The Quantitative Measurement of “New Leadership” Paradigm in Health Care: A Review of the Available Instruments

Abstract

Conceptual framework: The political, technological and economic changes that have occurred over the past twenty years are increasingly difficult to manage within the conventional framework of health-care, and the organisation of health-care is seen to need transformation to respond to increasing uncertainty, instability and complexity. In this context, leadership has been emphasized as a key factor in driving organizations forward. Over the past two decades, there has been an increasing interest in a school of leadership theory referred as “New Leadership” Paradigm. It describes and categorizes a number of approaches to leadership to exhibit common or at least similar themes, although there are few differences between them. These theories are charismatic leadership, transformational leadership, and visionary leadership. The common thread of these theories is that these leaders are able to develop and implement a vision, communicate this vision, and motivate subordinates to commit resources and energy toward vision- oriented goals. The evidence shows that transformational leadership behavior is related to a wide variety of positive individual and organizational outcomes. Taking into account the importance of the new leadership paradigm, measurement of the transformational leadership behaviour could be used in better understanding of leadership process and leaders development. Objective: The review’s objective is to appraise the quantitative instruments available to health services researchers who want to measure “new leadership” paradigm. Data sources: A broad literature search was conducted using Medline, CINAHL, Embase, HMIC (including Helmis, DoHdata, king’s Fund database), PsychInfo, Social science citation Index for articles published up to January 2005. All citations were checked. The experts over the world were contacted in order to find instruments that are not in the published literature. The search concentrated on instruments used to quantify measure new leadership paradigm with a track record, or potential for use, in health care settings. Data extraction: For each instrument, these items were considered: conceptual or theoretical framework that the tool is derived from; the scientific properties of the instrument (methodological description of development and testing, reliability and validity); the number of items for each questionnaire; the measurement scales selected; and its strengths and limitations. Principal finding: six instruments were found that satisfied the inclusion criteria: Multifactor Leadership Questionnaire (MLQ); Leadership Practice Inventory (LPI); The Leadership Profile (TLP); Transformational Leadership Questionnaire (TLQ); Transformational Leadership Behaviour Inventory (TLI); and Conger- Kanungo Questionnaire (C-K 20 questionnaire). Four of them have been used in health care organizations (MLQ; LPI; TLP; and TLQ). The TLI has strong potential to be used in health care settings and the C-K 20 questionnaire has some potential for use in such setting. Conclusion: A range of instruments with different characteristics is available to researchers, all of which have limitations in terms of their scope, scientific properties, and ease of use. The choice of instrument should be considered in terms of the purpose of the investigation and availability of resources. Although the quantitatively based surveys have been the favoured approach to the study of leadership, it should be kept in mind that they may fail to capture the richness of leadership phenomena and its dynamic process. Therefore, quantitative approach could be supplemented by different qualitative methods to develop a more detailed understanding of the leadership phenomenon.