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Correspondence
Ashley Loughman, Katherine Bowron and Cindy Kalai
UWA School of Medicine and Dentistry
Queen Elizabeth II Medical Centre
Perth
Australia
E-mail:
Lougha01@students.uwa.edu.au
Bowrok01@students.uwa.edu.au
Kalaic01@students.uwa.edu.au
Introduction
Effective Leadership
Effective leadership and its defining features is a
topic that has invoked much scientific interest
over the last 50 years. This is because leadership
is known to have the potential to improve overall
performance and the attainment of goals(1) and
also because it is a complex area of social
dynamics. Good leadership involves a complex
and delicate balance of multiple aspects in order
to be effective, including teaching, planning,
listening, judgement and decision-making(2, 3). In
addition to this, the occupational environment is
believed to be extremely important in
determining which leadership strategies are most
effective(4). This is believed to be because the
pressures, goals and potential crises that arise in
various lines of work favour very different
(14)
Methods
In order to compare leadership styles, data were
collected from employees in the three fields of
business, health and emergency. A previous study
by Sellgren, Ekvall and Tomson(2006)(5) which
looked at assessing preferred leadership
behaviour, was conducted in the form of a
questionnaire. Similarly, data for this study were
gathered by a survey which questioned workers
on what, in their opinion, were the qualities,
behaviours and beliefs of the best leaders in their
field. These questions were then repeated for the
worst leaders in their field. The survey contained
a series of open, closed and scaled questions(18).
The inclusion criteria for participation included
being over 18 years old, employed in health,
emergency services or corporate businesses south
of the Swan River and competent in written
English. Participants were asked for demographic
information in order to determine any statistically
significant differences in responses from those of
different age, gender, employment organisation
and level of education.
In each field, 130 surveys were distributed with
the aim of an ideal yield rate of 100 surveys each.
The health surveys were distributed amongst
medical, surgical and nursing staff at several
major teaching hospitals, business amongst
several large businesses south of the river and
emergency amongst volunteer SES officers and
law enforcement agents. Surveys were distributed
and collected either by a collection box placed at
their workplace or in a group setting with a
research team member present. What was
consistent, however, was that participants were
asked to complete the survey to the best of their
understanding and no direction was given by the
research team. Final returns for these completed
surveys totalled at 50 emergency surveys, 42
business surveys and 44 health surveys. This was
less than expected however a response rate of
Results
Respondents
The total number of survey responses received
was 136, each of which contained responses
pertaining to two leaders. Of the information on
271 leaders, the responses were incomplete for
15 of them resulting in their exclusion. There were
256 leaders with complete data sets. The
distribution of these leaders based on the
demographic information provided is shown in
Table 1. The included data consisted of 128
effective leaders and 128 ineffective leaders.
These were distributed between the three fields
with more overall responses in emergency (95) as
compared to business (82) and health (79). There
was an even distribution of effective and
ineffective leaders across all fields.
Total
257
.50
.81
44.75
Business
82
.49
.88
47.5
Health
79
.51
.71
46.25
Emergency
95
.50
.84
41.5
.64
.32
.15
.09
.08
.17
.66
0
.16
.01
0
.23
.49
.05
.23
.85
.09
0
.05
.01
.5
.22
.28
40
.73
.26
.01
63
.49
.45
.06
30
.31
.00
.69
29
Emergency
Health
Effective
42.19
41.8
(.3)
41.53
(.23)
Ineffective
27.38
29.44
(<.05)
25.07
(<.05)
Effective
41.19
34.48
(<.001)
39.98
(.05)
Ineffective
28.13
25.36
(<.05)
28
(.45)
Effective
34.58
42.48
(<.001)
33.18
(<.05)
Ineffective
25.27
26.64
(.13)
25.55
(.35)
Leadership Demographics
There was a gender bias across all three fields,
with an overall percentage of 81% male leaders
ranging from 71% in health to 88% in business.
The mean age of leaders was 44.75 years with
business and health marginally above this (47.5
and 46.25 respectively) and emergency having a
younger mean at age 41.5. The highest level of
education of the reported leaders varied between
the fields, as did employment sector. Number led
varied with 63 per business leader as compared to
health and emergency with 30 and 29
respectively.
Leadership Attributes
A comparison, of effective and ineffective
leadership attributes in the three fields is
presented in Table 2. Effective leaders had higher
scores in Production(P), Change(C) and
Employee(E) focus than ineffective leaders in all
fields. This comparison of mean E, P and C scores
between the fields of emergency, health and
business is also presented in Figure 1. This shows
that there was often a similar pattern across all
fields.
When compared to Emergency, effective health
leaders had a significantly higher employee focus
(34.58 to 42.48, p<0.001) and a significantly lower
change focus (41.19 to 34.48, p<0.001). This was
replicated in the ineffective health and emergency
workers, however only the difference in Change
Business
Table 3: Adjusted regression coefficients for Production Focus, Change Focus and Employee Focus as related to
overall effectiveness and field of employment
P
Effectiveness
Emergency
Health
Business
.719*
C
<.001
0 (Ref.)
.679*
E
<.001
0 (Ref.)
.667*
<.001
0 (Ref.)
.083*
.076
-.216*
0.081
**
**
**
**
.365*
**
<.001
**
* The analysis was adjusted for Age(numerical), Gender (male or not), Sector (Government, private or NGO), Highest level of education
(None, Bachelors, MBBS, Masters, PHD) and number of employees led(numerical).
** Business statistics failed to achieve significance for analysis on any of our independent variables
Discussion
Emergency and Health
Our analysis showed clear differences in the mean
values of Change focus and Employee focus
between effective and ineffective emergency
leaders and health leaders. However, both sectors
returned high Production focus in all sectors. The
high Production focus across the three sectors
may suggest that employees always prefer their
leader to take a more active role in planning,
communicating and directing tasks showing an
effective leader in any sector must be a
productively focused leader.
It is evident from the results that emphasis on
change focus differs between effective emergency
and health leaders, with significantly lower C
scores (34.48 vs. 41.19) in health suggesting that
effective health leaders need to adhere to current
protocols rather than generate growth and new
ideas. This is in contrast to leaders in the
emergency sector for whom, adaptability to
changing situations and the ability to incorporate
new ideas and methods to solve evolving
problems are perceived to be important
characteristics. It can be inferred that as leaders
in health deal with recurring situations in an
unchanging environment, there are already
evidence-based protocols in place on best
practice. This is in contrast to emergency leaders,
who operate in unique and novel situations within
variable environments. There may be set
protocols in these emergency situations but as the
circumstances of each situation differ, the leader
must then either adapt current protocols to the
novel situation or generate new ways to resolve
issues.
Similarly, there are significant differences in the
Employee Focus Mean Scores between
Emergency leaders and Health leaders. Effective
health leaders had a significantly higher E value
(42.48 vs. 34.58) than leaders in emergency
suggesting that health leaders are more relationoriented towards their subordinates. Both
emergency and health work in small teams which
require different styles from their leaders. Teams
in health, however, are designed to incorporate
ideas and opinions from many disciplines, with
each team members input being actively
encouraged by the team leaders. In contrast,
leaders in emergency are in a position where
executive decisions need to be made and the rest
of the team need to follow the instructions with
minimal input(19). The immediacy with which
actions need to be taken in emergency situations
also augments this effect.
These differences in leadership qualities between
Emergency and Health leaders may have
implications when the two sectors need to work
in tandem, as in a disaster relief situation. A good
leader working with both types of employees
would need to interact with health employees in a
more relation-oriented manner, being open to
suggestions and advice from their team. They
would also need flexibility in order to deal with
the rapid changes that may take place. The unique
circumstances of disaster relief may, however,
alter the required characteristics for an effective
leader, making it hard to extrapolate from our
current data.
Emergency and Business
In contrast, our results indicate that there is little
difference between qualities of effective leaders
in the emergency sector and the business sector.
Both sectors valued Production and task
orientation in their leaders, with high values of
Production focus (42.19 vs. 41.53) for their
effective leaders. The other mean values of focus
on change and employee-oriented focus were also
very similar between the two sectors (41.19 vs.
39.98 and 34.58 vs. 33.18, respectively), with the
means not statistically significantly different.
Similarly, adjusted regression coefficients
comparing business and emergency leaders
7
Conclusion
Consistent with our initial aim, the results of this
study outline the differences in leadership style
between effective and ineffective leaders in the
fields of health, emergency services and business.
Minimal significant difference was found between
effective business and emergency leaders,
indicating that in the future these fields could
perhaps share leadership research data and
effective leadership development techniques. A
significant difference was however found
between effective health and emergency leaders,
with health leaders shown to be more employee
focused and emergency leaders more change
focused. These differences are important to
consider given the close relationship these fields
have in situations such as that of a major
disasters.
Acknowledgements
The authors would like to thank all the staff across the
fields of emergency, health and business who took the
time to fill out this survey and also their leaders, who
permitted them to do so. We also thank Dr Deon
Canyon for providing us with our survey and Dr. Juliann
Lloyd-Smith for providing assistance with the statistics.
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