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Health Care Leader Competencies and the Relevance of Emotional Intelligence

Twila Weiszbrod, DBA, MPA

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As health care leader competencies continue to be refined and emphasized in health care administra- tion educational programs, the “soft skills” of emotional intelligence have often been implied, but not included explicitly. The purpose of this studywas to better understandwhat relationship, if any, could be identified between health care leader competencies and emotional intelligence. A quantitative cor- relational method of study was used, utilizing self-assessments and 360-degree assessments of both constructs. There were 43 valid participants in the study, representing the various types of health care delivery systems. Correlational analysis suggested there was a positive relationship; for each unit of increase in emotional intelligence, there was a 0.6 increase in overall health care leadership compe- tence. This study did not suggest causation, but instead suggested that including the study and devel- opment of emotional intelligence in health care administration programs could have a positive impact on the degree of leader competence in graduates. Some curricula suggestions were provided, and fur- ther study was recommended. Key words: competencies, emotional intelligence, health care, leader

AS THE SYSTEMS of health care in the United States have continued to grow

more complex, effective leaders are needed. Members of the Institute of Medicine recom- mended the establishment of competencies for all areas of health care, including leaders, to improve the quality of care provided in health care systems.1 Since then, several models of health care leadership competence were developed.2-4 Each of these models identified various domains of competence, including areas related to people or relationships, orga- nizational development, business execution, and technical skills.5 To varying degrees, col- lege programs in health administration have

rinted from Weiszbrod T. Health care leader

petencies and the relevance of emotional intelligence.

lth Care Manag. 2015;34(2):140-146. doi:10.1097/

.0000000000000060.

hor Affiliation: Saint Joseph’s College, Standish, Maine.

institutional review board of Saint Joseph’s College roved this study.

author reports no conflicts of interest.

respondence: TwilaWeiszbrod, DBA, MPA, 278Whites

ge Rd, Standish, ME 04084 ([email protected]).

: 10.1097/HCM.0000000000000307

adopted competency models as the basis of the curricula used. Despite this emphasis, research has shown that graduates of health administra- tion programs lack competencies, especially in the area of interpersonal competencies.6 Addi- tional research was warranted Emotional intelligence was identified as a

factor of effective leadership in a number of business industries,7,8 but little research has been done to determine the relationship of emotional intelligence with competencies in the health care industry.9,10 Because health care, as a human services industry, so heavily involves people and relationships, as well as technology and business practices,11 it would make sense that emotional intelligence would be a relevant construct.12

Theories of emotional intelligence have evolved over the past few decades,13 starting with Gardner’s14 theory of multiple intelligence and Payne’s15 doctoral work. Models of emotional intelligence have developed along 3 general paths, viewing emotional intelligence as an ability, a trait, or amixture of both plus additional characteristics. Salovey and Mayer16,17 explained emotional in- telligence as an ability and developed psycho- metric instruments for measuring it. They conceived emotional intelligence as an aspect of general intelligence that could be isolated.

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Leader Competencies and Emotional Intelligence 191

Others added to the model by developing in- struments for measuring emotional intelli- gence through self-assessment.18

The trait-basedmodels of emotional intelligence view the concept as a factor of personality19

that is best measured through self-assessment. This model of emotional intelligence suggests that some of the traits are innate and cannot be controlled, whereas others may be con- trolled, nurtured, and developed.20 The other type of emotional intelligence theories are known as mixed models.13,21,22 In this view- point, emotional intelligence is viewed as a combination of traits, abilities, and characteris- tics.23 While the trait-based models of emo- tional intelligence are best measured through self-assessment, the mixed models of emo- tional intelligence have been variously mea- sured through self-assessment and 360-degree assessment.24

The concern with using self-assessment to gauge emotional intelligence is that because self-awareness is a factor of emotional intelli- gence, individuals lacking in this area would likely have an inaccurate view of their own level of emotional intelligence. The risk of this unconscious incompetence25 can be off- set by including 360-degree evaluation in the assessment. A meta-analysis of studies relat- ing emotional intelligence with leadership found that the results of the 360-degree as- sessment of emotional intelligence are often significantly different from the participant’s self-assessment.26 For this reason, in the study referenced here, the choice was made to use an instrument specifically requiring the 360-degree assessment. While researchers have not agreed on a single

model of emotional intelligence, Mikolajczak27

proposed a unified view that could have appli- cability in the academic setting. Mikolajczak27

proposed a 3-level model of emotional intelli- gence in which the first level was knowledge of the concept, the second level reflected abili- ties, and the third level was related to the dispo- sitions or tendency to behave in specific ways. In the development of curricula, the goal of providing a context whereby students gain knowledge is standard. Instructors cannot en- sure that the knowledge will be grasped by

all students, nor can an instructor predict which students may choose to integrate the knowledge and develop abilities in relation to the material learned. It may be few students who reach a dispositional level of learning.27

The dilemma with attempting to teach emo- tional intelligence is that the instructor and course material would be provided with the in- tent to, at a minimum, increase the students’ knowledge of emotional intelligence, with the hope that some students would proceed to the ability and dispositional levels. It must also be noted that the study of emotional intel- ligence is relatively young and continuing to evolve,28 which may limit the methods avail- able for developing emotional intelligence. Another consideration with regard to emo-

tional intelligence was whether individuals’ emotional intelligence can be improved through training or other developmental activities. Boyatzis et al29 found that explicitly includ- ing emotional intelligence in the course mate- rial in a business degree program did increase the emotional intelligence of at least some of the students. More recently, Joyner and Mann30

reported successfully improving students’ emo- tional intelligence by explicitly including activi- ties in the curriculum intended to develop emotional intelligence. Taking the idea a step further, Allen et al31 suggested a new construct of Emotionally Intelligent Leadership that could be specifically used in the curricula of college degree programs. The construct of the Emotion- ally Intelligent Leader, as proposed, included the facets of context, self, and others, with 21 specific categories, some of which could be measured. Although Allen et al did not test the efficacy of this model in course work, with fur- ther study this model could provide a useful framework for the development of curricula for the education and training of health care leaders.31

A number of health care leader competence models have been established, including the Healthcare Leadership Alliance (HLA) Model4

adopted by the American College of Healthcare Executives, the Health Leadership Competency Model (HLCM)2 published by the National Center for Healthcare Leadership, and the HAL-360model.3 TheHLAmodel and theHLCM

192 THE HEALTH CARE MANAGER/OCTOBER–DECEMBER 2020

are both comprehensive and complex, whereas the HAL-360 model is intended to measure leadership behaviors more than knowledge.3

The HLCM includes 8 technical or knowledge competencies and 18 behavioral competencies.2

The HLA model includes 300 competencies that include skills, knowledge, and abilities. The HAL-360, in contrast, includes 26 behavioral competencies grouped into 7 domains. The 7 domains are charting the course, developing work relationships, broad influence, structur- ing the work environment, inspiring commit- ment, communication, and self-management.3

Because emotional intelligence is a relational concept, the HAL-360 is a relevant model to use for comparison.

CONCEPTUAL FRAMEWORK

Previously published research has suggested a relationship between emotional intelligence and various models of leadership in a variety of business settings,32,33 but a review of litera- ture did not identify other quantitative studies of this type specifically related to the health care industry. The primary research question was what relationship, if any, existed between emotional intelligence and health care leader- ship competencies. The factors of gender, years of management experience, and level of education were controlled in recognition of the fact that these could also impact leader competencies.

METHODS

A quantitative correlational researchmethod was used to examine the relationship between emotional intelligence and health care leader competencies. Two established 360-degree assessment surveys were used: the HAL-360 and the Emotional and Social Competency In- ventory (ESCI). The HAL-360 was chosen be- cause it was specifically intended to measure leadership behaviors, rather than knowledge, with a degree of specificity, and it was readily available as an open-source assessment instru- ment. In addition, the HAL-360 specifically required participant self-assessment as well as

360-degree assessment by peers, subordinates, and superiors. The ESCI was chosen to study the construct

of emotional intelligence.34 Notwithstanding the continued lack of consensus of whether emotional intelligence should be measured as a trait-based, ability-based, ormixedmodel, this mixed-model assessment tool was chosen for the study. The ESCI included both self-assessment and 360-degree assessment. Ability-based assess- ment, while having the added strength of being measured psychometrically, was based on per- formance rather than lived experience. Trait- based assessments required self-assessment, but most did not include 360-degree assessment. For this study, the availability of a 360-degree as- sessment was given priority so that the potential error of unconscious incompetence could be minimized,25 and there would be some stan- dardization between both constructs. Graduates of the health administration pro-

grams at Saint Joseph’s College were invited to participate in the study, as were members of the American College of Health Executives (ACHE) who were in the ACHE group in LinkedIn and managers within the Benedictine Health System, a long-term-care organization with 40 nursing homes in the United States. The graduates were sent an invitation to partic- ipate from the Director of the Health Adminis- tration Program at Saint Joseph’s College. A notice was posted in the ACHE group in LinkedIn. A vice president of the Benedictine Health Systems invited, via e-mail, the man- agers working in that system to participate. In all, the invitation was extended to 2417 man- agers in health care settings,5 representing a convenience samplingmethod. The invitations included a link to the assessments in the SurveyMonkey Web site. In order for an individual health caremanager

to be included in the study, a self-assessment and at least three 360-degree assessments had to be received by the researcher.5 This criterion was met by only 43 participants in the study, barely meeting the minimum sample size of 42 participants suggested by G*Power 3.1 devel- oped by professors at the Heinrich Heine Universitat Dusseldorf, for a high-medium ef- fect.34 For each participant, the self-assessment

Leader Competencies and Emotional Intelligence 193

and the 360-degree assessment data were aver- aged, resulting in total scores for emotional in- telligence and health care leader competencies. The total emotional intelligence score was also correlated with each of the competence do- mains of the HAL-360 for each participant, in order to compare the relationships in more detail.

FINDINGS

Participants in the study were 33% male and 67% female. The respondents reported a range of management experience from 1 year to more than 20 years. The highest levels of education re- ported by respondents were 47% graduate de- gree, 47% undergraduate degree, and 6% with some or no college courses.5 The reported em- ployer types were 56% in long-term care, 37% in hospital or hospital systems, and 7% in ambula- tory care settings. The participants representing long-term care in this study were disproportion- ately higher than that reported by the US Depart- ment of Labor for the health care industry as a whole.5,35 It was recommended that further study be done with participants in hospital and ambulatory care settings to determine if the find- ings would hold when these areas were more highly represented.5

Descriptive analysis found that the datawere normally distributed for both constructs.5 The range for total score of emotional intelligence was between 3.4 and 4.8 on a scale of 1 to 5. The mean was 4.2, and the SD was 0.33. For health care leader competencies, the range for the total score was 3.0 to 4.7 on a scale of 1 to 5, with a mean of 3.9 and an SD of 0.38. An examination of the total scores of emo- tional intelligence and health care leader com- petence using correlational analysis found that when the covariables of gender, years of experi- ence, and level of education were controlled, for every 1-point increase in emotional intelli- gence, there was a 0.63 increase in health care leadership competence with a significance value of .001. Interestingly, in this study, the level of education variable did not influence competence, but the years-of-experience variable was significantly related to compe- tence.5 This finding also suggested further

study was warranted, given the generally ac- cepted assumption that education would in- crease leader competence. Further analysis found that emotional intelli-

gence was most strongly related to the leader competence domain of charting the course (0.589) and least strongly related to developing work relationships (0.373) and communication (0.407).5 This finding was almost the opposite of what would have been expected, given the previously established role of emotional intelli- gence in relationships and communication.36

This bears further study, but perhaps the “soft skill” of emotional intelligence is more related to what could be viewed as more cognitive skills than was expected.

PRACTICE IMPLICATIONS

There are several benefits to explicitly in- cluding emotional intelligence in health care administration curricula. As the management of health care systems and departments con- tinues to become more complex, it makes sense that competencies will be increasingly important to effective leadership. Given the finding that there was a significant, strong rela- tionship between emotional intelligence and health care leader competence, there would be considerable benefit in including the study and development of emotional intelligence in college curricula and organizational develop- ment training initiatives. Second, there was a significant body of published research demon- strating a positive relationship between emo- tional intelligence and leadership effectiveness in general.32,33 Thus, improving emotional in- telligence should increase leadership effective- ness regardless of the setting. Freshman and Rubin37 also discussed the role of emotional in- telligence skills in maintaining social networks in health care organizations. As there is contin- ued emphasis in the coordination of health care services, emotional intelligence may prove to be critical. On an individual and personal level, increasing emotional intelligence could also im- prove individual well-being, including health, social, and overall performance,37 as well as im- proving individual ability to adapt to change.38

194 THE HEALTH CARE MANAGER/OCTOBER–DECEMBER 2020

There were several limitations of this study. The small sample size and the fact that more than half of the participants were managers in long-term-care organizations,5 whereas only 23% of the total population of health care leaders work in long-term-care organizations,35

were limiting. In addition, the population of ambulatory care facility managers was signifi- cantly underrepresented in this study, whereas the hospital or hospital system representation was consistent with the population.35 In other words, the sample size was small overall, and in particular some areas of health care were over- represented, and others were underrepresented in this study. Another limitation of the study was that the

assessment instruments used to measure each of the main constructs may not reflect the full spectrum of each construct. The HAL-360 as- sessment instrument measured 1 model of health care leadership,3 but may not fully rep- resent the National Center for Healthcare Lead- ership and HLA models of competencies. In fact, a comparison of the models showed that the HAL-360 model included significant em- phasis on the relationship or people domain of competencies and less emphasis on techni- cal and execution areas of the competencies.3

While the variability between the models of health care leader competencies may be a limitation to the reported study, the vari- ance between the constructs of emotional intelligence was more pronounced.5 The ESCI assessment instrument measured emo- tional intelligence as a mixed model. The re- sults may differ if ability or trait-based models were used. The remaining question is how to teach

emotional intelligence in amanner that facilitates the development and increase in emotional in- telligence in students or participants. There was little research published to suggest how emotional intelligence could actually be taught. The Hay Group and other consulting compa- nies offer training in emotional intelligence, but not in the context of a college education. As college programs in health administration

continue to respond to changes in health care in the United States, some attention should be paid to the role emotional intelligence may play

in helping students, leaders, and potential leaders develop health care leadership competence. Cur- ricula possibilities that bear further research in- clude a training developed by Nelis et al38 to increase emotional competence in the context of an undergraduate program and a spiral model to incorporate emotional intelligence training into a medical school program.39

Nelis et al38 used an 18-hour program in which 6 training sessions were provided. Each session focused on 1 aspect of emotional intel- ligence, with 2 sessions focusing on under- standing the participants’ own emotions, 2 sessions focused on expressing emotions and understanding others’ emotions, and 2 sessions focused on managing emotions and enhancing positive emotions. Each session included a brief lecture, role-play activities, group discus- sions, and working in pairs. Each participant also maintained a personal journal in which they recorded an emotional experience they had recognized that day, along with the analy- sis of the experience. Each participant was also sent 2 brief e-mails each week to reinforce the concepts learned in the sessions, along with a reading assignment. This model was found to increase emotional intelligence, with sustained improvement measured over a 6-month period after the training, assuming that this training would have lifetime impact.38 This model could be readily adapted for incorporation into a course or courses. The spiral model developed for use with

medical students correlated the teaching of emotional intelligence with the various devel- opmental stages in physician preparation. In brief, this model incorporated training for self-awareness throughout the program, but focused on the social awareness aspect of emotional intelligence with the resident phy- sicians. Self-management was a focus on the training of residents and medical students, whereas relationship management was the focus for medical fellows and faculty. This spiral model revisited each aspect of emo- tional intelligence throughout the years of medi- cal training, intending to provide a sustained developmental program for the physicians. Stoller et al40 did not report the outcome of this model, but the notion of adding the study of

Leader Competencies and Emotional Intelligence 195

emotional intelligence across a curriculum in health administration had merit. In both of these models, the 3-level concept

of learning would be applicable. Curricula and instructors should be intentional about assisting students to gain knowledge, while being avail- able to mentor, and encourage students who

seek to further gain ability and even develop a disposition of greater emotional intelligence. While there were several models of emotional intelligence from which to choose, the model chosen is less important than the explicit ad- dition of emotional intelligence into the cur- ricula for teaching health care administrators.

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http://www.bls.gov/ooh/management/medical-and-health-services-%20managers.htm