Lupine Publishers | Scholarly Journal Of Psychology And Behavioral Sciences
Introduction
Background to the study
Healthcare
leadership is a critical and far-reaching concept [1]. The best leaders have
been those with vision. The practice of leadership is often more of an art than
it is science [2]. Leadership within healthcare practice has been principally
the domain of medical doctors. However, healthcare outcomes are a function of
the involvements of healthcare workers such as, nurses, social workers and
psychologists [3]. Making clinician’s organizational leaders is a huge,
intricate and costly task. Is it worth it? Especially given the many competing
demands on clinician’s time? They and others will rightly seek evidence of the
link between clinical leadership competence and the organization’s performance,
in both clinical and financial terms [4]. Proof of a direct correlation will
remain elusive, thanks to the inherent complexity of health systems, whose
performance is affected by multiple, overlapping tasks in healthcare
management. Nonetheless, diverse and growing bodies of researchers have
suggested the enormous impact of clinical leadership in healthcare professional
practice [5-8].
The
Institute of Medicine (2001) reported that healthcare organizations world over,
who have incorporated the clinical leadership practices have witnessed
tremendous growth. For example, Kaiser Permanente, a large, integrated United
States healthcare provider operating in several states in the late 1990s, was
struggling with declining clinical and financial performance, and was losing
some top clinicians to private practice and rival organizations. A new CEO (a
pediatric plastic surgeon) made clinical leadership an explicit driver of
improved patient outcomes, defining the role of the clinician as “healer,
leader and partner” and revamping Kaiser’s leadership development programmes
for doctors [8,9]. However, within five years of adopting this new approach,
Colorado had become Kaiser’s highest-performing affiliate on quality of care
and a beacon of excellence within the United States healthcare; patient
satisfaction grew significantly; staff turnover fell dramatically; and net
income rose from a deficit budget to $87million (Institute of Medicine, 2001).
Hence, need arises for healthcare providers with a diverse and specific set of
competencies [10-12]. However, the question hinges on what set of competencies
will produce qualitative clinical leadership competency? Clinical leadership is
a readily used term to describe doctors and other health care mavens as leaders
within the health service but has thus far been less well defined [13].
Clinical leadership involves influencing and motivating others to deliver
clinically effective care by demonstrating clinical excellence, providing
support and guidance to colleagues through mentorship, supervision and
inspiration [14]. Clinical leadership can also be perceived as positioning
clinicians at the core of determining and overseeing clinical services, so as
to deliver first-rate outcomes for patients and populations, not as a one-off
task or project, but as a core part of clinicians’ professional identity and
concern [15,16]. The National Co-coordinating Centre for NHS Service Delivery
and Organization suggest that effective clinical leadership is pivotal in
ensuring that improvement in healthcare is not only on the agenda of all
National Health Scheme organizations but becomes part of their working
structure. Transforming healthcare is everyone’s business with the provision of
high-quality care being at the heart of everything [17]. Creating a culture of
visible commitment to patient safety and quality requires clinical and
professional leaders to work together so that health care systems can meet the
healthcare challenges of the future [18]. A clinician is a healthcare
practitioner such as a psychologist, physician, psychiatrist, occupational
therapist or nurse, involved in clinical practice, as distinguished from one
specializing in research or that works as primary care giver of a patient in a
hospital setting; or clinic setting [19-25]. In other words, a clinician can be
viewed as a health care professional that practices at a clinic [26]. While clinical
leaders are clinicians who has direct responsibility or influence on patient
care at ward, unit or team level which is applicable also to primary care and
general practice settings [27]. A clinical leader integrates research evidence
into practice, leads efforts to improve patient care, acknowledged as a leader
in all situations and is an advocate for transforming the health system and
implementing best practice [16].
Although,
clinical tradition and training make the idea of clinical leadership conflicting
to many clinicians, this perception have been regarded as rather detrimental to
clinical leadership approaches [17,28]. The conventional view is that doctors
and nurses should look after patients, while administrators look after
organizations [29]. Yet several pioneering healthcare institutions have turned
this assumption on its head by advocating and achieving outstanding performance
[30]. Clinical Leadership is about more than simply appointing people to
particular positions [30]. Rather, it is about recognizing the diffuse nature
of leadership in health care organizations, and the importance of influence as
well as formal authority [31-35]. Clinical leadership is not a new concept and
the need to optimize leadership potential across the healthcare professions and
the critical importance of this to the delivery of excellence and improved
patient outcomes, is now increasingly echoed by clinicians, managers and
politician’s world over [36,37]. Report that clinical leadership differs from
management responsibility in that, leadership is thought of as undertaking and
showing the way by helping to shape and manage clinical services for the better
of patients and staff. Whereas a manager might be expected to regularly deal
with relatively routine tasks, a clinical leader also uses their expertise and
evidence to provide solutions to clinical problems [36].
The
perception of leadership being dislocated from everyday medical practice
suggests that more must be done to explain the relevance of leadership to all
health care practitioners from a variety of backgrounds in order to provide the
type of expert leadership they advocate [36]. There has been increasing
recognition for the role that clinicians can provide in meeting the demands for
a better health care delivery system [38]. To respond effectively within some
predetermined health budget clinicians must not merely be at the forefront of
treatment but also integrated into health care decision and policy making [39].
Define self-esteem as when one has a good opinion of oneself. Self-esteem is
the way people think about themselves and how worth-while, they feel [40].
Assert that when a person's self-esteem is high, he tends to be motivated and
performs his job or task better. Task here refers to specific piece of
labour/work to be done as a duty required by an authority or delegated
responsibility [2,3]. Self-esteem is a state of mind, it is the way you think
and feel about yourself having high self-esteem means having feelings of
confidence, worthiness, and positive regard for one’s self [40,11]. People with
high self-esteem often feel good about themselves, feel a sense of belonging,
self-respect and appreciate others [41,15]. People with high self-esteem tend
to be successful in life because they feel confident in taking on challenges
and risking failure to achieve what they want [42].
Asserted
that clinicians with recognizable self-esteem have more energy for positive
pursuits because their energy is not wasted on negative emotions [4], feelings
of inferiority or working hard to take care of or please others at the expense
of their own self-care [43]. Posits that self-esteem is believed to be relevant
to the individual’s optional adjustment and functioning. However, an ingrained
skepticism emerges among clinicians about the value of spending time on
leadership, as opposed to the evident and immediate value of treating patients
[1,15,44] suggested high self-esteem indicates a person respect for self and
does not consider him or herself superior to others, recognizes
self-limitations, and expects to grow and improve. Low self-esteem implies
self-rejection or self-contempt, feeling disagreeable about oneself and wishing
it were otherwise (Table 1). Rosenberg explained self-concept is not a
collection but an organization of parts, pieces, and components and that are
hierarchically organized and interrelated in complex ways and [45] describe
global self-esteem to be an individual’s positive or negative attitude toward
the self as a totality, which is strongly related to overall psychological
wellbeing.
Self-esteem
has not been shown to predict the quality or duration of relationships among
spouses [11]. Yet high self-esteem makes people more willing to speak up in
groups and to criticize group's approach [46,47] refer that leadership does not
stem directly from self-esteem, but self-esteem may have indirect effects.
Furthermore, people with high self-esteem show stronger in-group favoritism,
which may increase prejudice and discrimination [48-50]. Extraversion is also one
of the personality characteristics that have found in some studies to be more
characteristic of leaders compared to non-leaders [7]. Extraversion refers to
interest in or behaviour directed toward others or one’s environment rather
than oneself [51]. One of the most consistent results in the study of
leadership, emotion and personality is that extraversion is having an indirect
effect on [52]. Leaders who are gregarious, active and outgoing tend to
experience more pleasant emotion than those leaders who are quiet, inactive and
introverted this does not portend leadership effectiveness, but this assertion
cannot be generalized in that this signify differing results among those in
healthcare practice [53]. Individual differences in leadership performance have
been linked to differences in personality and relationships especially with
leader’s span of control [48]. Research has shown that personality plays an
important role in shaping who earns leader status in work groups [54-60] by
signaling competence and shaping performance expectations when groups first
form [61]. In particular, extraverted members tend to express confidence,
dominance, and enthusiasm, and so are attributed with high status and
frequently selected for leadership positions [62-65]. Conversely, neurotic
members tend to express anxiety, withdrawal, and emotional volatility, earning
lower status and rarely emerging as leaders [66].
Clinicians
in general, therefore have considerable opportunity to influence patients'
attitudes and behaviours in relation to their treatment, rehabilitation, and
recovery process [67]. As nursing requires a focus on therapeutic and
interpersonal interaction between the clinician and the patient, it is likely
that the attitudes and interpersonal practices the clinician brings to this
interaction will influence his/her care of the patient [68,61] suggested that
it is potentially useful to study the nurse/ doctor, nurse/patient interaction
by measuring aspects of this interaction through the use of an instrument that specifically
examines nursing approach towards a particular type of patient and improve
understanding of interpersonal attitudes and practices which enhance the
ability of nurses to provide problem focused care that is appropriate to the
patient. A clinical leader is perceived as proficient, well-trained, and
knowledgeable health care professional who have the vision to see improvements
to services or who is able to address limitations within the health system and
share their vision with their fellow practitioners [69]. Extensively, doctors
who were able to use influence or change management skills are considered most
likely to be successful in turning a vision into reality [70]. However, the
issue bothers around which set of competencies will produce qualitative
clinical leadership? Hence, this research tends to fill this gap by
investigating self-esteem, extraversion along with interpersonal relationship
as predictors of clinical leadership among clinicians in Ondo and Lagos State,
Nigeria.
Statement of the Problem
In
the past few years, the healthcare industry in Nigeria have witnessed strikes
like the one recently embarked upon by the Nigerian Medical Association in
conjunction with the Nigerian Pharmacological Society (NPS) who embarked on an
indefinite strike to press on their 24 point demand with the government of
Nigeria chief among these demands, is the demand that medical practitioners
should direct the affairs of all healthcare organization in Nigeria as
obtainable in other developed countries of the world [17]. Although, these
demand and policies are aimed at enhancing the safety of patients and the
welfare of medical practitioners to better improve the services of the health
sector and the welfare of hospital employees to compete favorably in Africa and
the global system [15,26] noted that the clamour would create enormous
challenges for those hospitals and healthcare organizations who are not
equipped to practice clinical leadership. Some of the challenges identified by
this author are: personality characteristics of clinicians and the role in
plays within the leadership spectrum, lack of leadership training skills in the
curriculum of health workers in the industry, the demands of leaders by
developing the right personality needed for leadership and closer monitoring by
the regulatory body (Table 2). These developments will make most healthcare
organizations in Nigeria lay emphasis on service delivery which is in the best
interest of patients.
While
the primary focus of regulation for clinicians is on their professional
practice, all clinicians, registered or otherwise, work in systems and most
within organizations. It is vitally important that clinicians have an influence
on these wider organizational systems and thereby improve the patient experience
and outcome [71]. Clinicians have an intrinsic leadership role within
healthcare service and have a responsibility to contribute to the effective
running of the organization in which they work and to its future direction
[27]. Therefore, the development of leadership competency as an integral part
of a clinician’s training will be a critical factor. Delivering services to
patients, service users, care givers and the public is at the heart of the
Clinical Leadership Competency Framework. Clinicians work hard to improve
services for people [46]. Furthermore, Nigeria’s Federal Ministry of Health has
observed that the lack of performance of the country’s health system is
attributable to the weakness in leadership role of government in health [72].
In an attempt to address this situation a leadership and governance training
workshop was held in August 2010 in Abakaliki, the capital of Ebonyi State
southeastern Nigeria. This workshop recommended that no matter how adequate
Nigeria’s Federal Ministry of Health or the Nigerian Medical Association (NMA)
policy reforms are, such policies may not yield desired results if the hospital
employees who are to execute the policy are not adequately trained in
leadership practices [73]. The desire for improved healthcare and sustenance of
the industry in Nigeria might become short-lived if adequate attention is not
given to the factors responsibility for clinical leadership. In the last
decade, clinical leadership has been a subject of investigation in the United
Kingdom, Canada and the United States of America [74,75]. However, despite the
growing body of literature on clinical leadership, only few African studies
have explored clinical leadership [17,28,46]. In particular, there are
relatively no considerable empirical studies on the influence of self-esteem,
interpersonal relationship, and extraversion on clinical leadership among
clinicians in Nigeria. To this date, arguably, no Nigerian study has been found
to empirically investigate the predictors of clinical leadership.
In
view of this gap, this study investigates the influence of self-esteem,
extraversion, and interpersonal relationship on clinical leadership among
clinicians in Ondo and Lagos State, Nigeria. Exploring clinical leadership from
this angle might help proffer lasting solution to clinician’s psychosocial
requirement for clinical leadership in Nigeria. In light of these it would be
pertinent to ask some relevant question:
- Would self-esteem predict
clinical leadership competency?
- Would extraversion predict
clinical leadership competency?
- Would interpersonal
relationship predict clinical leadership competency?
- Would self-esteem, interpersonal
relationship, and extraversion predict clinical leadership competency?
Purpose of Study
The
purpose of this study is to examine the relationship among self-esteem,
extraversion, and the influence of interpersonal relationship on clinical
leadership. However, the specific major purpose of this study is to:
- Examine the predictive role of
self-esteem on clinical leadership among clinicians in Ondo and Lagos
State.
- Determine the predictive role
of extraversion on clinical leadership among clinicians in Ondo and Lagos
State.
- Access the predictive role of
interpersonal relationships on clinical leadership among clinicians in
Ondo and Lagos State.
- Ascertain the combined
predictive roles of self-esteem, extraversion and interpersonal
relationships on clinical leadership among clinicians in Ondo and Lagos
State.
The
quality of interpersonal relationship has been found to predict treatment
adherence and outcome across a range of patient diagnoses and treatment
settings [57] and may even be considered a curative agent in its own right
[11]. In community psychiatry, community mental health teams provide
comprehensive care programmes for people with severe mental illness. Although
there is a shared caseload in assertive community treatment [38] one named
person is usually responsible for keeping in close contact with the patient and
coordinating care. Priebe suggests that the relationship between a patient and
a clinician takes centre stage of managed care delivery in community mental
health services. A study by McKinsey and the London School of Economics, in
2008, involving over 170 general managers and heads of clinical departments in
the United Kingdom National Health Service (NHS), found that hospitals with the
greatest clinician involvement in management scored some 50% higher on key
measures of organizational performance than hospitals with low clinical
leadership [29]. Among the growing base of academic evidence, a National Health
Service study found that in 11 examples of attempted service improvement, organizations
with stronger clinical leadership competence were more successful in delivering
change (National Co-coordinating Centre for National Health Service Delivery
and Organization). National Coordinating Centre for NHS Service Delivery and
Organization found an ingrained skepticism among clinicians about the value of
spending time on leadership, as opposed to the evident and immediate value of
treating patients. Participants explained that playing an
organizational-leadership role is not seen as vital either for patient care or
their own professional success and therefore seemed irrelevant to the
self-esteem and careers of clinicians. Moreover, many participants expressed
discomfort with knowing that the impact of clinical leadership is often
difficult to prove.
According
to Felfe and Schyn extraversion seems to influence the perception of
leadership. Felfe and Schyns warn that feedback of followers high in
extraversion tend to be biased positively, in contrast to feedback from
introverts because of the positive correlation of extraversion with acceptance.
According to Myers-Briggs Type Indicator (a measurement instrument of human
behaviour based on the studies of Carl Jung), the categorization of
extraversion is a reflection of an individual’s preference for interacting with
the world [17]. Extroverts are energized by the outer word of people, places
and things. Whereas introverts are energized by their inner world of ideas,
thoughts and concepts [52], another definition of extraversion, ‘refers to the
extent to which individuals are sociable, loquacious, energetic, adventurous
and assertive [71]. This risk-taking behaviour of extroverts may be very useful
in some fields where taking risks is an essential part of everyday
decision-making [8,16]. Despite these contributions in the reviewed studies,
there is a dearth in the examination of psycho-social and personality studies
on clinical leadership in Nigeria. As a matter of fact, there had never been
any empirical study on clinical leadership in Nigeria. In view of this gap in
literature, this study therefore explored the joint and independent influence
of self-esteem, interpersonal relationship, and extraversion on clinical
leadership among clinicians in south-western Nigeria.
Research Hypotheses
a)
Self-esteem will independently significantly predict clinical leadership.
b) Interpersonal relationship will independently significantly predict clinical
leadership.
c) Extraversion will independently significantly predict clinical leadership.
d) Self-esteem, interpersonal relationship, and extraversion will jointly
significantly predict clinical leadership.
Method
Research Design
A
cross-sectional survey design was adopted in the study. Moreover, variables of
this study were not actively manipulated. The dependent variable is clinical
leadership. The predictor variables are self-esteem, interpersonal relationship
and extraversion.
Research Setting
Employees
in the health industry in Lagos and Ondo states metropolis, Nigeria constitute
the population of this study because healthcare workers in Lagos and Ondo State
are strategically located in the hub of the most populous nation in Africa. The
pluralistic, commercial, and strategic nature of Lagos and Ondo states informed
the choice of hospitals used in the study.
Participants
A
total of 412 employees across 3 federal and 2 state hospitals, including 4
general hospitals and health centers in Lagos and Ondo metropolis, Nigeria were
sampled using accidental sampling technique. The federal and state hospitals,
including general hospitals and health centres were also selected. The
participants comprised of 212 (51.5%) males and 200 (48.5%) females. The ages
ranged from 20 to 59 with a mean of 38.19 years and SD of 9.52. Also, 106 (25.7
%) of the participants were single, 255 (61.9%) were married, 29 (7.0%) were
widowed, and 19 (4.6%) were divorced. Their qualification also varied; 5 (1.2%)
had WAEC/GCE, 30 (7.3%) had NCE/OND, 137 (33.3%) HND/B.Sc., Masters 207 (50.2%)
and PhD 28 (6.8%). Their job position revealed that 161 (39.1%) were of junior
cadre and 245 (59.5%) were of senior cadre. In addition, their job tenure
ranged from 1 year to 33 years with a mean of 8.58 years and SD of 6.345.
Instrument
Relevant
data were gathered through the use of validated questionnaire which comprises
of four sections (A-E). Section A: Socio-demographic information. These include
age, gender, marital status, job position, job tenure and academic
qualification. Section B, The Rosenberg Self-Esteem Scale. The Rosenberg
self-esteem scale is a widely used self-report instrument for evaluating
individual self-esteem, 10-item scale that measures global self-worth by
measuring both positive and negative feelings about the self. The scale is
uni-dimensional. All items are answered using a 4-point Likert type scale
format ranging from strongly agree to strongly disagree. Scoring: Items 2, 5,
6, 8, and 9 are reverse scored. Give “Strongly Disagree” 1 point, “Disagree” 2
points, “Agree” 3 points, and “Strongly Agree” 4 points. The scores are on a
continuous scale. Higher scores indicate higher self-esteem. Samples items
included: ‘‘I am able to do things as well as most other people’’. Byrne showed
that the RSES had adequate internal reliability, and test-retest correlation of
0.61 over a 7-month period in Ontario, Canada. Reported a Cronbach’s Alpha
coefficient of 0.79 and [12] reported a Cronbach’s Alpha coefficient of 0.86,
among health workers. and he reported a Cronbach’s Alpha of the Rosenberg scale
coefficient of .92 showing good internal consistency using Nigerian Sample.
Section
C contains the Relationship Assessment Scale developed by Hendrick (1988) was a
7-item scale designed to measure general relationship satisfaction. Respondents
answer each item using a 5-point scale ranging from 1 (low satisfaction) to 5
(high satisfaction). The instrument takes a critical look at a central
construct in relationship satisfaction. Eight well-validated self-report
measures of relationship satisfaction. Scoring: Items 4 and 7 are
reverse-scored. Samples items included ‘‘in general, how satisfied you with
your work relationship are’’. ‘‘How good is your relationship with your co-workers
compared to most of the other employees’’. Among Nigerian samples, Iheonunekwu,
Anyatonwu, & Eze reported a Cronbach’s Alpha coefficient of 0.88. In the
present study, a Cronbach’s Alpha of .589 was obtained for the scale.
Respondents answer each item using a 5-point scale ranging from 1 (low
satisfaction) to 5 (high satisfaction).
Section
D contains the measures of extraversion from the Big Five Personality
Inventory. The instrument used for collection of data for extraversion was the
big five personality traits questionnaire, coined by [41]. However, only the
section measuring extraversion was used in the study and not the composite
sections of the instrument [61]. The instrument measured facets of (and
correlated trait adjective) extraversion including gregariousness (sociable),
assertiveness (forceful), activity (energetic), excitement-seeking
(adventurous), positive emotions (enthusiastic), and warmth (outgoing). Samples
items included ‘‘I like to start most conversations’’. ‘‘I talk to a lot of different
people at gatherings and events’ and he reported Cronbach’s Alpha coefficients
were between 0.66 and 0.87 and the inventory was validated through
criterion-related validity with coefficients between 0.65 and 0.76.
Section
E contains the Clinical Leadership Competency Framework (CLFC): The Clinical
Leadership Competency Framework was created with the agreement of the NHS
Institute for Innovation and Improvement and the Academy of Medical Royal
Colleges. The Clinical Leadership Competency Framework which was created
developed and is owned jointly by the NHS Institute for Innovation and
Improvement and Academy of Medical Royal Colleges (Department of Health, 2001).
The scale is a 39 item Likert type scale, divided into 5 distinct but
interrelated domains, i.e. Demonstrating Personal Qualities (DPQ), Working with
Others (WWO), Managing Services (MS), Improving Services (IS) and Setting
Direction (SD). Sample item include: ‘‘I apply my learning to practical work’’,
‘‘I take action to improve performance’’, ‘‘I take responsibility for embedding
new approaches into working practices’’. Malcolm, Wright, Barnett & Hendry
obtained Cronbach Alpha of 0.78 and [45] obtained Cronbach Alpha of 0. 77. In
the present study, Cronbach’s Alpha coefficient of .791 was obtained. However,
there are no studies yet in Nigeria that has empirically studied the concept of
clinical leadership competency.
Procedure
In
order to get the clinicians that participated, permission and ethical approval
was sought and obtained from the ethical review committee of the Federal
Neuro-Psychiatric Hospital, Lagos. In a bid to get clinicians to participate in
the study, approval was sought and obtained in form of informed consent before
they were selected for the assessment. The respondents were adequately informed
about the nature of the study and its benefits. The purpose of the study was
explained to the participants as they were also given assurance of
confidentiality and anonymity of their identities and responses. In addition,
the respondents were told that there was no right or wrong answers, and as such
should try to be honest as possible in their responses. The choice of hospitals
was arrived at after the researcher sought and obtained permission and was
granted by the authorities of these hospitals which included a letter from the
Ethic Review Board, Federal Neuro-Psychiatric Hospital, in Lagos. Using
accidental sampling technique, the researcher administered four hundred and
thirty questionnaires to clinicians across various disciplines that consented
in such a way that averages of 45 copies of questionnaire were administered per
hospital. The reason for using accidental sampling technique and not
randomization was because most hospital employees are always busy and their
job-schedule (shift rotation) situations in most hospitals and clinics did not
allow for a more rigorous sampling technique. So, the only way to get
sustainable participants is by using this non-probabilistic method. Although,
four hundred and thirty (430) copies of questionnaire were administered but
only four hundred and twelve (412) copies of questionnaire were found usable
for the analysis. This yielded a response rate of 95.8%.
Inclusion Criteria
Eligibility
to participate in the study included all qualified employed resident/consultant
clinicians which comprises of Psychiatrists, General Practitioners, Surgeons,
Neuro-surgeons, Orthopedics, Ophthalmologists, Pharmacist, Occupational
Therapists, Clinical Psychologists, Psychiatric Nurses, Laboratory Analysts, Social
workers and Interns (Medicine, Pharmacy and Psychology) who have spent not less
than 6 months and who are in direct contact with patient or who provide
healthcare for inpatients and outpatients in managed care institutions.
Exclusion Criteria
The
respondents that were ineligible or excluded from the study comprised those
classified as outliers who included, retired healthcare practitioners,
healthcare artisans and those chronologically less than 18 years of age,
clinicians with less than six-month experience, laboratory workers, ambulance
drivers, administrative staffs, hospital domestic workers and all nonpracticing
healthcare professionals.
Data Analysis
In
order to determine the extent and direction of associations among the study
variables, Pearson Product Moment Correlation (PPMC) analysis was conducted.
Multiple regression analysis was then used to test hypothesis 1, 2, 3 and 4.
Some of the sociodemographic variables were codified. For example, gender was
coded male 0, female 1. Marital status was coded single 0, married 1, widow 2
and divorce 3. Job position was coded junior 0, senior 1. All analyses were
conducted using SPSS 20.0 Wizard.
Results
Test of relationship among the study variables
The
first analysis involved inter-correlations of all the variables of the study.
The result Results in Table 1 indicated that age, gender, job position, job
tenure and academic qualification had no significant relationship on clinical
leadership. However, marital status depicted significant relationship with
clinical leadership. Table 1 showed that self-esteem did not have a significant
relationship with clinical leadership [r (412) = -.017; p > 0.05]. This implies
that self-esteem does not have any relationship with clinical leadership.
Interpersonal relationship had significant negative relationship with clinical
leadership [r (412) = -.159; p < 0.01]. This indicates that clinicians who
reported high interpersonal relationship develop low clinical leadership.
Similarly, extraversion had significant negative relationship with clinical
leadership [r (412) = -.198; p < 0.01]. This imply that clinicians who
reported high extraversion show low clinical leadership competency.
Test of hypotheses 1, 2, 3 and 4
In
order to test hypothesis 1, 2, 3 and 4, multiple regression analysis was
conducted. The result is presented in Table 2 Results in Table 2, showed that
self-esteem did not significantly predict clinical leadership (β = -.00; t =
.006; p > 0.05). This means that self-esteem of clinicians will not
determine clinical leadership competence. Therefore, hypothesis 1 was rejected.
Interpersonal relationship showed an inverse relationship with clinical
leadership (β = -.13; t = -2.74; p < 0.01), it implies that clinicians who
reported high on interpersonal relationship showed low clinical leadership
competency compared to those who scored low on interpersonal relationship. The
result confirmed hypothesis two. Therefore, hypothesis 2 was confirmed.
Extraversion inversely predicted clinical leadership (β = -.17; t = -3.69; p
< 0.01). This implied that clinicians who reported high on extraversion
showed lower clinical leadership competency compared to clinicians who scored
low on extraversion. This result did confirmed hypothesis 3. Therefore, the
hypothesis was accepted.
Hypothesis
4, which was based on the contribution of all the independent variables
(self-esteem, interpersonal relationship, and extraversion) to the prediction
of clinical leadership, the outcome of the summary in Table 2 signifies that
all the independent variables when pulled together yield a multiple R of 0.239
and R2 of .057 [F = (3, 412) = 8.195, p < 0.01]. This is an indication that
all the independent variables contributed 5.7% of the variance in clinical
leadership. Meanwhile, other variables not considered in this study therefore
accounts for 94.3%.
Discussion
The
study examined the influence of self-esteem, interpersonal relationship, and
extraversion on clinical leadership among clinicians in Ondo and Lagos State,
Nigeria. In hypothesis 1, the result showed that self-esteem did not
significantly predict clinical leadership. Therefore, the hypothesis was
rejected. The result of this study supported the findings [21] and according to
these authors self-efficacy, self-confidence and self-esteem does not directly
contribute to leader success. Rather, they suggested that it is the
individual’s belief regarding his or her capabilities to successfully perform
the leadership task that is the key causal factor. Also, this result
corroborates with the findings [45] and these authors stated that laboratory
studies have generally failed to find that self-esteem predicts good task or
leadership performance with the important exception that high self-esteem
facilitates persistence after failure. An explanation for this is that
leadership does not stem directly from self-esteem, but self-esteem may have
indirect effects [5]. Clinicians with high self-esteem show stronger in-group
favoritism that may lead to or increase prejudice and discrimination that are
detrimental to healthcare management. Also, self-esteem is heavily invested
with feelings about the self, as specific facets of selfesteem include a
variety of self-related thoughts whereas, clinicians are trained to work as
unit where competence is commended, and personal identity is consigned to the
background [70].
In
addition, the result revealed that interpersonal relationship significantly
negatively predicted clinical leadership. As a result, hypothesis 2 was not
confirmed. This implies that clinicians with high interpersonal relationship
predict low clinical leadership competence. This is viable because studies and
[11,16] have revealed that interpersonal relationship between clinicians and
patients are ethically restricted because the association is a therapeutic
relationship for example, the relationship between the clinician and client
differs from both a social and an intimate relationship in that the clinician
maximizes his or her communication skills, understanding of human behaviors,
and personal strengths to enhance the client’s growth.
Further
reason for the negative correlation between interpersonal relationship and
clinical leadership can be tied to the ingrain code of ethics and standards of
practice for healthcare quality professionals which stipulates that healthcare
professionals must always maintain the highest standards of professional
conduct by not permitting relationships interpersonal or otherwise to influence
the free and independent exercise of professional judgment on behalf of
patients [56]. The results of the current study revealed that extraversion
negatively predicted clinical leadership which corroborated with the findings
of Redfern [9]. who found a significant negative association between
extraversion and clinical leadership? Research on the “dark sides” of
extraverted behaviors finds that with experience working together, peers
interpret extraverts as poor listeners who are unreceptive to input from others
[16]. For example, Opayemi and Balogun determined that when subordinates are
proactive (i.e., they voice constructive ideas, take charge to improve work
methods, and exercise upward influence), groups with more extroverted leaders
are less effective due to heightened competition and conflict.
Conclusion
Based
on the findings, the study has empirically demonstrated that clinicians who
perceived a diminish sense of self-esteem, low interpersonal relationship and
extraversion showed higher tendency to demonstrate clinical leadership
competence than their counterparts. Moreover, the results revealed that
hospital employees who have high self-esteem showed lower tendency to exhibit
clinical leadership competence. The result of this study also showed that all
the independent variables (self-esteem, interpersonal relationship, and
extraversion) jointly predicted clinical leadership. Conclusively, findings of
this study established that self-esteem, interpersonal relationship, and
extraversion jointly exert significant influences on clinical leadership
competence among clinicians.
Implications of the findings
Findings
of the study have some direct practical implications for management and boards
of directors in ministries of health in government owned hospitals in Nigeria
and Africa. The findings of this study also have practical implications for
reviewing and updating Nigerian hospital reforms and training manual,
specifically in relations to teaching, training of hospital employees. It is
therefore suggested that hospital management should include measure of clinical
leadership as part of assessment tools, and academic course during training.
Clinical leadership training should also form an important area of
concentration in colleges of medicine, and schools of nursing.
Recommendations
Based
on the findings of this study, the researcher recommends as follows: Colleges
of medicine and various schools of Nursing under the Ministry of Health in
Nigeria should take adequate steps to inculcate clinical leadership structures
that suit and encourages the cultural and environmental demands of clinical
leadership competencies. In other words, clinicians who work in healthcare
environments in Nigeria shall acquire career development possibilities and
leadership training like those in the United Kingdom (UK), and central Europe who
are already reaping the dividends of clinical leadership competency. Since
clinicians interact and work directly with patients and hold the interest of
the patient the most. The researcher therefore recommends that the Nigeria
healthcare reforms and policies should be reviewed, specifying issues relating
to enrollment, conscription, and training of clinicians. It is therefore
recommended, that hospital management in Nigeria should include measure of
clinical leadership competency as part of their training and assessment tools
during enrolling in medical colleges, and schools of nursing. This may help
hospital employee’s deal with work pressures, physician-nurse relationship,
medical team structure and functional responsibility. Healthcare practice needs
evidences that are proved by research outcomes. Integration of research
evidence into clinical leadership performance is essential for the delivery of
high-quality clinical care. Leadership behaviors of doctors, psychologists,
nurses, especially, managers and administrators have been identified as
important to support research use and evidence-based practice. Yet, minimal
evidence exists indicating what constitutes effective clinical leadership
competency for this purpose or what kinds of interventions help clinical
leaders to successfully influence research-based care. It is recommended that
research centred on these areas should be intensified.
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