Q&A with Christina Hasemann: Firm hand manages best

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Studying leadership styles of nursing home administrators for her doctoral research at Marywood University in Scranton, NJ, veteran nutritionist Christina Hasemann wasn't surprised to find that the authoritarian style seems to be more effective in getting positive results. Administrators displaying authoritarian methods interestingly labeled themselves as "participative" leaders.

Q You have completed an intriguing study about nursing-home leadership styles. What was your focus?
A Based on what I have seen in my many years as a nursing home consultant, I had a theory that quality of care within the facilities was linked somehow to the leadership of the facility. There were no studies addressing the possibility of leadership as an influencing factor.
I was determined to set my course to determine if leadership style influenced quality of care and began to look for appropriate research methods that would allow me to do that.

Q What was the key finding from your work? And why did you choose this area to study?
A Well, as with any research project you hope to affirm your beliefs on what you set out to find, and additionally, you learn things that you never expected to learn. The key finding was that there may be an optimal leadership style to positively influence quality of care in the nursing homes.
We measure quality indirectly via the recertification survey process, and statistically an authoritarian style of leadership was noted to be associated with a lower number, scope and severity of deficiencies on surveys – therefore, a higher level of quality of care.
I chose this "slice of nursing home experience" because I wanted to tie together my two main interests -- leadership and nursing home quality -- in a meaningful way. I have always been intrigued by leadership styles and the multiple theories. Leadership has such roots in our day-to-day life and particularly in the healthcare industry where we are struggling for leadership and direction at the present time.
When I speak of struggling for direction, I am referring to quality. I see so many facilities struggling for a superior level of quality while others struggle to maintain the bare minimum level of quality as dictated by the regulations. I just knew that this was the project that I wanted to conquer ... just to see if my findings could make a difference.

Q What was the most surprising finding from your research, and why?
A The most surprising findings of my research to me were elicited from the short interviews with the administrators. The first surprise was to learn that the majority of administrators saw themselves as participative leaders when in fact they were one of the authoritarian types. We don't like to see ourselves as authoritarian because the stereotypical authoritarian brings to mind images of Hitler and other strong, unyielding rulers. In healthcare, a "people profession" we don't wish to have that image: overbearing, unforgiving, unyielding.
The second surprise was that the majority of administrators have not changed their leadership style over their years of tenure. Many failed to recognize that they need to change with the times to keep one step ahead of deficiencies, particularly with the changes over the years in the applicant pool and the ever-changing needs of employees.
The third surprise to me was the number of candid interviews that I had. While some administrators gave me very brief answers to the three interview questions, others more than made up for it with volumes of insight and experiences.
The most surprising finding of my research to others was that the authoritarian style may be the optimal leadership style to get quality of care back on track. Based on my consulting experiences, I really was not surprised.

Q What has been the reaction by others in the nursing-home and academic communities to your findings?
ASome are surprised that the authoritarian style was statistically significant -- in that it was associated with a lower number of deficiencies on recertification surveys.

Q What were the parameters for your study, and the characteristics of your study subjects?
A Having only "star" administrators participate was a big fear. Fortunately, though, that did not happen. Although it was a small study, I had what I think was a great cross section of the central New York nursing home population.
I had 23 homes that ranged in size from about