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Leadership, Emotional Intelligence, and Quality Care in Long-Term Care Facilities

Dissertation
Author: Joya Marotta
Abstract:
As the population ages and the need for skilled nursing and rehabilitative services grows, the demands and expectations of consumers will continue to cultivate. The quality of patient care within skilled nursing facilities will continue to be a concern as long as the lack of leadership remains a barrier to providing quality care. The purpose of the quantitative correlational study was to determine whether a relationship exists among transformational leadership characteristics and emotional intelligence levels of nursing home administrators (NHAs) and directors of nursing (DONs) and quality care outcomes within a skilled nursing facility environment. The sample consisted of 173 nursing home administrators and 95 directors of nursing employed by a multi-facility organization located throughout the United States of America. The analyses of data provided descriptive and inferential statistics. The results of the current research revealed that no statistically significant relationship existed between leadership characteristics, emotional intelligence ability of a group of NHAs and DONs, and quality patient care. Future research recommendations should include participation from all skilled nursing facilities throughout the United States.

Table of Contents List of Tables ............................................................................................................ xi List of Figures .......................................................................................................... xii Chapter 1: Introduction .............................................................................................. 1 Background of the Problem ....................................................................................... 3 Social concerns ................................................................................................... 3 Theoretical interests ............................................................................................ 4 Statement of the Problem ........................................................................................... 6 Purpose of the Study .................................................................................................. 7 Significance of the Study ........................................................................................... 9 Significance of the Study to Leadership .................................................................. 10 Nature of the Study .................................................................................................. 11 Research Questions .................................................................................................. 14 Hypotheses ............................................................................................................... 15 Theoretical Framework ............................................................................................ 17 Transformational leadership. ............................................................................ 17 Emotional intelligence ...................................................................................... 18 Definition of Terms.................................................................................................. 19 Assumptions ............................................................................................................. 21 Scope ........................................................................................................................ 22 Limitations ............................................................................................................... 22 Delimitations ............................................................................................................ 23 Summary .................................................................................................................. 23

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Chapter 2: Review of the Literature ......................................................................... 25 Title Searches, Articles, Research Documents, and Journals .................................. 25 Transformational Leadership ................................................................................... 26 Historical overview ........................................................................................... 26 Current theories ................................................................................................ 28 Gaps .................................................................................................................. 35 Emotional Intelligence ............................................................................................. 36 Historical overview ........................................................................................... 37 Current theories ................................................................................................ 38 Gaps .................................................................................................................. 46 Quality Outcomes .................................................................................................... 48 Historical overview ........................................................................................... 48 Current theories ................................................................................................ 50 Gaps .................................................................................................................. 57 Conclusions .............................................................................................................. 57 Summary .................................................................................................................. 59 Chapter 3: Method ................................................................................................... 60 Research Method and Design Appropriateness ....................................................... 61 Research Questions .................................................................................................. 64 Hypotheses ............................................................................................................... 65 Population ................................................................................................................ 66 Sampling Frame ....................................................................................................... 67 Informed Consent..................................................................................................... 68

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Confidentiality ......................................................................................................... 68 Geographic Location ................................................................................................ 69 Instrumentation ........................................................................................................ 70 Multifactor Leadership Questionnaire Form 5x-Short ..................................... 70 Mayer-Salovey-Caruso Emotional Intelligence Test ........................................ 71 Demographic form ............................................................................................ 72 OSCAR Database and Customer Satisfaction .................................................. 72 Data Collection ........................................................................................................ 75 Validity and Reliability ............................................................................................ 76 Data Analysis ........................................................................................................... 79 Analysis of Demographic Information ............................................................. 79 Analysis of Transformational Leadership ........................................................ 79 Analysis of Emotional Intelligence .................................................................. 80 Summary .................................................................................................................. 81 Chapter 4: Results .................................................................................................... 83 Data Collection and Analysis Procedures ................................................................ 85 Findings.................................................................................................................... 86 Descriptive statistics of study participants ....................................................... 87 DON and NHA instrument descriptive............................................................. 94 Inferential statistics ......................................................................................... 100 Summary ................................................................................................................ 104 Chapter 5: Conclusions and Recommendations .................................................... 106 Findings and Interpretations .................................................................................. 106

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Limitations and Assumptions ................................................................................ 107 Implications and Recommendations ...................................................................... 110 Recommendation 1: Lack of employment tenure of NHAs and DONs. ........ 110 Recommendation 2: Education and training of NHAs and DONs. ................ 111 Recommendation 3: Measuring quality of care. ............................................. 111 Recommendations for Future Research ................................................................. 112 Summary ................................................................................................................ 114 Conclusion ............................................................................................................. 115 References .............................................................................................................. 118 Appendix A: MLQ Form 5x-Short Sample ........................................................... 137 Appendix B: MSCEIT Survey Sample .................................................................. 139 Appendix C: Demographic Survey ........................................................................ 142 Appendix D: Permission to use the Premises ........................................................ 144 Appendix E: OSCAR Database ............................................................................. 146 Appendix F: Cover Letter ...................................................................................... 148 Appendix G: Reminder Notice .............................................................................. 150 Appendix H: Informed Consent ............................................................................. 152 Appendix I: Permission to use an Existing Survey ................................................ 154

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List of Tables Table 1 Descriptive Statistics Top Five Locations of Facility by State

................... 91 Table 2 Descriptive Statistics for NHAs and DONs

................................................ 93 Table 3 Descriptive Statistics for Leadership Characteristics (N = 268)

............... 94 Table 4 Descriptive Statistics for Leadership for NHAs and DONs

........................ 95 Table 5 Descriptive Statistics for Emotional Intelligence Levels (N = 268)

........... 96 Table 6 Descriptive Statistics for Emotional Intelligence for NHAs and DONs

..... 97 Table 7 Descriptive Statistics for Quality Outcomes (N = 268)

.............................. 98 Table 8 Descriptive Statistics for Quality Outcomes for NHAs and DONs

........... 100 Table 9 Correlation between MLQ Survey Subscale Scores and Quality Outcomes (N = 268)

.............................................................................................. 101 Table 10 Correlation between MSCEIT Subscale Scores and Quality Outcomes (N = 268)

............................................................................................................... 102 Table 11 One-Way Analysis of Variances for the Difference of MLQ and MSCEIT Scores between NHAs and DONs

........................................................... 104

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List of Figures Figure 1. Descriptive Statistics for Demographic Information Variables.……….90 Figure 2. Descriptive Statistics for Demographic Information Variables.……….90 Figure 3. Descriptive Statistics for Demographic Information Variables.……….91 Figure 4. Descriptive Statistics Number of Years of Experience in Role…….......91 Figure 5. Descriptive Statistics Years Working in Facility……………..………..92 Figure 6. Descriptive Statistics Number of Beds in Facility……………………..92 Figure 7. Descriptive Statistics for NHAs and DONs…………………..………..94 Figure 8. Descriptive Statistics for NHAs and DONs…………………..………..94

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Chapter 1: Introduction The quality of patient care provided in skilled nursing facilities continues to be a major concern and efforts to improve quality have been inadequate (Gorski & Hackbarth, 2005; U.S. Government Accountability Office [GAO], 2005, 2007). Many factors exist that affect the quality of health care services. One of the major factors affecting health care organizations is employee turnover and shortages (Adams-Wendling & Lee, 2005; Castle, 2005; Swearingen, 2009; Tellis-Nayak, 2007). The leadership styles and emotional intelligence abilities of 268 long-term care leaders (173 NHAs and 95 DONs) and quality outcomes were correlated. One of the most significant causes of turnover and poor quality is lack of leadership (Adams-Wendling & Lee, 2005). The Centers for Medicare & Medicaid Services (CMS) developed an action plan specifically designed to address the quality care issues within the long-term care industry (CMS, 2008b). The focus of the research study was to determine if a relationship existed between leadership characteristics, emotional intelligence (EI), and quality patient care outcomes for a group of nursing home administrators (NHAs) and directors of nursing (DONs). Adams-Wendling and Lee (2005) described two main barriers to quality improvement in skilled nursing facilities, limited leadership training, and high turnover in leaders. Leader turnover can influence nursing staff turnover (Castle, 2005; Swearingen, 2009; Tellis-Nayak, 2007) as leadership styles can influence employee turnover (Donoghue & Castle, 2009). High nursing staff turnover is associated with lower quality of care (Castle & Engberg, 2006). Nursing home leaders lack the leadership and communication skills necessary to improve quality care (Scott, Vojir, Jones, & Moore, 2005). Some of the many challenges that exist for the long-term care industry are the

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following: staffing shortages, high staff turnover rates, rising costs, lack of adequate reimbursement from the government, and high expectations for quality (Castle, 2005; Castle & Engberg, 2006; Kapp, 2005; Quadagno & Stahl, 2003). The nursing home industry is the second most regulated industry in the United States next to the nuclear energy industry (Forbes-Thompson & Gessert, 2006). In the state of Florida, the governmental officials threatened to close over 432 nursing home beds for failure to meet quality standards (Quadagno & Stahl, 2003). Organizations that filed for bankruptcy protection operate over 40% of the nursing home beds in Florida (Quadagno & Stahl, 2003). The healthcare environment is constantly changing and leaders in healthcare organizations must be flexible, consumer-focused, innovative, and oriented towards change (Dana & Olson, 2007; Zinn, Mor, Feng, & Intrator, 2007). The theories of transformational leadership and emotional intelligence provided the framework of the study. Presented in both theories are positive relationships with organizational performance. Despite the improvements made by long-term care providers, continued attention to quality care is still necessary (GAO, 2007). By exploring the leadership characteristics and emotional intelligence levels of Nursing Home Administrators (NHAs) and Directors of Nursing (DONs) and to what degree, the characteristics affect quality patient care outcomes, leaders could use the results to improve the quality of care patients receive. To expand the knowledge of the relationship between leadership, emotional intelligence, and quality care outcomes in the long-term care industry, a correlational study among the variables was used in the current study. Discussed in Chapter 1 are the background of the problem, problem statement, and purpose of the study. Chapter 1 contains information concerning the significance of

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the problem and the significance of the study to leadership. The chapter also includes a discussion of the nature, research questions, hypotheses, theoretical framework, definitions, assumptions, scope, limitations, and delimitations of the study. Background of the Problem Approximately 1.5 million people live in nursing homes in the United States and more than 3 million individuals require services provided by skilled nursing facilities in a year (CMS, 2008b). With the population of elderly individuals growing at a high rate as well as individuals living longer, the need for skilled nursing care services will increase (Mermin, Johnson, & Murphy, 2007). Between 2008 and 2050, the 85 and older population is expected to triple (U.S. Census Bureau, 2008). By the year 2030, 1 in 5 Americans will be 65 and older (U.S. Census Bureau, 2008). According to the U.S. Census Bureau (2008), the elderly population of 65 years and older was projected to increase to 88.5 million in 2050, which more than doubles the 65 and older population. The percentage of the population between the ages of 18 to 64 is projected to decline from 63% in 2008 to 57% in 2050 (U.S. Census Bureau, 2008). The demand and the costs for health care services are increasing (Mermin et al., 2007), yet the supply and quality of health care leaders are decreasing (Lindner, 2007; Stoil, 2005). Social concerns. The needs of the growing elderly population will continue to evolve. The elderly population will not only need long-term care services, but also skilled nursing and rehabilitative care services, which will add to the level of administrative leadership and clinical leadership qualifications necessary for quality improvement (Dana & Olson, 2007; Zinn et al., 2007). As the need for the services grows, the demands and expectations of consumers will continue to cultivate. As health

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care technology improves, and costs rise, along with increased life expectancy, individuals will require skilled nursing and rehabilitative care for their elective surgeries and chronic conditions (Mermin et al., 2007; Stunk, Ginsburg, & Banker, 2006). The skilled nursing facility or the nursing home is no longer a place for the elderly to live and die in, but it is a place for the elderly to recover and return to the community. The baby boomer population will continue to work longer and thoughts of retirement will be past the age of 65 (Mermin et al., 2007). Strunk et al. (2006) predicted an increase in the use of inpatient hospital services with the highest growth rate in services used by elderly patients. The need for the population to continue to work after the age of 65 will increase the demand for skilled nursing and rehabilitative care (Mermin et al., 2007; Strunk et al., 2006). Individuals will need and want to feel healthy, which could mean replacing that knee or hip in order to continue working. Skilled nursing and rehabilitative care will continue to be provided by skilled nursing facilities because it is a less costly alternative to longer expensive hospital stays. Theoretical interests. Transformational leaders have the ability to motivate, satisfy needs, and inspire others to higher performance levels (Burns, 1978). In the current study, higher performance was defined by quality patient care outcomes. Transformational leaders demonstrate positive relationships to organizational performance (Bass & Riggio, 2006; Chan & Chan, 2005; Colbert, Kristop-Brown, Bradley, & Barrick, 2008; Mary, 2005; Matzler, Schwarz, Deutinger, & Harms, 2008; Wong, 2007). Most researchers who examined a relationship between transformational leadership and performance did so within multiple industries. Between 2005 and 2009,

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three researchers completed studies within the long-term care industry (Chiabotti, 2006; Crawford, 2005; DeMary, 2008). Transformational leadership and emotional intelligence (EI) have been studied as being related to one another, specifically higher levels of EI has been associated with transformational leadership characteristics (Barbuto & Burbach, 2006; Butler & Chinowsky, 2006; Downey, Papageorgiou, & Stough, 2006; Skinner & Spurgeon, 2005). Salovey and Mayer (1990) described emotional intelligence (EI) as one’s ability to recognize others’ emotions and respond to the emotions with empathy. Goleman (1995) expanded EI as an ability that could be learned. Researchers in emotional intelligence indicated both positive and negative correlations between EI and organizational performance (Chrusciel, 2006; Cote & Miners, 2006; Dulewicz, Young, & Dulewicz, 2005; Rode et al., 2007; Victoroff, 2007). Emotional intelligence ability can be learned and developed (Boylan & Loughrey, 2007; Edmond-Kiger, Tucker, & Yost, 2006; Groves, McEnrue, & Shen, 2008; Johnson, 2006; Palethorpe, 2006; Reeves, 2005). Dykeman (2006) conducted the only study validating that Nursing Home Administrators used emotional intelligence as a leadership strategy. No other researchers conducted studies regarding EI within the long-term care industry using both the NHAs and DONs as their sample population. Both of the positions, the NHA and the DON, are leadership positions that have the ability to affect the quality of the care provided to the patients (Tellis-Nayak, 2007). Many researchers found that transformational leadership and emotional intelligence positively correlated to organizational outcomes, such as organizational commitment, job satisfaction, leadership effectiveness, job performance, and retention

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(Barbuto & Burbach, 2006; Bono, Foldes, Vinson, & Muros, 2007; Butler & Chinowsky, 2006; Downey, Papageorgiou, & Stough, 2006; Mary, 2005; McGuire & Kennerly, 2006; Rosete & Ciarrochi, 2005; Spinelli, 2006; Wong, 2007). No other researchers conducted studies regarding leadership and emotional intelligence within the long-term care industry using both the NHAs and DONs as its participants. The evolution of long-term care and the expectations of quality, limitations in human resources, stressed finances, and increase in competition has made leadership a requirement for organizations to survive and prosper (Dana & Olson, 2007; Zinn et al., 2007). According to Lindner (2007), the requirements and the training necessary to become a NHA are not sufficient to sustain quality of care in long-term care. The sole requirement for a DON is to have an active registered nurse license within that state and does not require any type of leadership education or training. Directors of nursing do not have the required training in leadership necessary to improve the quality of care being provided in skilled nursing facilities (Harvath et al., 2008). The leadership of a facility’s director of nursing and administrator provides the foundation of good quality (Tellis-Nayak, 2005). Statement of the Problem The demand for skilled nursing care services continues to grow due to the aging of the population (Chapman Dronsky et al., 2006; Quadagno & Stahl, 2003; U.S. Census Bureau, 2008). The quality of the patient care provided in skilled nursing facilities continues to be a concern (Gorski & Hackbarth, 2005; GAO, 2005, 2007). In 2006, 20% of nursing homes were in violations of actions that caused harm or could have caused harm to patients (GAO, 2007). Approximately 1800 individual residing in nursing homes in the United States die every year from fall-related injuries (Centers for Disease Control

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and Prevention [CDC], 2008). The results of poor quality of care in nursing homes are preventable deaths and injuries (GAO, 2005). According to the Office of the Inspector General (2007), Medicare spent an estimated $2.7 billion due to poor quality of care issues such as medical errors and accidents. By 2030, the population of people 65 and older will consist of almost 20% of the total population (Chapman et al., 2006). The number of nursing home applicants declined, which caused a decline in the number of licensed nursing home administrators (Stoil, 2005). Nursing home administrators and directors of nursing lack the leadership training necessary to ensure quality patient care is provided (Harvath et al., 2008; Linder, 2007; Peck, 2006). The specific problem is that it is unknown if there is a relationship between leadership characteristics and emotional intelligence levels of DONs and NHAs and if the variables predict quality of care in long-term care (Dana & Olson, 2007; Newton, 2007; Tellis- Nayak, 2007; Zinn et al., 2007). The focus of the current quantitative correlational study was to determine if and to what degree a relationship existed between leadership characteristics, emotional intelligence levels, and quality patient care for a group of NHAs and DONs. Purpose of the Study The purpose of the quantitative correlational study was to determine to what degree a relationship exists between transformational leadership characteristics, emotional intelligence (EI) levels, and quality patient care for a group of NHAs and DONs. Quantitative research is more appropriate than qualitative, as sought in the study was not an exploration of in depth experiences of NHAs and DONs in nursing homes, but rather a determination of whether there is a relationship between the variables of interest.

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Used in the study was quantitative number to gather data from a large group of individuals and testing of hypotheses about relationships among the variables. The current study would not be possible using a qualitative design. A qualitative design would also not allow for the predictive nature of the study in identifying outcomes or patient satisfaction from a set of leadership variables. In quantitative research, the research questions or hypotheses are specific to gather measurable and clear data on variables (Creswell, 2008). Correlational research assesses the strength of the relationship between two variables (Creswell, 2008). A quantitative correlational survey design is appropriate for the study to measure the strength of the relationship between the subscales of the MLQ Form 5x-Short, MSCEIT, and quality care outcomes including patient satisfaction. The population included 173 NHAs and 95 DONs, totaling 268 participants, from a multi-facility company with facilities located in 25 states throughout the United States. Both the NHA and DON are the individuals working in skilled nursing facilities as the top leaders who have the ability to affect the quality of patient care provided. The independent variables, leadership characteristics and emotional intelligence levels, were measured using the Multifactor Leadership Questionnaire Form 5x-Short (MLQ Form 5x-Short) (see Appendix A) (Avolio & Bass, 2004) and the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) (see Appendix B) (Mayer, Salovey, & Caruso, 2002), respectively. The dependent variable, quality patient care, was measured by gathering each facility’s annual survey inspection results, analyzing the number of citations and the scope and severity of the citations, and by gathering each facility’s annual customer satisfaction results conducted by My InnerView®, an outside agency,

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analyzing two types of surveys: (a) former patient and (b) family member or responsible party. Each participating NHA and DON completed a demographic questionnaire for secondary descriptive data (see Appendix C). Significance of the Study Leadership is a necessary ingredient to quality patient care (Castle & Engberg, 2006). Skilled nursing facilities must have administrators (NHAs) and directors of nursing (DONs) who possess the leadership characteristics necessary to positively impact patient outcomes (Dana & Olson, 2007; Sikma, 2006; Tellis-Nayak, 2007; Zinn et al., 2007). A lack of effective leadership exists in the long-term care industry, which contributes to poor quality of care (AHRQ Summit, 2005; Smith & Herbert, 2007). The current study is significant because of the developing importance on quality leadership within the long-term care industry (Scott-Cawiezell, 2005; Scott-Cawiezell et al., 2005; Swagerty, Lee, Smith, & Taunton, 2005). The ability for NHAs and DONs to have high levels of transformational leadership and emotional intelligence levels can influence the quality of care provided to the patients. Researchers showed that a relationship existed between transformational leadership and emotional intelligence and organizational performance (Barbuto & Burbach, 2006; Butler & Chinowsky, 2006; Downey et al., 2006; Rosete & Ciarrochi, 2005). By 2016, 1 million licensed registered nurses will be needed to provide healthcare services in the United States (Dohm & Shniper, 2007). The sole requirement of an individual becoming a DON in a skilled nursing facility is that the individual must be a licensed registered nurse. The minimum educational requirement of a registered nurse is an associate degree.

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Lindner (2007) reported a 50% decrease in the number of individuals taking the nursing home administrator examinations over the last 10 years. Officials in most states require individuals to complete an Administrator in Training Program (AIT), which range from a 200-hour to a 2080-hour on-site training in order to be eligible to take the national and state licensure examinations to become a licensed nursing home administrator (National Association of Long Term Care Administrator Boards, 2008). The level of education required in most states for a NHA is a high school diploma (National Association of Long Term Care Administrator Boards, 2008). Only 17 out of 50 states require a baccalaureate degree to become a NHA (National Association of Long Term Care Administrator Boards, 2008). The requirements, education, and training are not sufficient for individuals to be successful for the care and services delivered to the most vulnerable population (Harvath et al., 2008; Lindner, 2007). The supply of long-term care leaders is declining, but the demand of the leaders is increasing (Lindner, 2007; Stoil, 2005). Significance of the Study to Leadership A gap exists in the literature with regard to skilled nursing facilities, leadership, emotional intelligence, and patient outcomes. No researchers examined if a relationship among transformational leadership characteristics, emotional intelligence levels of NHAs and DONs, and patient outcomes existed in the long-term care industry. The results of the current research could assist in not only identifying quality NHAs and DONs, but also developing NHAs and DONs to lead successfully the operation of a skilled nursing facility and the ability of its staff to provide quality healthcare. The ability of the NHA

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and the DON of a skilled nursing facility to provide the right leadership will increase the chances of his or her staff providing quality care to its patients (Sikma, 2006). Identified in the research study was that no relationship existed between leadership characteristics, emotional intelligence levels, and quality patient care outcomes for a group of NHAs and DONs. Results from the current study added valuable information to the body of knowledge on leadership in order to improve the quality of care provided in the long-term care industry. Identified in the results of the study was a trend of leadership having minimal education levels as well as low emotional intelligence ability. The study contributes to the body of knowledge and future research of leadership and emotional intelligence abilities in the long-term care industry in that future research is needed with regard to education and training. Nature of the Study Used in the current study was quantitative correlational design. A correlational design study assesses the strength of the relationships between pairs of variables (Creswell, 2008). Qualitative uses words, images, or interviews to research and explore problems or studies variables that are unknown and need exploration (Creswell, 2008). In the current study, the purpose was to examine the relationship between transformational leadership, emotional intelligence of nursing home administrators and directors of nursing, and patient quality care. Because the variables were identified in the current study, a qualitative study was not appropriate. Unlike a qualitative design, use of a quantitative correlational design may determine the strength of the relationships existing between variables (Creswell, 2008).

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Nursing home administrators (NHAs) and directors of nursing (DONs), working for a multi-facility long-term care organization, represent the population for the current research study. Each of the 284 skilled nursing facilities’ NHAs and DONs, totaling a possible 568 participants, was selected as the population because both positions were considered positions of leadership within a skilled nursing facility. All NHAs and DONs employed at a multi-facility organization located throughout the United States were eligible to participate in the study. A list of names, e-mail addresses, and phone numbers of every NHA and DON was provided by the organization (see Appendix D, Permission to use the Premises). Each NHA and DON was invited via email and follow-up telephone conversations, as necessary, to solicit voluntary participation in the current research study. Once the permission was obtained, each participant completed the survey questionnaires. A website, www.surveymonkey.com, was used to gather the data. The first questionnaire was a demographic and informational questionnaire (see Appendix C). The demographic and informational questionnaire was given to 3 NHAs and 3 DONs not participating in the study prior to administering the questionnaire to the participants to test for usefulness, ability to complete the questionnaire, and validity. Transformational leadership was measured using the Multifactor Leadership Questionnaire Form 5x-Short (MLQ Form 5x-Short) (Avolio & Bass, 2004). Emotional Intelligence was measured by using the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) (Mayer et al., 2002). Both instruments have been tested for validity and reliability (Antonakis, Avolio, & Sivasubramaniam, 2003; Avolio & Bass, 1999; Cole, Bedeian, & Field, 2006; Mayer et

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al., 2004; McEnrue & Groves, 2006). Each participant providing a self-rater report completed the MLQ Form 5 x-Short and MSCEIT. Quality patient outcomes was measured by gathering each facility’s annual survey inspection results using the On-Line Survey, Certification, and Reporting System (OSCAR) and gathering each facility’s annual customer satisfaction results conducted by My InnerView®, an outside agency. The annual survey inspection results were obtained through the organization to ensure accuracy of the federal agency’s database as the most recent survey results may not have been entered into the database. The data obtained from the OSCAR database was used to score each institution’s quality care outcomes according to the total number of deficiency citations and the scope and severity of each of the citations (see Appendix E). The annual customer satisfaction results conducted by My InnerView® were obtained through the participating organization. To match patient quality care and customer satisfaction to the responses of NHA and DONs, it was necessary to keep track manually of each facility that responded or participated in the current study to enable matching of data. The study was descriptive in nature and utilized correlation and analysis of variance (ANOVA) as the statistical analysis to address the research questions and hypotheses posed by the study. Descriptive statistics (mean, median, mode, and frequency) were used to obtain an understanding of the demographic information. A Pearson Product Moment correlation was used to calculate the correlation coefficients to test for relationships between pairs of variables. Univariate ANOVA was used to test for differences between DONs and NHAs on the MLQ Form 5x-Short and MSCEIT. A probability level of p = .05 was used as the criteria to reject or fail to reject the null

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hypotheses for the correlations and ANOVAs. The data were checked prior to conducting the analysis to ensure the data meets the assumptions of the appropriate statistic: normality, equality of variance, and distribution. Research Questions Three research questions were addressed in the research study. The first question inquires about the relationship between leadership styles as measured by the subscales of the MLQ Form 5x-Short (transformational, transactional, and laissez-faire) and quality patient care outcomes. The rationale for the question rests on the responsibility of leaders to guide and direct organizations and develops positive outcomes for consumers. In the case of the current study, the outcomes were for patients in long-term care facilities. The second question asks about the relationship between scores on the MSCEIT (perceiving emotions, using emotions, understanding emotions, and managing emotions) and quality patient outcomes. Leadership plays an important role in setting the emotional context of an organization and the leaders’ influence patient outcomes in long-term care facilities. Posed by the study involves asking whether differences existed in the self-reported perceptions of NHAs and DONs on the MLQ Form 5x-Short subscales and MSCEIT subscales. The question is important to determine if differences existed in the perceptions of the two groups in their leadership style and level of emotional intelligence ability. The research questions are as follows: RQ1: What is the relationship, if any, between the subscale scores of the MLQ Form 5x-Short (transformational, transactional, and laissez-faire) and patient quality care in skilled nursing facilities for a group of nursing home administrators and directors of nursing?

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RQ2: What is the relationship, if any, between the subscale scores of the MSCEIT (perceiving emotions, using emotions, understanding emotions, and managing emotions) and patient quality care in skilled nursing facilities for a group of nursing home administrators and directors of nursing? RQ3: What are the differences, if any, between nursing home administrators and directors of nursing on the subscale scores of the MLQ Form 5x-Short (transformational, transactional, and laissez-faire) and the subscale scores of the MSCEIT (perceiving emotions, using emotions, understanding emotions, and managing emotions)? Hypotheses Hypotheses were tested and stated in the null and alternative forms. The null states there is no difference or relationship. The null is rejected if statistically significant results are found (Creswell, 2008). A failure to reject the null is found if there are no significant findings (Creswell, 2008). In the study a probability level of p = .05 or less was used as the criteria for rejecting or failing to reject the null hypothesis. The first and second hypotheses stated there was no relationship between the subscales of the MLQ Form 5x-Short and patient quality care and the subscales of the MSCEIT and patient quality care. The third hypothesis states that there was no difference in perceptions of NHAs and DONs on the subscales of the MLQ Form 5x-Short and MSCEIT. The hypotheses were as follows: H1 0 : There is no relationship between the subscales scores of the MLQ Form 5x- Short (transformational, transactional, and laissez-faire) and patient

Full document contains 169 pages
Abstract: As the population ages and the need for skilled nursing and rehabilitative services grows, the demands and expectations of consumers will continue to cultivate. The quality of patient care within skilled nursing facilities will continue to be a concern as long as the lack of leadership remains a barrier to providing quality care. The purpose of the quantitative correlational study was to determine whether a relationship exists among transformational leadership characteristics and emotional intelligence levels of nursing home administrators (NHAs) and directors of nursing (DONs) and quality care outcomes within a skilled nursing facility environment. The sample consisted of 173 nursing home administrators and 95 directors of nursing employed by a multi-facility organization located throughout the United States of America. The analyses of data provided descriptive and inferential statistics. The results of the current research revealed that no statistically significant relationship existed between leadership characteristics, emotional intelligence ability of a group of NHAs and DONs, and quality patient care. Future research recommendations should include participation from all skilled nursing facilities throughout the United States.