

healthcare. It will demonstrate that the effectiveness of leadership styles is contingent on the

specific hospital context, allowing for the development of tailored leadership strategies that align

with the unique needs and challenges of each healthcare setting.

4.3. Theoretical and Practical Implications:

The pursuit of this research will create new understandings and generate information with both

theoretical and practical implications. The innovative aspect lies in the comprehensive

examination of multiple leadership styles and their interactions within the healthcare context. By

systematically studying transformational, transactional, and servant leadership, the research will

provide a holistic view of their impact on hospital care quality, enriching the theoretical

foundation of leadership studies.

The study's findings will have practical implications for healthcare leaders, administrators, and

policymakers. The insights gained will aid in the formulation of evidence-based leadership

strategies that cater to the diverse needs of hospitals. For instance, understanding when and how

to integrate transactional leadership for standardized care practices, or when to adopt servant

leadership for a patient-centered approach, will enable leaders to enhance both employee

engagement and patient satisfaction.

Furthermore, the research will assist in refining leadership development programs within

healthcare organizations. By identifying the most effective leadership styles in specific contexts,

organizations can tailor their training programs to cultivate the necessary skills and competencies

in their leaders, ultimately leading to improved patient care quality.

In conclusion, this research holds significant promise in contributing to the discipline of

healthcare leadership. By addressing critical research questions, the study will advance

theoretical understanding, extend existing knowledge, and challenge conventional notions of

leadership practices. The innovative and original approach of examining multiple leadership

styles within the complex healthcare landscape offers both theoretical insights and practical

applications. As the findings of this research unfold, they are expected to pave the way for the

development of strategic leadership approaches that foster improved hospital care quality,

benefiting both patients and healthcare professionals alike.

5. Research limitations

While this research endeavors to contribute to the understanding of leadership styles' impact on

hospital care quality, it is important to acknowledge its limitations. These limitations shape the
scope of the study, providing insights into potential constraints that could influence the

interpretation and generalization of findings.

1. Sample Size and Diversity: The scope of this research may be constrained by the size and

diversity of the sample. Due to practical constraints, the study might involve a limited number of

healthcare organizations, departments, or units, potentially restricting the generalizability of the

findings to a broader healthcare context. The demographic and professional diversity of

participants, including various healthcare roles and levels of experience, might also be limited,

impacting the comprehensiveness of insights.

2. Contextual Specificity: The research's findings could be influenced by the specific context in

which the study is conducted. Healthcare organizations vary significantly in terms of size, type,

location, and patient population. Therefore, the conclusions drawn from this research might be

most applicable to the specific healthcare settings under study, limiting the extent to which they

can be extrapolated to other contexts.

3. Methodological Approach: This research employs a mixed-methods approach, combining

quantitative surveys and qualitative interviews. While this allows for a comprehensive

exploration of the research questions, it also introduces potential challenges related to data

integration and triangulation. The interplay between quantitative and qualitative data might be

complex, impacting the depth and accuracy of the analysis.

4. Self-Report Bias: Both surveys and interviews rely on participants' self-reported data and

perceptions. This introduces the possibility of response bias, where participants might provide

socially desirable answers or misrepresent their experiences. Moreover, participants might have
varying levels of self-awareness regarding their own leadership styles and their impact on

hospital care quality.

5. Time and Resource Constraints: The timeline and resources allocated to this research could

impose limitations on its depth and scope. The comprehensive exploration of multiple leadership

styles and their intricate effects on hospital care quality might require an extended period of data

collection and analysis. The available resources, both in terms of time and funding, could

potentially constrain the extent to which the research can delve into nuances and complexities.

6. Causality and Longitudinal Analysis: Due to the cross-sectional nature of the study,

establishing causal relationships between leadership styles and hospital care quality might be

challenging. Longitudinal analysis, tracking changes over time, would be ideal for capturing the

dynamic interplay between leadership interventions and care outcomes. However, this is beyond

the scope of the current research design.

7. Ethical and Social Desirability: Despite efforts to ensure ethical conduct, the research could

face challenges related to participant confidentiality and social desirability bias. Participants

might provide responses they believe are expected, potentially altering the accuracy of their

contributions. Moreover, ethical considerations might limit the extent to which sensitive

information can be probed in interviews.

8. External Factors and Generalizability: External factors, such as changes in healthcare policies,

economic conditions, or advancements in medical technology, could impact the research's

applicability over time. As healthcare environments continue to evolve, the generalizability of

findings might be influenced by these external shifts.

6. Work Plan
The work plan outlines the feasibility and structure of the research, ensuring that the research

objectives are achievable within the designated timeframe. This plan demonstrates a clear

understanding of the time required for each research phase, from data collection to analysis and

dissemination. While the preliminary timeframe is provided, it will be adjusted and finalized

based on the guidance of assigned supervisors after proposal approval.

6.1. Preliminary Timeframe:

Phase Duration (Weeks)

Literature Review and Framework 2

Research Design and Ethics Approval 1

Quantitative Data Collection 2

Qualitative Data Collection 3

Data Analysis and Synthesis 4

Results Interpretation 2

Conclusion and Recommendations 1

Thesis Writing and Review 4

Final Revisions and Submission 1

Total Duration 20

6.2. Explanation of Phases:

1. Literature Review and Framework (2 Weeks): During this phase, an extensive review of

existing literature will be conducted to ensure a comprehensive understanding of leadership

styles, healthcare quality, and their interplay. This phase will also involve the formulation of a

theoretical framework that guides the research approach.

2. Research Design and Ethics Approval (1 Week): The research design, including the mixed-

methods approach, survey instruments, interview protocols, and ethical considerations, will be

finalized. Ethical approval will be sought from the relevant institutional review board (IRB).

3. Quantitative Data Collection (2 Weeks): Data will be collected through structured surveys

administered to healthcare professionals and patients. The quantitative phase aims to gather

measurable data related to leadership styles, employee satisfaction, patient outcomes, and

compliance rates.

4. Qualitative Data Collection (3 Weeks): Semi-structured interviews with hospital leaders,

managers, and staff members will be conducted to capture rich qualitative data on their

perceptions and experiences of leadership styles and their impact on hospital care quality.

5. Data Analysis and Synthesis (4 Weeks): Quantitative data will be analyzed using statistical

methods such as regression analysis to identify relationships between variables. Qualitative data

will undergo thematic analysis to uncover patterns and themes within participants' responses.

6. Results Interpretation (2 Weeks): The findings from both quantitative and qualitative analyses

will be interpreted to understand the implications for leadership styles and hospital care quality.

Patterns, trends, and connections between variables will be highlighted.

7. Conclusion and Recommendations (1 Week): Based on the interpreted results, conclusions

will be drawn regarding the impact of leadership styles on care quality. Practical

recommendations for healthcare administrators and leaders will be formulated.

8. Thesis Writing and Review (4 Weeks): The research findings, analysis, conclusions, and

recommendations will be synthesized into a comprehensive thesis. The document will undergo

multiple drafts and revisions, incorporating feedback from supervisors and peers.
9. Final Revisions and Submission (1 Week): The final version of the thesis will undergo

thorough proofreading, formatting, and revision. Once polished, the thesis will be submitted for

evaluation.

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Path–Goal Leadership Questionnaire:

Instructions: This questionnaire contains questions about different styles of path–goal

leadership. Indicate how often each statement is true of your own behavior.

Key: 1 ~ Never 2 ~ Hardly ever 3 ~ Seldom 4 ~ Occasionally 5 ~ Often 6 ~ Usually 7 ~ Always

1. I let subordinates know what is expected of them. 1 2 3 4 5 6 7

2. I maintain a friendly working relationship with subordinates. 1 2 3 4 5 6 7

3. I consult with subordinates when facing a problem. 1 2 3 4 5 6 7

4. I listen receptively to subordinates' ideas and suggestions. 1 2 3 4 5 6 7

5. I inform subordinates about what needs to be done and how it needs to be done. 1 2 3 4 5

67

6. I let subordinates know that I expect them to perform at their highest level. 1 2 3 4 5 6 7

7. I act without consulting my subordinates. 1 2 3 4 5 6 7

8. I do little things to make it pleasant to be a member of the group. 1 2 3 4 5 6 7

9. I ask subordinates to follow standard rules and regulations. 1 2 3 4 5 6 7

10. I set goals for subordinates' performance that are quite challenging. 1 2 3 4 5 6 7
 11. I say things that hurt subordinates' personal feelings. 1 2 3 4 5 6 7

12. I ask for suggestions from subordinates concerning how to carry out assignments. 1 2 3 4

567

13. I encourage continual improvement in subordinates' performance. 1 2 3 4 5 6 7

14. I explain the level of performance that is expected of subordinates. 1 2 3 4 5 6 7

15. I help subordinates overcome problems that stop them from carrying out their tasks. 1 2 3

456

16. I show that I have doubts about subordinates' ability to meet most objectives. 1 2 3 4 5 6

17. I ask subordinates for suggestions on what assignments should be made. 1 2 3 4 5 6 7

18. I give vague explanations of what is expected of subordinates on the job. 1 2 3 4 5 6 7

19. I consistently set challenging goals for subordinates to attain. 1 2 3 4 5 6 7

20. I behave in a manner that is thoughtful of subordinates' personal needs. 1 2 3 4 5 6 7

Scoring

1. Reverse the scores for Items 7, 11, 16, and 18.

2. Directive style: Sum of scores on Items 1, 5, 9, 14, and 18.

3. Supportive style: Sum of scores on Items 2, 8, 11, 15, and 20.

4. Participative style: Sum of scores on Items 3, 4, 7, 12, and 17.

5. Achievement-oriented style: Sum of scores on Items 6, 10, 13, 16, and 19.

Scoring Interpretation

 Directive style: A common score is 23, scores above 28 are considered high, and scores

below 18 are considered low.

  Supportive style: A common score is 28, scores above 33 are considered high, and scores

below 23 are considered low.

 Participative style: A common score is 21, scores above 26 are considered high, and

scores below 16 are considered low.

 Achievement-oriented style: A common score is 19, scores above 24 are considered high,

and scores below 14 are considered low.

The scores you received on the path–goal questionnaire provide information about which style of

leadership you use most often and which you use less often. In addition, you can use these scores

to assess your use of each style relative to your use of the other styles.

SOURCES: Adapted from "A Path–Goal Theory Investigation of Superior Subordinate

Relationships" by J. Indvik, unpublished doctoral dissertation, University of Wisconsin–

Madison, 1985; and Indvik (1988). Based on the work of House and Dessler (1974) and House

(1977) cited in Fulk and Wendler (1982). Used by permission.