To examine the way in which hospital administrators have changed
leadership behaviors as a result of a change in the hospital environment.
The sample consisted of 84 CEOs from a random sample of 250 CEOs
from the roster of the American Hospital Association. The LPI was used to "provide a
practical and understandable description of these [transformational] behaviors" (50). CEOs
described their leadership practices prior to the Medicare Prospective Payment System
(PPS) in 1982 and since the implementation of that system. The typical hospital was a rural
(58%), independent community-based hospital (62%), with 153 beds. The typical hospital
executive was a 46-year old, well-educated (80% had graduate degrees) male (92%), with
11+ years of experience as a CEO.
The pre-PPS (change) composite leadership score (all 30 items from the
LPI) was significantly lower than the post-PPS score, indicating that "executive leaders
perceive that their use of transformational leadership behaviors increased after the
implementation of Medicare PPS" (130). Three leadership practices--Challenging, Enabling,
and Modeling--were also significantly higher following the change.
Number of years in position and educational level were not significantly correlated
with any of the leadership practices. Age was negatively correlated with three leadership
practices (Inspiring, Modeling, and Encouraging). None of the facility/hospital
characteristics (hospital type, type of ownership, medicare certification, or urban/rural)
were correlated with the composite leadership score, or with Challenging, Inspiring,
Enabling, or Encouraging. Modeling was significantly correlated with medicare
"The study findings support the conclusion that hospital administrators changed
their leadership behavior toward a transformational model since the implementation of
Medicare PPS ..and.. the change in leadership behavior was not positively correlated with
either institutional or personal characteristics" (143). The author suggests that a key area
for future leadership development of hospital CEOs is Inspiring a Shared Vision.