An analysis of leadership practices and their influence on providers and service delivery in Lusaka province-Zambia

Abstract

In an evolving health care environment, hospitals need managers with high levels of technical and professional expertise who do not only concentrate on patient care, but also go further to demonstrate good leadership practices. In Zambia, the health sector’s mission is “to provide equity of access to cost-effective quality health services as close to the family as possible”. Only competent leadership can drive such an agenda. This study, conducted in selected 1st level Lusaka hospitals aimed at establishing the existing common leadership practices and their influence on healthcare providers and service delivery. The study used a two-phase cross sectional concurrent, mixed method design, to examine leadership practices through 12 health system managers and 30 healthcare providers. Quantitative data was obtained using a Multifactor Leadership Questionnaire (MLQ) and analysed using Statistical Package for Social Sciences Version 20 (SPSS 20). Qualitative data was obtained using in-depth interviews, focus group discussion, participant observation and document review. Quantitative analysis used averages and Pearson Chi-square tests to assess the interaction between Transformation, Transaction and Laissez-faire as independent variables and extra effort, effectiveness, motivation, satisfaction as dependent variables. The P- value of 5% was used to determine the significance. Qualitative data analysis was done by first transcribing audio-recorded interviews and grouping them into data sets (matrixes) where emerging themes were categorised manually. Qualitative data was used to build on the quantitative data to make conclusions and interpretations by providing prominent explanations. The common leadership practices preferred and perceived or experienced was the transformational leadership followed by transactional leadership while laissez-faire was rare type. The significant p-value of 0.001 demonstrated this. These practices were explained as networking, interpersonal relationship, human/material resources management, monitoring and evaluation, dictatorial tendencies and overworking of employees. Furthermore, the above practices were seen to have strong influence on healthcare providers through enhanced confidence, motivation for hard work and compromised quality of care. The resultant impact on service delivery was high quality performance as well as poor performance. Conclusion: The Ministry of Health policy makers should focus their attention on planning and implementing ongoing leadership and management trainings strategies that would strengthen the prevailing transformational and transactional leadership styles. This will help to strengthen health systems in leadership and governance, human resources for health and service delivery. The recommendation is that a similar study be done to compare the impact of leadership styles between government and private or mission hospitals.