LEADERSHIP STYLES, AND THEIR RELATIONSHIP WITH QUALITY

MANAGEMENT PRACTICES IN PRIVATE HOSPITALS IN THE

Hospitals are very important institutions for the economic and social well-being of society.

Their curative and rehabilitative functions enable them to restore individuals to being productive

members of society and for those individuals to enjoy the benefits that can be derived from it. The

success of hospitals in their mission is therefore important. This success is highly dependent on

the hospitals' managerial capability. An understanding of how hospitals are managed will

contribute immensely to future successes in hospital management and towards the enhancement

of their roles in society.

Throughout the world, the healthcare sector is struggling to provide quality healthcare to

citizens while managing costs (Walston, Al-Harbi, & Al-Omar, 2008). Healthcare organizations

recognize the need to provide quality services if they want to survive as a healthcare provider that

is intended to meet the physical, psychological, and social needs of people seeking care. According

to Khan (2011), quality is the focus of most organizations as it is considered to be the main

competitive and business practice; quality management has become a strategic tool to achieve

superior performance and competitiveness. Top management support is essential and the most

important factor for quality management in providing a clear direction to employees’ satisfaction

Antonaros (2010) argue that leadership is about the skills, abilities, behavior, and knowledge

necessary for the success of quality initiatives, which is significant given the number of

organizations striving to weave quality programs into their overall strategic orientation.

Additionally, Fredendall (2009) contends that leadership traits are essential to achieve quality

improvements in product, processes, and services. Top management’s commitment and

involvement are necessary to bring about quality enhancement in any organization. Several studies
show that continuous quality improvement implementation and similar strategies require a long-

term commitment of several years in order to result in a successful outcome (Cantrell, 2009).

According to Bass and Avolio (1994), the turbulent healthcare environment shows that it

poses challenges and has made management aware of the need for appropriate leadership as

healthcare professionals function in an environment of uncertainty, disorder, and ambiguity. The

current turbulent environment requires speed, innovation, and flexibility, with which traditional

organizational practices are unable to cope with. Suffice it to say, the right leadership in an

organization can stimulate a group to articulate innovative ideas. These are known as the “strong

forces” of leadership, which can shift the focus from quantity to quality and speed (Bass & Avolio,

1999). Quality and speed can provide an organization with a competitive edge; these two factors

can be responsible for the long-term success of an organization. Leadership can facilitate

qualitative change by changing associates’ viewpoints. Hence, leadership style influences the

quality environment.

In summary, the concepts of leadership styles and quality management practices (QM) are

very critical in organizations. The application of these concepts often determines how

organizations achieve their goals and objectives (Khan, 2011). Even though these concepts are

related to a greater extent, they also differ in terms of their meaning and application in the

organizations. It is important to point out that in as much as they may be different concepts, the

success of each of these approaches in the organization depends on the working of the other; that

is, when applied in a given organization, the two are rarely separable because they are intertwined

(Goetsch &Davis, 2011).

Hence, leadership requires many things, but the most important is service to others. The

combination of competencies, characteristics, traits and methods of each style will yield an
effective leadership mode capable of driving quality management and sustaining long-term

evolution in the organization. A synthesized integration of these leadership styles will drive

forward the leader’s ability to effectively influence the organization and therefore impact quality

management practices. To begin with, it is important to understand the role of the leadership styles

and organizational culture on the quality management practices in private hospitals in the cities of

Laoag and Batac especially when the results of studies on specific leadership styles have not been

clear or consistent.

STATEMENT OF THE PROBLEM

This paper will focus on the leadership styles, and their relationship with quality

management practices in private hospitals in the cities of Batac and Laoag. Specifically, it will

seek to answer the following questions:

1. What are the leadership styles of hospital owners as perceived by the employees?

2. What are the Quality Management Practices of the private hospitals in Laoag and

Batac?

3. Is there a significant relationship of leadership styles and quality management

practices in the private hospitals in the cities of Laoag and Batac?

SIGNIFICANCE OF THE STUDY

This research study will help hospital owners and managers identify their leadership styles

and their quality management practices that will guide to come up with a developmental plan to

improve services offered to their clientele. Moreover, the result of this study will help employees

to render quality services to clienteles since they have a basis on quality management.
 In addition, this paper will also provide clienteles an overview of the services offered by

the private hospitals so that they may be able to understand the protocols used inside the system.

SCOPE AND DELIMITATION OF THE STUDY

This research study will focus on the leadership styles and its relationship with quality

management. This paper will be delimited only to the private hospitals operating in the cities of

Batac and Laoag. Survey-Questionnaires will be used as a data collection instrument.

All information and conclusions that will be drawn from this study will be obtained from

the private hospitals operating in the cities of Batac and Laoag.

Leadership styles and quality management practices

The present research draws from leadership style, and quality management practice

theories. Theories of quality management practices form the basis of this research, particularly

Anderson et al.’s (1995) theory that traced Deming’s (1982) management method development.

Review of literature indicates that Anderson et al. made the first attempt to synthesize quality

management theory from Delphi method-based research, using it with both managers and

academic sources closely related to quality (Rungtusanatham, Forza, Filippini, & Anderson, 1998;

Fisher, Barfield, & Mehta, 2005; Chowdhury, Paul, & Das, 2007). However, Anderson et al.

pointed out that in Deming’s management method, the basic premise is creating an organizational

system that fosters quality management practices implementation including customer focus,

continuous improvement, and teamwork, which all require effective leadership.

In addition, the leadership theory applied in the current research is drawn from Bass’s

(1985) theory. Bass’s work on the theory of transformational leadership grew out of James

MacGregor Burns’s (1978) qualitative examination of charismatic political leaders (Howell &

Avolio, 1993) as well as House’s (1971) theory of charismatic leadership (Yukl & Van Fleet,

1982), which stemmed from ideas originating from the early work on charisma by Weber (Bass,

1990).

The development of leadership theories and quality management practices share the

common objectives of improving organizational performance and enhancing the work experience

of organizational members. But it is unclear what specific leadership styles are most effective in
organization pursuing quality management practices. It is however evident that the role of

leadership is a key factor in effective quality management in organizations as all excellence models

include leadership as an enabling driver. The role of leadership includes long-term commitment to

innovation and creativity. Managing human resources is a strategic issue that requires managerial

capability. Knowledge is an important organizational resource, and leadership plays a key role in

facilitating the acquisition of that knowledge. Thus, leaders must have the ability to realize

formulated vision by managing quality elements to transform the firm into using quality

managerial practices (Idris & Ali, 2008). This is possible through a transformational leader, who

has the capability to inspire and direct subordinates.

Moreover, authors have found that top management support is essential for quality

improvement. Salaheldin (2009) concurred to this notion based on an exploratory study conducted

on the specific problems that Qatar Steel Company faced in the implementation of the quality

program. The study revealed that lack of support from top management was the biggest

impediment to TQM implementation. When commitment and support from the top management

was forthcoming, Quality Circles (QC) implementation led to an atmosphere of cooperation and

brought in many positive results, like quality improvement, productivity increases, and improved

management style.

Added to the importance of top management in TQM implementation, Deming predicted

that visionary leadership was essential for an effective QM program. Several case studies support

the claim that effective QM requires top management to provide a clear direction to employees

(Laohavichien et al., 2009).

The importance of leadership has been highlighted even in the MBNQA (Anderson et al.,

1995). Accordingly, Pannirselvam and Ferguson (2001) studied the strength of the relationships
among the various quality management constructs as well as between quality management and

organizational performance. They found that leadership considerably—whether directly or

indirectly—affected all system units.

A more comprehensive effort was exerted by Anderson et al. (1995) who tried to develop

a theory of quality management to describe and explain the effectiveness of Deming’s

Management Method. The seven constructs that could capture the essence of the Deming method

include visionary leadership, learning, internal and external cooperation, process management,

employee fulfilment, continuous improvement, and customer satisfaction. The empirical study by

Anderson et al. (1995) conducted in Japanese-owned and American-owned plants found that

employee fulfilment is directly related to customer satisfaction. The authors emphasized that

organizational leadership impacts the creation of organizational form and institutes organizational

practices for the sake of organizational survival. The study concluded that innovation is essential

for achieving quality improvements in product, processes, and services. This leads to employee

satisfaction, which enhances customer satisfaction and consequently the theoretical survival of the

organization. However, what is sought is not merely the survival of the firm, but TQM.

Organizational leadership should be responsible for innovation, not just the survival of the firm.

In a related study, Berson and Linton (2005) examined the relationship between leadership

style and the establishment of a quality environment in research and development settings (R&D).

They found that both transactional contingent-reward leadership and transformational leadership

lead to a quality environment in the R&D section of a telecommunications firm, but in the latter

case, it is not significant. The role of contingentreward leadership is less important than that of

transformational leadership. Transformational leadership also leads to employee satisfaction.

Leaders have to deal with uncertain goals and performance targets. Transformational leadership,
which comprises inspirational leadership, can lead to multiple outcomes in technology

environments and have an extraordinary impact on the employees, thereby impacting quality.

Another related study by Laohavichien et al. (2009) tested the influence of both

transactional and transformational leadership on a firm’s quality improvement. Through a study

of quality managers in the United States, the study found that although transformational leadership

affects infrastructure and core quality management, transactional leadership does not affect either.

To date, no studies have used leadership theories to determine the impact on quality management

practices; hence, Laohavichien et al.’s study is significant. Leaders influence employees and this

enhances quality performance or processes and products. The study also found that

transformational leadership provides visionary leadership for successful quality management.

However, transactional leadership does not decrease the quality, according to this study, which is

contrary to previous findings.

With regards to the impacts of leadership style and quality management practices on

company performances, Idris and Ali (2008) carried out a study based on the empirical evidence

from business firms in Malaysia. They found that the ability to adapt to change is critical to survive

in the new global economic order. This ability, in the form of transformational leadership,

combined with the best practice capability, could lead to organizational success. The study found

that transformational leadership—mediated by best practice management—can enhance financial

performance. In other words, an effective management approach can bring about muchneeded

organizational change. The transformational leaders establish the vision and through effective

communication, they motivate followers to achieve that vision.

To sum up, the various studies concur as to what practices can be termed under quality and

which factors are responsible for quality improvement. Literatures from different sources,
pertaining to different industrial sectors and from different nations, have been reviewed. Top

management support has been emphasized by most researchers and authors in regard to

contributing to quality performance. The literature review suggests that quality improvement is

influenced by several factors, including top management support, training, workforce

management, process management, employee involvement, and overall employee relations.

Quality of the physical product is not sufficient to maintain a sustained advantage. Customer

relationships are an integral part of the system for enhancing quality performance. Top

management support and commitment, which most papers have discussed, are nothing but another

name for leadership. Transactional leadership has not been found to be of significance in quality

improvement primarily because this type of leadership is associated with rewards and punishment,

and hence an exchange. Meanwhile, transformational leadership could impact quality management

practices because top management or leaders play the role of motivators who guide subordinates.

Overall, when an organization has transformational leaders, it is able to engage and involve the

employees who—when motivated—give their best. This leads to product and process quality

improvement in a people-oriented culture. In addition, when firms have a customer-centered

approach, they focus on customer satisfaction. To derive customer satisfaction, firms must realize

that internal customers (i.e. employees) need to be satisfied first. Thus, quality improvement is

directly related to leadership styles.

Research Design

The purpose of the study is to determine the impact of leadership styles on quality

management practices in private hospitals in Laoag City and Batac City. A quantitative research

design will be adopted to collect data, test hypotheses, and answer the research questions. A cross-

sectional survey method will be used to conduct this study. Probability sampling was used to

select the sample.

Research Instruments

Leadership Styles

Theory of transformational leadership proposed by Bass (1985) was further developed by

Avolio and Bass (1995) who extended the theory by integrating a level-of-analysis framework.

Avolio and Bass have also developed Multi-factor Leadership Questionnaire (MLQ) whereby its

latest version (Form-5x-short) includes the full range leadership (Transformational, transactional,

and laissez-faire) and was used in the present study to measure leadership styles. The Bass and

Avolio MLQ scale was adapted in this research owing to its extensive development and validation

of scale and because it is considered one of the best instruments available to evaluate leadership

styles. The instrument begins from transformational at one end to highly avoidant at the other end.

All the leadership styles had nine items and each was rated on a five-point scale, ranging from ‘1’

(not at all) to ‘5’ (frequently, if not always).

Data of quality management practices was obtained through the use of questionnaire. The

seven constructs that are the most common principles of quality management practices were

included with the exception of leadership owing to the independent investigation of this principle

as the predictor variable (Adam, 1994; Ahire, Golhar, & Waller, 1996; Ahmed, 2009; Anderson,

Jerman, & Crum, 1998; Antony, Leung, Knowles, & Gosh, 2002; Awan, Bhatti, Qureshi, &

Bukhari, 2009). These constructs include employee focus, strategic quality planning, customer

focus, quality information and performance, continuous improvement and innovation, process

management, and role of the quality department. All these items were rated on a five-point scale,

ranging from ‘1’ “Strongly Disagree” to ‘5’ “Strongly Agree.” The instrument includes 41 items

that are selected after a careful review of the literature. The instrument has been tested, validated

and refined with a focus in the context of healthcare.

Data Collection

The questionnaires will be distributed to the private hospitals in the cities of Laoag and

Batac.

Statistical Treatment

The data to be collected will be analyzed using mean and percentage. Responses will be

analyzed using pearson r correlation and will also go through significant testing.