• Non ci sono risultati.

10 2.1 Leadership competencies of public health professionals in Nigeria

N/A
N/A
Protected

Academic year: 2021

Condividi "10 2.1 Leadership competencies of public health professionals in Nigeria"

Copied!
49
0
0

Testo completo

(1)

1 LITHUANIAN UNIVERSITY OF HEALTH SCIENCES

MEDICAL ACADEMY FACULTY OF PUBLIC HEALTH

Ikenna Charles Ujuagu

EVALUATION OF LEADERSHIP COMPETENCIES AMONG PUBLIC HEALTH PROFESSIONALS IN NIGERIA

Master Thesis (Public Health)

Student Supervisor

Ikenna Charles Ujuagu Prof. Mindaugas Stankunas

KAUNAS, 2020

(2)

2 TABLE OF CONTENTS

ACKNOWLEDGEMENT...3

ABSTRACT ...4

ABBREVIATIONS ...6

INTRODUCTION ...7

1.AIM AND OBJECTIVES ...9

2. LITERATURE REVIEW ... 10

2.1 Leadership competencies of public health professionals in Nigeria. ... 10

2.2 Competency development and organizational success ... 12

2. 3 Leadership and public health system efficiency... 14

2.4 Research Gap ... 15

3. METHODOLOGY... 17

3.1 Organization of study ... 17

3.2Study instrument ... 18

3.3 Data Analysis ... 18

4. RESULTS ... 19

4.1Demographic and social indicators of respondents ... 19

4.2 Results showing evaluated scores in domain categories ... 20

4.3 Results showing the respondent’s current and required levels for each competency statement. ... 21

4.4 Comparison between social-demographic indicators and competency domains ... 29

5. DISCUSSSION ... 35

6. CONCLUSION ... 37

7. PRACTICAL RECOMMENDATIONS ... 38

8. REFERENCES ... 40

9. ANNEXES ... 46

(3)

3 ACKNOWLEDGEMENT

My foremost gratitude goes to God almighty for his grace throughout writing my thesis. I would also want to express my profound appreciation to my supervisor, Professor Mindaugas Stankunas for his guidance and encouragement throughout the process of my thesis. Also to Professor Kregždytė Rima, thank you for your relentless efforts and guidance.

To the amiable management and staff at ICARH, many thanks for opening your arms to me and ensuring that I had a smooth sail during my research at your organization.

To my mentor and pastor, Dr. Victor Mfam, thank you for helping me stay on course and giving me all the push I needed to make this reality.

Finally, to my parents and siblings, my deepest appreciation goes to you for being with me all through the journey. Thank you.

(4)

4 ABSTRACT

Aim: The aim of this study is to evaluate leadership competencies among public health professionals in Nigeria.

Objectives: 1) To assess the opinion of public health professionals on essential leadership competences2) To reveal the gap between the current level of competences and the required level of competences for optimal performance.

Methods: A cross-sectional survey was carried out between October- December, 2019 at the International Center of Advocacy on Right to Health (ICARH, Abuja, Nigeria). A robust leadership competency questionnaire developed from EU LEPHIE (Leaders of Public Health in Europe) project was used in this research. The eight competency domains consist of 52 statements The respondents were asked to rate their current level and required level of competency for each statement. Competencies were evaluated using a Likert scale from 1 to 5. Where 1 represents the minimum and 5 represents the maximum. All data were entered into the SPSS (Statistical Data for the Social Sciences) software version and analyzed.

Ethical consideration: Approval for the conduction of this research was granted by ICARH, Abuja, Nigeria and this approval was further certified by the Bioethics center of the Lithuanian University of Health Sciences upon which the final approval was granted by the center.

Results: Out of the 120 questionnaires issued, 72 were returned (60% response rate). The mean age of respondents was (33.72 ±5.94). With regards to gender 46 (63.9%) of the respondents were male while 26(36.1%) were female. A total of 34(47.2%) respondents have worked in the public health sector between 1-4 years, while 38(52.8%)have worked in the sector between 5-8 years. The mean years of experience were (4.68±1.85). For education, 62(86.1%) respondents had a biomedical degree while 10(13.9%) respondents had a non-biomedical degree. For the job position, 46(63.9%) of the respondents were working in non-executive positions while the remaining 26(36.1%) were working in the executive positions. There was a statistically significant difference (p<0.001) between respondents’ current competence level and the level deemed for optimal performance at their job. The respondents rated their current level of competence significantly lower than their required level of competence. Respondents had the highest level of competence in the domains of with ‘ethics and professionalism’ and ‘collaborative leadership: building and leading interdisciplinary teams’. They also perceived that the competences in these domains were the most important for their job positions as the competences in these domains were evaluated highly in the required level of competences.

(5)

5 Conclusions:

Nigerian public health professionals believe that exemplary leadership in healthcare greatly depends on ‘ethics and professionalism’ and ‘collaborative leadership: building and leading interdisciplinary teams’. Findings from this study show that the respondents rated their existing competencies significantly lower than leadership competencies required for optimal performance in their jobs.

(6)

6 ABBREVIATIONS

WHO -World Health Organization FMOH -The Federal Ministry of Health LMICs -Low-to middle-income countries

ICARH- International Center of Advocacy on Right to Health

Keywords: competences, leadership, management, program, framework

(7)

7 INTRODUCTION

Leadership is a key determinant in the growth and success of any institution. The concept of leadership is a complex and ever-changing process that has been interpreted in so many ways.

Situational leadership, self-directed leadership, transformational leadership and many more are some of the documented theories and models of leadership(1). The International Journal on Leadership Studies gave an integrative definition of a leader as thus “A leader is one or more people who selects, equips, trains, and influences one or more follower(s) who have diverse gifts, abilities, and skills and focuses the follower(s) to the organization’s mission and objectives causing the follower(s) to willingly and enthusiastically expend spiritual, emotional, and physical energy in a concerted coordinated effort to achieve the organizational mission and objectives(2).”

Actuality of the problem

Today, discussions on the significance of leadership have been lacking in the healthcare sector especially in culturally diverse countries(3). The failure of leadership in the field of healthcare is regarded as one of the salient issues in society. A lot of healthcare institutions have been plagued with several challenges and have been seeking for improved service delivery and efficiency. The conceptual framework for improving leadership and management capacities of the World Health Organization (WHO) 2007 provides relevant organizational skills required for successful delivery of health services. 'Competency' is regarded as the professional skills, knowledge, and attitudes needed to perform a job. Health-care workers and managers need additional skills to complement the planning, direction, organization, and control functions of traditional management in complex health-care systems to be successful. These additional skills are essential for efficient patient care and continuous improvement in quality of health(4). The deficiency of competent leadership and governance in the healthcare sector has long remained a major deterrent in the growth and development of healthcare systems in most low-to middle-income countries(LMICs)including Nigeria. According to the WHO, leadership and governance are directly connected to not only the role the government plays in health but also the activities of stakeholders whose impact is felt in health. The Federal Ministry of Health(FMOH) in Nigeria has recognized eight major factors that hinder the leadership role of government in the healthcare sector: a)poor explanation of roles and responsibilities of key actors; b) lack of essential management and mentorship tools; c) the challenges of promoting inter-sectoral collaboration with other arms of government; d)poor communication and enforcement of health policy implementation e) non-existent legal support for the implementation of health polices; f) current policies do not include conclusive roles and responsibilities of the private sector; g) bad budget management practices; and h)inadequate funding

(8)

8 of the healthcare sector(5).The last two decades have seen a surge in the existence of private and non-profit healthcare organizations in many LMICs including Nigeria. This has been deemed to be extremely beneficial as it has helped and supported the already heavily-burdened public health care system in LMICs.

Novelty of the problem

The need to evaluate leadership competencies in healthcare has been grossly undermined. Research and studies show that very few healthcare institutions in Nigeria have taken evaluations and training in the area of leadership very seriously. Only medical directors, hospital administrators, and managers are seen as public health leaders and as such should be the only ones to be upskilled in this area. The ideology that every public health personnel is a leader and should function as one regardless of their position is far-fetched. Hence, the conduction of this research will show the assessed level of leadership competencies among public health professionals in a Nigerian healthcare organization.

Practical Use

The results from this research give us a clear view however narrow on the level of leadership competencies of public health professionals, how public health professionals perceive leadership and its importance as an effective ingredient in bettering the state of public health in a country, and the need to develop leadership training programs and initiatives for building an efficient public health workforce.

Personal input

I personally conducted a cross-sectional study on leadership competencies at the International Center of Advocacy on Right to Health (ICARH) in Abuja, Nigeria using a robust leadership competency questionnaire. The competency areas examined in the study were tailored to reflect the mission and goals of EU LEPHIE (Leaders of Public Health in Europe) project. The approval for the use of this questionnaire was granted by my supervisor, Professor Mindaugas Stankunas.

(9)

9 1.AIM AND OBJECTIVES

Aim:

The aim of this study is to evaluate leadership competencies among public health professionals in Nigeria.

Objectives:

1) To assess the current competence level of public health professionals.

2) To reveal the gap between the current level of competences and the required level of competences for optimal performance.

(10)

10 2. LITERATURE REVIEW

Inefficient leadership practices have resulted in ineffective health care systems in the majority of low to middle-income countries (LMICs), including Nigeria, with the majority of the population receiving inadequate health care as well as low access rate to the health systems (6,7). There are reports on inefficiencies and ineffectiveness of leadership in the Nigerian health care sector linking its failure to provide quality health care with such attributes as massive movements of public health professionals to developed countries in search of better working conditions, lack of funding, the battle for supremacy among the health care professionals, conflicts over collective bargaining agreements as well as inadequate policy frameworks (8-10).

Asuzu et al. (11) indicate that as a result of inefficiencies and failure in the health care system, Nigerian has been unable to manage epidemics and other health crises. In overcoming these challenges and carry out their task as leaders, there is a need for improved leadership practices in the Nigerian healthcare system and, this calls for a review of existing evidence on leadership competencies of healthcare professionals in the country (6, 9). The following is a review of existing literature on leadership competencies, the link between leadership and organizational success, competencies’ development, and efficiency, as well as a research gap identified.

2.1 Leadership competencies of public health professionals in Nigeria.

Leadership competencies are crucial in any organization and particularly in the health care sector, where the focus is the provision of high-quality health care service (12). Olu-Abiodun and Abiodun (13) conducted a cross-sectional study focusing on the transformational leadership behavior among 176 nurses in Ogun state, Nigeria. They concluded that nurses perceived that their nurse leaders used transformational leadership with the perception dependent on the work setting and the levels of qualification of the nurses. The study focused on general hospital nurses and argued that in general hospitals, nurse leaders used their actions and worked towards inspiring their followers towards a shared vision. Leaders who adopt transformational leadership are associated with high levels of interpersonal skills that enable them to inspire their followers into taking action (12). This is in contrast to a study conducted by Archibong (14) that reported lower scores in regards to the perception of nurses on transformation leadership style in a tertiary hospital in Enugu, South-east Nigeria. Further, Adeleye and Aduh (15) indicate that leadership in tertiary and general hospital nursing differs due to the different statuses and settings of the hospitals, thus explain the differing perception of the leadership style applied. Further, Ugwa (16) reports that transformational leadership is one of the most used leadership styles by nurse leaders in Nigeria.

(11)

11 A similar study investigating the leadership styles used by head nurses to make a decision was conducted in Lithuania and concluded that transformational leadership was one of the most used styles by head nurses with such leadership skills as interpersonal skills and communication displayed in providing leadership in their health care setting (17). Onwe and Nwigboji (18) report that the application of transformational leadership style, which is attributed to high levels of interpersonal skills, is linked to job satisfaction by nurses whereby they feel engaged and included with inspiration to meet common goals. A study in the Lithuanian health care system provides that as a result of dissatisfaction among employees, there is reported high health professional mobility resulting in an inefficient health care system (19).

Asuzu et al. (11) link efficiencies in Nigerian health care practices such as providing leadership in epidemics to an effective health care center. Further, Oyewunmi et al. (9) noted that leadership which does not illustrate emotions and has little considerations on the emotions and challenges faced by employees is merely endured and has little loyalty on the commitment of its followers unlike leadership with empathy and is supportive of employees thus have the capacity to promote commitment and loyalty to common goals. Agreeing with these contentions, Gabriel (20) recommended inspiring and engaging employees arguing against toxic behavior such as authoritarian leadership with the leader restricting autonomy and initiative as well as micromanaging employees reporting that it negatively impacts performance. As such, the particular leadership style displays specific leadership skills such as empathy in transformational leadership which critically influences the performance and productivity of nurses as well as positively impacting the outcomes of patients.

Similarly, Oyewunmi et al. (9) linked emotional intelligence with improved employee performance in the Nigerian health sector. They argued that this would enable the leaders to carry out their roles as leaders as well as be able to handle the multiple challenges within the country’s public health care sector. Stankunas (21) indicate that through emotional intelligence, health care executive cannot only provide leadership for other health care professionals but also provide innovative solutions to the challenges facing the health care system. As indicated by Oyewunmi et al. (9) and Abubakar (23), poor policy frameworks that do not provide for leadership results in inefficiencies health care systems. Leaders that have high levels of emotional intelligence are linked to effective decision making as well as conflict management whereby they can adequately scan the environment at the health care sectors, consider the consequences to their actions and use the most appropriate leadership approaches that are acceptable to their followers (9). Additionally, Gabriel (20) and others (9, 23) observe that inaction to poor leadership competency negatively impacts the performance of employees and

(12)

12 service provision in Nigerian public hospitals. Emotional intelligence is thus a critical competency for public health professionals.

Comparing leadership competencies in public and private hospitals, Yakubu et al. (24) undertook a comparative study on leadership competencies of leaders in public and private hospitals in Nigeria and reported that the perceived leadership competencies are low with the leaders unable to promote effective decision making as well as conflict resolution. Further, the study indicated that there was no difference in regard to hospital affiliation and status but reported that some competencies were higher in private hospitals than in public hospitals. A similar study in Iran agreed with the contention and added that hospital affiliation was not a mediating factor for leadership competencies (25. This argument is further reflected in a similar study in India, reporting related reports, and indicating a need for holistic and sector-wide training to improve leadership competencies (26). Inadequate leadership competencies in Nigeria can be rectified through the use of experiential training on effective decision-making approaches, effective conflict management, among others (27). Yakubu et al. (24) indicate that neglecting leadership competencies makes it challenging to ensure efficiency in health systems and achieving universal coverage.

2.2 Competency development and organizational success

Human resources in the health care system in Nigeria are faced with many challenges with conflicts and disagreements on overpayment, inadequate leadership and management of health care resources, and allowances and collective bargaining agreements with no focus or plans for professional development (7, 22, 28-30). Thus, Onwe and Nwigboji (18) link inadequate leadership competencies with dissatisfaction and lack of motivation of employees. They argue that this impacts the performance, thus affecting the success of the health care facilities in providing optimal health care. Abubakar (6) conducted a study focusing on professional skills and employee behavior in the decision making process of patients in which hospital to seek health care in the North-West Region of Nigeria and concluded that employee competencies influenced the patient’s choice of hospital in the country. The study indicated that an efficient management process within the hospital through appropriate leadership is linked to customer satisfaction and choosing a particular hospital to access health care.

On the other hand, Dankyau (31) linked leadership competencies to the satisfaction of the employees. The cross-sectional survey analyzed the competencies of managers, specifically the nursing and non-nursing managers at an urban tertiary hospital in North Central Nigeria. It

(13)

13 concluded that the competencies of those in a management position influences the effectiveness of the hospital in providing health care and employee satisfaction. Agreeing with this contention, Mabuchi et al. (32) indicated that high leadership competency is a factor influencing differentiated performance in primary health care facilities in the country. Similarly, a study in Lithuania linked the emotional intelligence of health sector executives to improve and efficient management of employees and improved health care quality provided (21). Other studies in the Lithuanian health care system reported that appropriate management and leadership skills help in improving the value provided to the patients (33, 34). Further, Ekenedo and Ezedum (35) provide a rationale for competency development, arguing that it results in such competencies as teamwork and emotional intelligence leading to improved health practices. Similarly, a study in Lithuania reported that teamwork is an attribute that requires to be promoted and enforced by leadership in the health care system (36).

However, Donald (37) argues that the challenges affecting health care professionals are systematic with a comprehensive strategy to improve the health care system necessary. This is an indication of the need for policy change within the health care systems with elements such as leadership competencies required for those with leadership and management positions.

Further, job satisfaction and leadership style among nurses in Nigeria are reported that higher job satisfaction for those led by leaders with democratic leadership competencies when compared with those illustrating autocratic leadership competencies (9). This is in agreement with Adeloye et al. (38), who linked competencies in leadership with high performance and job satisfaction. A similar study in Uganda reported that the leadership styles used are related to motivation, teamwork, and satisfaction of the healthcare employees (39). Job satisfaction has been linked with motivation and teamwork as well as improved performance resulting in high- quality provision of health care (41, 42). Therefore, improving the leadership competencies of health care professionals would improve satisfaction, motivation as well as teamwork resulting in an enhanced and efficient health care system.

Uneke et al. (8) conducted a study on leadership and governance competencies, concluding that leadership development is linked to a more successful and efficient health care system and recommended that training of the health care professionals on different leadership competencies should be implemented. Abubakar (23) links high-quality care in health care professionals to efficient leadership, where public health leaders provide direction and direct employee behavior.

However, Oyewunmi et al. (9) indicate that competency development among public health professionals in Nigeria is limited due to inadequate funding. Adinma (10) support this, stating that providing funding to improve efficiency in the health care system is an untapped solution

(14)

14 where leadership competencies can be improved. In support of competency development, Uzochukwu et al. (43) emphasize the need for health care financing to ensure that the operations within the systems run smoothly but also that health care professionals have the appropriate competencies and capacities.

2. 3 Leadership and public health system efficiency

Efficiency within public health systems has been linked to leadership competencies and skills.

For instance, Adeloye et al. (38) employees’ perception leadership is positive. In contrast, Ojo and Akinwumi (44) investigated the role of doctors in managerial and leadership positions on health care resources in Nigeria. They reported that there is a perception of poor management and leadership skills by the general public and some healthcare workers. Additionally, Asuquo (45) concluded that effective leadership is yet to be actualized in research as well as policy in the country despite the critical role they play in achieving health care goals.

In Nigeria, the majority of the private and public hospitals are under the management of medical doctors, while other leadership positions at the health care facilities are filled by nurses (4).

Yakubu et al. (29) indicate that those in a leadership position are referred to as clinical specialist with the assumption made that they have appropriate competence in providing leadership.

However, the majority of the hospitals in Nigeria are inefficient and marked by constant industrial strikes, poor staff motivation as well as strained relationships among the health care professionals. Further, Abubakar (27) reports that the health care system in Nigeria is characterized by the monopoly of government health care facilities over private health care setting in regards to the human resources available, technological capabilities as well as the cost of services. Olu-Abiodun and Abiodun (13) explain that poverty is high in the country, the majority of the population cannot afford to access private health care and instead seek public hospitals. In Lithuania, like Nigeria, the population is characterized by high inequalities, and this impacts the accessibility to health care and thus the need for the public health care professional to ensure high-quality care (46, 47). Leadership is an effective strategy that can be used in enhancing and promoting efficiency within the public health system (48, 49). Therefore, it is crucial for improved health care delivery through improved leadership.

Various studies in Nigeria provide evidence on the link between employee’s behavior and efficiency with leadership. One of the elements affecting employee’s behavior within the health care sector is the role played by doctors as leaders (12). According to Adeloye et al. (38), the Nigerian health workforce is faced with crises and characterized by distrust and recurring

(15)

15 conflicts with the dominance of doctors favored while compared to nurses, laboratory workers, and pharmacists. They agreed with this contention, Ojo, and Akinwumi (44) report that doctors are mostly the managers of health care facilities despite indicating low leadership competencies.

Adeloye et al. (38) study further explain the favoring of doctors has resulted in disputes and conflicts over salaries, consultancy status, leadership as well as allowances which negatively impacts on the efficiency of the health care system. It is essential for a health care system to have effective leadership with teamwork, collaboration, and efficiency in resource management promoted among the health care professionals (50, 51). Gabriel (21) agrees and recommends the training of supervisors to develop emotional intelligence, enabling them to be able to appropriately manage their employees by illustrating positive behavior such as teamwork.

Dankyau et al. (31) further observed that supervisory managers, both nurse and non-nurse managers, should be continually assessed for competency and specific training and retraining to ensure that they had the appropriate leadership competencies. Further, Oyewunmi et al. (9) recommend that leadership should be empathic, recognizing, and valuing employees to develop more reliable as well as healthier relationships within the health care setting. While doctors can continue with their roles as managers of public health resources and other leadership positions, Ojo and Akinwumi (44) recommend that such doctors need to be trained on leadership competencies to handle the current challenges and the evolving role of leadership in health care.

Asuquo (45) argues the case of nurses indicating that mentoring, adequate resource provision, the inclusion of nurses in management and policy development as well as overall improvement of nursing leadership competencies provides nurses with leadership opportunities in the Nigerian health care system. In Lithuania there is poor leadership and mentorship in public health study programs are poor, resulting in public health professionals with limited leadership competencies (52). Kalėdienė et al. (53) report that Lithuania is marked by mortality inequalities and inefficient health care system linked to poor leadership and management of resources.

Lunden (54) and Welcome (55) indicate that for improvement in the health care center, leadership and professional development need to be put as top priorities. As such, it is essential for considerations and understanding of leadership competencies and how they can be developed in health care professionals.

2.4 Research Gap

Research conducted on leadership competencies in the health care system in Nigeria reports a gap despite evidence indicating the link between leadership competencies with organizational efficiency and success within the health care system. Health care organizations need to ensure

(16)

16 that leadership is a top agenda and identity measures and assessment of leadership competency among their leaders to ensure that appropriate support and strategies are used to improve competency levels of those in leadership. Future research needs to track measures of leadership development with correlation made with how they impact the quality and efficiency within the Nigerian health systems. A research gap exists on the attribute of the Nigerian system favoring doctors with future research targeting this characteristic and identifying the perception of health care professions and proposed strategies to manage the problem. While research in Nigeria has focused on key leadership competencies such as interpersonal skills, emotional intelligence, decision making, conflict management, and prudence in the management of resources, little focus has been given to critical competencies such as communication, political skills as well as social intelligence. There is a need to fill this gap by investigating the link between these leadership competencies to the efficiency of a health care system.

(17)

17 3. METHODOLOGY

3.1 Organization of study

This study was carried out between October- December, 2019 at the International Center of Advocacy on Right to Health (ICARH, Abuja, Nigeria). International Centre for Advocacy on Rights to Health is a non-governmental organization established in 1999 for the main purpose of contributing to policy issues affecting the rights of sexual minorities and people living with HIV aids in Nigeria, through research, analysis, training, awareness campaign development and advocacy. ICARH works to reduce the incidence, prevalence and impact of HIV/AIDS amongst key populations in Nigeria. It was one of the key organizations involved in the HIV Integrated Biological and Behavioral Surveillance Survey conducted in 2007 and 2010 by the Federal Government of Nigeria. The study looked into the prevalence rate of HIV among key populations, was conducted by the Federal Ministry of Health (FMOH) through the National Agency for The Control of AIDS (NACA). In a similar vein, ICARH also played a key role in the Presidential Comprehensive Response Plan, aimed at contributing to the National HIV/AIDS response.

The sample for the study was the staff of the International Center of Advocacy on Right to Health (ICARH, Abuja, Nigeria). These are people who were directly involved in the creation, development and implementation of healthcare programs in the organization. A total of 120 staff were working in the organization at the time of the research. A total of 120 questionnaires were sent out for the research. Approval for the conduction of this research was granted by the organization and this approval was further certified by the Bioethics center of the Lithuanian University of Health Sciences upon which the final approval was granted by the center. Both approvals were issued on the grounds that participation in the study would be voluntary after informed consent, that the anonymity of the participants would be maintained, and that such result would be treated with utmost confidentiality and only for study intent. Only 72 questionnaires were duly filled and returned(60% response rate).

(18)

18 3.2Study instrument

This study was designed to assess leadership competencies among public health specialists in Nigeria. A robust leadership competency questionnaire was used in this research. The approval for the use of this questionnaire was granted by my supervisor, Professor Mindaugas Stankunas. The questionnaire was developed by a team of academic experts in public health from Maastricht University, Netherlands, the Lithuanian University of Health Sciences, Lithuania, Medical University of Graz, Austria, the Sheffield Hallam University, United Kingdom, and Griffith University, Australia. This team was led by Professor Katarzyna Czabanowska. The questionnaire consists of 52 competency statements that are categorized into eight domains. The questionnaire was developed to bridge the gaps in leadership competency development as far as competency- based education and continuing education were concerned since existing frameworks didn’t highlight leadership as such. Each competency is evaluated for both the current and required level.

Competencies were evaluated using a Likert scale from 1 to 5. Where 1 represents the minimum and 5 represents the maximum.

3.3 Data Analysis

Data analysis started by creating all variables necessary for the analysis in the SPSS software. For the quantitative data, 52 competency statements were split into 8 domains for both the current level of competencies and required level of competencies.These 52 statements were further categorized into eight domains namely: systems thinking, political leadership, ethics and professionalism, emotional intelligence and leadership in team-based organization, leading change, leadership and communication, collaborative leadership: building and leading interdisciplinary teams, organizational learning and development. Descriptive statistics were analyzed for each competency statement and their domains. These included mean, median, interquartile range, confidence interval, standard deviation, etc. We applied Kolmogorov-Smirnov test to check for normality of the distribution. The distribution was found to be significantly different from a normal distribution as(p<0.001). Since the distribution wasn’t normal, non-parametric Mann-Whitney U test was applied to compare levels of different domains between gender, age groups, groups of years of experience, job position, and degree groups. Wilcoxon rank sum test was applied to assess the difference between current and required levels. The participant’s ages were categorized into two age groups- ‘less than 35 years and equal or more than 35 years. The years of experience were further categorized into two groups; ‘1-4 years’ and ‘4-8years’. Degrees obtained were also categorized into two groups- ‘biomedical’ and ‘non-biomedical’.

(19)

19 4. RESULTS

4.1Demographic and social indicators of respondents

Out of the 120 questionnaires issued, 72 were returned suggesting that the response rate for the study was 60%. The mean age of respondents was 33.72 (SD=5.942). With regards to gender 46 (63.9%) of the respondents were male while 26(36.1%) were female. A total of 34(47.2%) respondents have worked in the public health sector between 1-4 years, while 38(52.8%)have worked in the sector between 5-8 years. The mean years of experience were (4.68±1.85). This suggests that most of the workers had many years of experience. In terms of their education, 62(86.1%) respondents had a biomedical degree while 10(13.9%) respondents had a non-biomedical degree. For the job position, 46(63.9%) of the respondents were working in non-executive positions while the remaining 26(36.1%) were working in the executive positions.

Table 4.1.1 – Social-demographic characteristics

Social-demographic characteristics

Total number (N=72)

Percent

Gender Male

Female 46

26

63.9 36.1 Age

<35 years

≥35 years

Mean Age (±SD)

46 26 33.72±5.94

63.9 36.1

Job Position Executives

Non-executives 26

46 36.1

63.9 Years of experience

1-4 years 5-8 years

Mean Years of experience (±SD)

34 38 4.68±1.85

47.2 52.8 Degree categories

Biomedical

Non-biomedical 62

10

86.1 13.9

Where N- total number of respondents, M±SD= mean, standard deviation.

(20)

20 4.2 Results showing evaluated scores in domain categories

The total scores for all participants for all the competency statements were categorized into eight domains namely: systems thinking, political leadership, ethics and professionalism, emotional intelligence and leadership in team-based organization, leading change, leadership and communication, collaborative leadership: building and leading interdisciplinary teams, organizational learning and development.

A statistical significance was observed between respondents’ current and required level of competency for each domain. The respondents perceived and rated their competencies in each domain positively; the highest being in ‘ethics and professionalism’ (4.36±0.56) and the lowest being in ‘leading change’ (3.87±0.56). As for the required level of competences for their jobs, the respondents rated all the competencies in each domain highly with ‘ethics and professionalism’ and

‘collaborative leadership: building and leading interdisciplinary teams’ being the highest.

Furthermore, a significant gap was revealed between the current level of competence and the required competence levels of the respondents. (Table 4.2.1)

Table 4.2.1- Table illustrating the total evaluated scores in the domain categories

Domains of competency

Current level of competencies

M±SD

Required level of competences

M±SD Significance level

N=72 N=72 p

Systems thinking 4.04±0.34 4.81±0.32 p<0.001

Political leadership 3.90±0.49 4.82±0.24 p<0.001

Collaborative leadership: building

and leading interdisciplinary teams 4.01±0.34 4.95±0.18 p<0.001 Leadership and communication 4.06±0.49 4.91±0.22 p<0.001

Leading change 3.87±0.56 4.80±0.30 p<0.001

Emotional intelligence and leadership in team-based organizations

4.08±0.49 4.88±0.21

p<0.001

(21)

21 Leadership, organizational learning

and development 3.94±0.42 4.84±0.24 p<0.001

Ethics and professionalism 4.36±0.56 4.96±0.13 p<0.001

Where N- total number of respondents, M±SD= mean, standard deviation, P= significance level

4.3 Results showing the respondent’s current and required levels for each competency statement.

Among the 52 competency statements, the respondents rated ‘facilitate reassessment and adaptation of mission to match vision’ least (3.60±0.94) as shown in table 4.3.5 and rated ‘exercise the sensitivity needed to communicate with diverse cultures and disciplines’ highest (4.40±0.71) as shown in table 4.3.4. The respondents perceived that they required a high level of each competency to be effective public health leaders. This was reflected in the high mean competency scores in the required levels for all 52 competency statements. For the current competency levels, the ‘leading change’ domain had the least evaluated competency statements as illustrated in table 4.3.5 while the domain of ‘ethics and professionalism’ had the most highly evaluated competency statements as illustrated in table 4.3.8.

Table 4.3.1- Table mean and standard deviations of evaluated scores in the domain categories- systems thinking

Competency statement

Current level of competencies

M±SD

Required level of competences

M±SD

Significance level

N=72 N=72 p

Understand current public health issues and

engage in systemic change to address them 4.04±0.34 4.81±0.32 p<0.001 Synthesize and integrate divergent

viewpoints for the good of an organization. 3.90±0.49 4.58±0.75 p<0.001 Understand reflective leadership and

demonstrate that all leadership begins from within.

4.17±0.56 4.82±0.42 p<0.001

Facilitate the development of servant leadership capacity including selflessness, integrity and perspective mastery.

4.04±0.54 4.78±0.45 p<0.001

p<0.001

(22)

22 Recognize the relevance of adaptive

leadership and use it in the appropriate circumstances.

4.11±0.64 4.96±0.26 p<0.001

Recognize the relevance of leading from behind and use this in the appropriate circumstances.

3.97±0.56 4.93±0.26 p<0.001

Identify opportunities for growth,

innovation, change and development of the organization.

3.99±0.54 4.94±0.23 p<0.001

Where N- total number of respondents, M±SD= mean, standard deviation, P= significance level

Table 4.3.2- Table illustrating mean and standard deviations of evaluated scores in the domain categories-political leadership.

Competency statement

Current level of competencies

M±SD

Required level of competences

M±SD

Significance level

N=72 N=72 p

Foresee potential impacts and consequences of decision-making in both internal and external situations.

3.94±0.69 4.94±0.23 p<0.001

Understand and apply effective techniques for working with boards and governance structures.

3.86±0.70 4.93±0.26 p<0.001

Evaluate and determine appropriate actions

regarding critical political issues. 3.85±0.66 4.60±0.66 p<0.001 Promote the national public health agenda.

3.82±0.74 4.85±0.36 p<0.001

p<0.001 Translate broad strategies into practical

terms for others. 4.03±0.56 4.96±0.20 p<0.001

Build alliances, partnerships, and coalitions to improve the health of the community or population being served.

4.06±0.60 4.83±0.38 p<0.001

Identify and engage stakeholders in

interdisciplinary projects to improve public health.

3.88±0.77 4.71±0.46 p<0.001

Advocate and participate in public health policy initiatives at the local, national and/or international levels.

3.81±0.97 4.82±0.42 p<0.001

Where N- total number of respondents, M±SD= mean, standard deviation, P= significance level

(23)

23 Table 4.3.3- Table illustrating mean and standard deviations of evaluated scores in the domain categories- collaborative leadership: building and leading interdisciplinary teams.

Competency statement

Current level of competencies

M±SD

Required level of competences

M±SD

Significance level

N=72 N=72 p

Provide an environment conducive for

opinion sharing. 4.03±0.50 4.96±2.62 p<0.001

Model effective group process behaviors including listening, dialoguing, negotiating, rewarding, encouraging, and motivating.

3.82±0.51 4.86±0.39 p<0.001

Model effective team leadership traits including integrity, credibility, enthusiasm, commitment, honesty, caring, and trust.

3.96±0.35 4.99±0.12 p<0.001

Understand and manage expectations. 4.11±0.57 4.97±0.17 p<0.001 p<0.001 Offer opportunities for collaborative

learning and quality improvement. 4.18±0.61 4.99±0.12 p<0.001 Where N- total number of respondents, M±SD= mean, standard deviation, P= significance level

(24)

24 Table 4.3.4- Table illustrating mean and standard deviations of evaluated scores in the domain categories-leadership and communication.

Competency statement

Current level of competencies

M±SD

Required level of competences

M±SD

Significance level

N=72 N=72 p

Demonstrate effective written and oral

communication, and presentation skills. 4.19±0.62 4.97±0.17 p<0.001 Recognize and use non-verbal forms of

communication when putting across your own perspective on a situation.

3.76±0.72 4.82±0.42 p<0.001

Effectively share information and responsibility at different organizational levels in pursuit of population-based goals.

3.83±0.77 4.93±0.31 p<0.001

Use the media to communicate routinely with target audiences regarding public health needs, objectives, accomplishments, and critical crises-related information.

3.82±0.83 4.90±0.34

p<0.001 p<0.001 Share views in a non-judgmental, non-

threatening way. 4.31±0.64 4.94±0.29 p<0.001

Exercise the sensitivity needed to communicate with diverse cultures and disciplines

4.40±0.71 4.97±0.17 p<0.001

Effectively use negotiation skills to mediate disputes and find appropriate and workable solutions

4.10±0.59 4.83±0.38 p<0.001

Where N- total number of respondents, M±SD= mean, standard deviation, P= significance level

(25)

25 Table 4.3.5- Table illustrating mean and standard deviations of evaluated scores in the domain categories-leading change

Competency statement

Current level of competencies

M±SD

Required level of competences

M±SD

Significance level

N=72 N=72 p

Facilitate reassessment and adaptation of

mission to match vision. 3.60±0.94 4.67±0.50 p<0.001

Manage staff to effectively deal with

change. 3.79±0.75 4.83±0.41 p<0.001

Serve as a driving force for change,

including strategies of change. 3.67±0.67 4.81±0.43 p<0.001 Make strategic decisions based on

recognized values, priorities and resources.

4.00±0.75 4.82±0.39 p<0.001

p<0.001 Identify and communicate new system

structures as needs are identified and

opportunity arises. 3.99±0.68 4.81±0.43 p<0.001

Ensure that organisational practices are aligned with changes in the public health system and the larger social, political, and economic environment.

4.15±0.62 4.89±0.32

p<0.001

Where N- total number of respondents, M±SD= mean, standard deviation, P= significance level

(26)

26 Table 4.3.6- Table illustrating mean and standard deviations of evaluated scores in the domain categories-emotional intelligence and leadership in team-based organization.

Competency statement

Current level of competencies

M±SD

Required level of competences

M±SD

Significance level

N=72 N=72 p

Demonstrate awareness of the impact of your own beliefs, values, and behaviors on your own decision-making and the reactions of others.

4.18±0.64 4.90±0.30 p<0.001

Demonstrate empathy and concern for people as individuals while ensuring that

organisational goals and objectives are met. 4.15±0.66 4.89±0.36 p<0.001 Be aware of the impact of your own

behaviours and reactions on the behaviours and reactions of others

4.22±0.68 4.92±0.33 p<0.001

Demonstrate personal responsibility and accountability for the achievement of a

given task.. 4.19±0.60 4.93±0.26 p<0.001

p<0.001 Respond appropriately to the positive

criticism of others about your own behavior or performance.

4.14±0.68 4.93±0.31 p<0.001

Demonstrate resilience and the ability to call upon personal resources and energy at times of threat or challenge.

3.61±0.51 4.74±0.48 p<0.001

Where N- total number of respondents, M±SD= mean, standard deviation, P= significance level

(27)

27 Table 4.3.7- Table illustrating mean and standard deviations of evaluated scores in the domain categories-leadership, organizational learning and development.

Competency statement

Current level of competencies

M±SD

Required level of competences

M±SD

Significance level

N=72 N=72 p

Foster an environment of trust. 3.94±0.44 4.85±0.36 p<0.001 Develop and mentor potential future leaders

within the organization. 3.97±0.50 4.85±0.36 p<0.001

Advocate for learning opportunities within

the organization. 4.01±0.49 4.85±0.36 p<0.001

Create and communicate a shared vision for the future and inspire team members to

achieve it. 3.78±0.77 4.72±0.39 p<0.001

p<0.001 Encourage others to feel ownership in the

public health mission in the organization. 4.04±0.64 4.88±0.33 p<0.001 Assist others to clarify thinking, create

consensus, and develop ideas into actionable plans.

3.92±0.31 4.82±0.39 p<0.001

Offer opportunities for collaborative

learning and quality improvement 3.97±0.75 4.86±0.35 p<0.001 Where N- total number of respondents, M±SD= mean, standard deviation, P= significance level

(28)

28 Table 4.3.8- Table illustrating the mean and standard deviations of evaluated scores in the domain categories-ethics and professionalism.

Competency statement

Current level of competencies

M±SD

Required level of competences

M±SD

Significance level

N=72 N=72 p

Adhere to ethical legal and regulatory

standards. 4.47±0.67 4.97±0.17 p<0.001

Encourage a high level of commitment to

the purposes and values of the organization. 4.46±0.71 4.96±0.20 p<0.001 Make a clear declaration of any conflict of

interest that is likely to affect your leadership or decision-making and take appropriate action to minimize this.

4.17±0.65 4.96±0.20

p<0.001

Respect diverse cultures and build upon the strength of diversity to bring about

innovation and added value in the work environment.

4.47±0.70 4.97±0.17

p<0.001 p<0.001 Practice and promote professional

accountability and social responsibility. 4.19±0.62 4.97±0.17 p<0.001 Actively work towards reducing inequalities

in access to public health. 4.42±0.80 4.94±0.23 p<0.001 Where N- total number of respondents, M±SD= mean, standard deviation, P= significance level

(29)

29 4.4 Comparison between social-demographic indicators and competency domains

Mann-Whitney U test was conducted to determine whether significant differences exist between the two age groups. For all the domains except ethics and professionalism, there were no statistically significant differences in the competency domain between respondents aged <35 years and those aged ≥ 35 years old for both current competency level and required level (p>0.05). However, there was a significant difference in the required level of competency for ethics and professionalism domain (p= 0.013). This means that respondents aged <35 years old had rated competencies in ethics and professionalism higher than respondents aged 35 years and above.

As shown in table 4.4.2, there was a statistically significant difference in the emotional intelligence domain (p=0.021). Therefore, respondents with 1-4 years of experience had significantly higher level of emotional intelligence than leaders with 5-8 years of experience. For the other leadership domains there were no significant differences between the two groups (p>0 .05).

In table 4.4.3, for each of the domains examined whether in the current competency level or the required competency level there were no statistically significant differences between males and females (p> 0.05). Therefore, leadership competency levels for all the domains were similar between males and females.

In table 4.4.4, respondents who occupied executive positions rated their current competency levels for all domains significantly higher than their non-executive counterparts (p<0.05). There were no statistically significant differences between job positions for the required competency levels (p>0.05).

In table 4.4.5, for each of the domains examined whether in the current competency level or the required competency level there were no statistically significant differences between respondents with and without a biomedical degree (p> 0.05). Therefore, leadership competency levels for all the domains were similar between those with a biomedical and those without a biomedical degree.

(30)

30 Table 4.4.1- Table comparing age groups and domains of competency

Where N- total number of respondents, M±SD= mean, standard deviation, P= significance level Domains

Age groups

Current level of competencies

M±SD

Required level of competence

s M±SD

Current level

Required level

<35, ≥35 N=72 N=72 P value P value

Systems thinking

<35

≥35

4.04±0.31 4.02±0.40

4.83±0.31 4.78±0.36

0.939 0.642

Political leadership

<35

≥35

3.87±0.46 3.96±0.54

4.82±0.24 4.84±0.23

0.671 0.836

Collaborative leadership: building and leading

interdisciplinary teams

<35

≥35

4.05±0.29 3.96±0.41

4.96±0.80

4.93±0.28 0.295 0.211

Leadership and

communication <35

≥35

4.06±0.47 4.05±0.53

4.92±0.19 4.88±0.27

0.623 0.711

Leading change

<35

≥35

3.87±0.58 3.87±0.54

4.78±0.34 4.85±0.24

0.818 0.490

Emotional intelligence and leadership in team in team-based

organizations

<35

≥35

4.10±0.52 4.06±0.43

4.87±0.24 4.91±0.18

0.873 0.331

Leadership, organizational learning and development

<35

≥35

3.97±0.40 3.92±0.47

4.82±0.23 4.87±0.23

0.403 0.295

Ethics and professionalism

<35

≥35

4.46±0.54 4.19±0.57

4.99±0.07 4.92±0.19

0.061 0.013

(31)

31 Table 4.4.2- Table comparing years of experience and domains of competency

Where N- total number of respondents, M±SD= mean, standard deviation, P= significance level Domains

Years of experience

Current level of competencies

M±SD

Required level of competences

M±SD

Current level of competencies

Required level of competences

1-4,5-8 N=72 N=72 p-value p-value

Systems thinking

1-4 5-8

4.06±0.31 4.02±0.37

4.80±0.32 4.83±0.33

0.685 0.498

Political leadership

1-4 5-8

3.85±0.47 3.95±0.51

4.82±0.25 4.84±0.23

0.497 0.802

Collaborative leadership: building and leading

interdisciplinary teams

1-4 5-8

4.01±0.31 4.03±0.36

4.96±0.82

4.94±0.23 0.668 0.266

Leadership and

communication 1-4

5-8

4.08±0.49 4.04±0.49

4.91±0.21 4.91±0.23

0.669 0.561

Leading change

1-4 5-8

3.88±0.57 3.86±0.56

4.75±0.36 4.84±0.24

0.891 0.314

Emotional intelligence and leadership in team in team-based organizations

1-4 5-8

4.09±0.53 4.07±0.45

4.83±0.26 4.92±0.15

0.973 0.021

Leadership, organizational learning and development

1-4 5-8

3.95±0.37 3.94±0.47

4.81±0.27 4.87±0.21

0.560 0.142

Ethics and professionalism

1-4 5-8

4.45±0.55 4.28±0.57

4.99±0.86 4.94±0.16

0.193 0.123

(32)

32 Table 4.4.3- Table comparing gender and domains of competency

Where N- total number of respondents, M±SD= mean, standard deviation, P= significance level Domains

Gender

Current level of competencies

M±SD

Required level of competences

M±SD

Current level of competencies

Required level of competences

Male,

Female N=72 N=72 p-value p-value

Systems thinking

Male Female

4.07±0.34 3.99±0.35

4.80±0.35 4.84±0.28

0.427 0.897

Political leadership

Male Female

3.97±0.54 3.79±0.38

4.83±0.24 4.83±0.24

0.379 0.979

Collaborative leadership: building and leading

interdisciplinary teams

Male Female

4.03±0.37 3.99±0.30

4.94±0.21

4.96±0.74 0.656 0.985

Leadership and

communication Male Female

4.09±0.48 4.00±0.51

4.90±0.25 4.92±0.16

0.449 1.000

Leading change

Male Female

3.93±0.57 3.75±0.55

4.80±0.34 4.81±0.24

0.217 0.835

Emotional intelligence and leadership in team in team-based organizations

Male Female

4.14±0.50 3.97±0.45

4.86±0.26 4.92±0.12

0.170 0.845

Leadership, organizational learning and development

Male Female

3.94±0.43 3.96±0.42

4.81±0.26 4.91±0.20

0.854 0.078

Ethics and professionalism

Male Female

4.41±0.54 4.29±0.59

4.97±0.11 4.96±0.16

0.347 0.942

(33)

33 Table 4.4.4- Table comparing job position and domains of competency

Where N- total number of respondents, M±SD= mean, standard deviation, P= significance level Domains

Job position

Current level of competencies

M±SD

Required level of competences

M±SD

Current level of competencies

Required level of competences

Executive Non- executive

N=72 N=72 p-value p-value

Systems thinking

Executive Non- executive

4.31±0.16

3.89±0.32

4.83±0.34

4.80±0.32

0.000 0.191

Political leadership Executive Non- executive

4.23±0.54

3.72±0.35

4.87±0.21

4.80±0.25

0.001 0.168

Collaborative leadership: building and leading

interdisciplinary teams

Executive Non- executive

4.20±0.23 3.92±0.35

4.97±0.66

4.94±0.21 0.000 0.493

Leadership and

communication Executive

Non- executive

4.19±0.44

3.98±0.51

4.93±0.13

4.90±0.26

0.047 0.949

Leading change

Executive Non- executive

4.00±0.62

3.79±0.52

4.82±0.27

4.79±0.32

0.274 0.748

Emotional intelligence and leadership in team in team-based

organizations

Executive Non- executive

4.32±0.47

3.94±0.44

4.94±0.78

4.84±0.26

0.001 0.130

Leadership, organizational learning and development

Executive Non- executive

4.18±0.40

3.81±0.38

4.85±0.27

4.84±0.22

0.000 0.438

Ethics and professionalism

Executive

Non- executive

4.75±0.23

4.14±0.58

4.94±0.16

4.85±0.27

0.000 0.056

Riferimenti

Documenti correlati

Reactive oxygen species (ROS), Nitric oxide (NO) and salicylic acid (SA). 1.8.4 Jasmonic acid

La PHL rappresenta il livello di competenza delle perso- ne e delle comunità nell’autonomo controllo del proprio stato di salute, soprattutto al fine di operare come valido e

Relative quantitative expression of autolytic, cell-wall charge and virulence regulator genes in drug-free

system of adiponectin (ADN), an insulin-sensitizing and anti- inflammatory adipokine, in tissues known to be the target of chronic diseases associated to obesity

When proposing the contract, the principal faces a tradeoff between participation and incentives: leaving the agent unaware allows the principal to exploit the agent’s

Specifically, the superficial-habit model has the counterfactual implications that the real exchange rate appreciates and that consumption falls following an expansionary

CONTENTS: 1.0 The European Union as a project driven by values – 1.1 European approaches to human rights – 1.1.1 Mechanisms of human rights protection in the EU – 1.1.2 Tasks

In the financial statement there were reported, for each contract, the contract’s notional principal, the interest on the bond that the city paid, the interest rate applied by