Exploring the Relationship Between Adventist Hospital Board Chair Leadership Behaviors and Effectiveness
Authors:   ,   Andrews University, Stahl Anthony 
Published: April 2023

Problem and Purpose. There is a lack of empirical research regarding the leadership behaviors that predict an effective community hospital board chair. Researchers indicate that an effective organization normally has a well-led board. However, the chair role has been largely neglected in the research of board functions and operations. With many hospitals facing reorganization or closing, it is important to understand and identify effective chair behaviors. Thus, the purpose of this study was to determine the relationship between hospital chair leadership behaviors and effectiveness, and the relationship of effective chairs to effective hospitals. Method. This study used an ex post facto research design with stated and alternative hypotheses. The study was based upon a repeated measures design where the board chairs’ effectiveness and behaviors were measured more than once. An online survey using the Multifactor Leadership Questionnaire (MLQ) was administered to 333 board members serving 34 Adventist Health System hospitals. This survey measured board member perceptions of chair leadership behaviors and chair effectiveness. Patient satisfaction and clinical and financial data were also collected from each hospital to measure hospital effectiveness. Descriptive statistics, correlation, and multiple regression models were used to describe and examine the statistical relationship between variables. Of the 55 hypotheses tested, 34 (62%) were statistically significant and three others approached statistical significance. Results and Conclusions. The chairs reviewed by respondents were all Caucasian and male, ranging from 38 to 68 years old with 70% being 51 to 66 years of age. They had college education, ranging from bachelor’s degrees to doctorates, with 67% having master’s degrees. The chair’s length of service at their current facility ranged from 7 months to 12.9 years, with 55% serving 5 to 6 years. With the p value set at .05, correlations and multiple regression analysis revealed the following: 1. There was statistical significance and a positive relationship between transformational leadership behaviors and chair effectiveness (r = .869; p =.000). 2. There was statistical significance and a positive relationship between transactional leadership behaviors and chair effectiveness (r =.382; p =.000). 3. There was no statistically significant relationship between laissez-faire leadership behaviors and chair effectiveness (r = -.122; p = .178). 4. There was statistical significance and a positive relationship between financial margin; Earnings Before Interest, Taxes, Depreciation, and Amortization (EBITDA) and Clinical Outcomes (CM) (r = .331; p = .000). There was no statistical significance in the relationship between hospital financial margins and patient satisfaction (r = .169; p = .066). 5. There was no statistical significance in the relationship found between chair leadership effectiveness and hospital effectiveness metrics such as EBITDA (r = -.019; p = .831), Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS; r = -160; p = .083), and CM (r = -.044; p = .632). 6. There was statistical significance and a positive relationship between chair education and chair effectiveness (r =.235; p = .009). 7. There was statistical significance and a positive relationship between chair education and the organizational metric EBITDA (r = .349; p = .000) but no statistically significant relationship between chair education and patient satisfaction (r = -.043; p = .643). 8. There was no statistically significant relationship between chair longevity and chair effectiveness (r = -.023; p = .803). 9. There was a statistically significant relationship between chair longevity and patient satisfaction as measured by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS; r =.221; p = .016). However, there was statistical significance and a negative relationship between chair longevity and hospital financial success as measured by EBITDA (r = -.233; p = .010). 10. While nearing statistical significance, there was no statistically significant relationship between chair age and chair effectiveness (r = -.169; p = .061). 11. There was statistical significance and a negative relationship between chair age and hospital financial performance as measured by EBITDA (r = -203, p = .024). Conclusions and Recommendations. In this study, both transformational and transactional leadership behaviors predicted chair effectiveness. The relationship between Laissez-faire leadership behaviors and effectiveness was not statistically significant (r = -.122; p = .178). In addition, the study showed chair education had a statistically significant relationship on the hospitals’ financial margins (r = .349; p = .000). Finally, while strong financial margins predicted clinical outcomes (r = .331; p = .000), they did not have a statistically significant relationship to patient satisfaction (r = .169; p = .066). Several recommendations to boards, hospitals, and researchers can be made from this study. First, given the significance of transformational and transactional leadership behaviors on chair effectiveness, boards may wish to screen potential chairs for these behaviors or provide training that facilitates the development of these behaviors. Second, given the significance of chair education on chair effectiveness and hospital financial margins, boards may wish to screen chairs for higher levels of education to better predict chair and hospital effectiveness. Finally, given this study was done only on Adventist Health System hospitals and only White male chairs, other researchers may wish to replicate this study in other healthcare systems with more diverse chairs. In addition, initiating a qualitative study of chairs would provide additional answers to questions raised in this study.