1. Leadership in Hospital Disaster Planning and Response
Erin Downey, MPH, ScD
Tulane University School of Public Health and Tropical Medicine March 5, 2007

2. Purpose
Apply established leadership principles to the field of disaster response
Assess relationship of leadership style to disaster response performance at the “front-line” of the hospitals in the immediate post disaster period of 2005
Consider future applicability to other levels of emergency preparedness/disaster response systems
Consider the question: are disaster response leaders born or can they be developed?

3. With Special Thanks to: The Designated Regional Coordinators and
Designated Hospital Coordinators in Louisiana,
Gene Beyt, MD, MS, Chair, Committee Chair,
Janet Rice, PhD, MS, Committee Biostatistician, and
The Dissertation Committee and Industry Experts.

4. Region 8 R Region 7 Region 6 Region 2 Region 9 Region 5 Region 4
Rex Oxner
-VA Medical Center
Mark Severns
-Lake Charles Memorial Hospital
Keith Phillips
-Earl K. Long Medical Center
Anna Silva & Allyn Whaley
-Our Lady of the Lake RMC
Claiborne
Morehouse
Region 8
Union
West and East Carroll H
Bossier R
Lincoln
Webster
Richland
Caddo
Ouachita
Madison
Region 7
Bienville
Jackson
Red River
Caldwell
Franklin
Tensas
De Soto
Winn
Natchitoches
Region 6
Catahoula
La Salle
Sabine
Grant
Concordia
Region 2
Region 9
Rapides
Vernon
Avoyelles
West Feliciana
East Feliciana
St. Helena
Washington
Evangeline
Beauregard
Allen
St. Landry
Pointee Coupee
Tangipahoa
E.B.R.
St. Tammany
W.B.R.
Livingston
Jefferson Davis
Acadia
Calcasieu
St. Martin
Iberville
Ascension
St. John
Lafayette
St. James
St. Martin
Iberia
St. Charles
Orleans
Cameron
Vermillion
Assumption
St. Mary
Jefferson
St. Bernard
Terrebonne
Lafourche
State Emergency Response Regions
Plaquemines
Region 5
Region 4
Region 3
Region 1

5. Project Overview Cross sectional study of Louisiana hospitals
Hospital-based disaster coordinators (N = 258 / n = 135)
Two Survey Instruments:
Multifactor Leadership Questionnaire
Emergency Preparedness Indicator Questionnaire
360-degree assessment using both survey instruments
Three Subgroups:
Designated Regional Coord Acute Care (DRC_AC) (n = 22)
Designated Hospital Coord Acute Care (DHC_AC) (n = 73)
Designated Hospital Coord Non Acute Care (DHC_NonAC) (n = 40)
Time frame:
HRSA Planning Grant (through Hurricanes Katrina and Rita)
Data collection 2006 (February - April)
During an emergency, the role of the DRC is to interface with both DRCs in other regions and the state.
During an emergency, the role of the DHC is to interface with the DRC by communicating hospital status information. To this end, DHC emergency preparedness leadership is from an individual hospital perspective. DRC emergency preparedness leadership is from a regional perspective.

6. Sample Participants Ratees Raters All n = 135 + 405 = 540
Hospital-Based
Coordinators
Tool: MLQ Survey
Predictors
Leadership Style
“Above”
Hospital-Organizational Performance
Tool: EPI Survey
Outcomes
Cohesion Scores
“Below”
“Peers”
n = = 540

7. Leadership of Coordinators Performance of Hospital
Hypotheses*
Leadership of Coordinators
Performance of Hospital
Demographics
Hospital:
Profit Structure
Bed Size
Transformational
High
Transactional
Cohesion in Priorities
and Performance
Laissez-Faire
Low
*Depicts Hypotheses 1-3
*Depicts Hypotheses 4, 5

8. Research Questions
What are the associations of group leadership style with cohesion scores of
hospital performance?
defining hospital priorities?
Is the association of group leadership style with cohesion scores moderated by
profit/not for profit structure?
hospital size?

9. Analysis: Leadership Transformational:
Interested in the development of the individual;
Interested in the outcome over the process
“I help others develop their strengths.”
Transactional:
Performance exchange concept
Interested in the process over the outcome
“I express satisfaction when others meet expectations” & “I keep track of all mistakes.”
Passive Avoidant:
Hands off
Avoids making decisions
“If it ain’t broke, don’t fix it.”
Environments:
Bureaucratic, military, tax status (for profit/not for profit)
What one can do for one’s country verses what one’s country can do for them.

10. Findings: Leadership Style
Note: DHC-AC did not have 1 PAV Index Case

11. Findings: Leadership Style
Examples of Questions:
1.83
3.12
3.34
Passive Avoidant Behavior
Transactional
Transformational

12. Findings: Leadership Style

13. Findings: Leadership Style

14. Analysis: Cohesion Scores

15. Analysis: Cohesion Scores
Agree strongly
No Opinion
Disagree Moderately
Disagree Strongly
Not Applicable
Agree Moderately n

16. Findings: Cohesion Score
High Cohesion
Low Cohesion

17. Findings: Cohesion Score3

18. Findings: Associations
No statistically significant difference was found between group leadership style and cohesion scores, but positive associations were present within all groups.
Profit structure and hospital size do not moderate the relationship between leadership styles and cohesion scores, which suggests that emergency preparedness leadership transcends these characteristics.

19. Additional Findings 2.2 DRC_AC 2 Parallel lines indicate that
2.10
1.94
1.78
DRC_AC 2
Parallel lines indicate that
for every 1 unit change in
transformational leadership,
the cohesion score will get tighter by 2.1.
DHC_NonAC
DHC_AC
Cohesion
Scores 1 1 2 3 4
Transformational Leadership Style

20. Findings: Priorities

21. Findings: Priorities

22. Findings: Priorities

23. HRSA Coordinators
76% (n=103) of the individuals have another role that is there primary responsibility (of 9 other roles)
65% (n=88) had experienced 3 or more declared emergencies; 20% (n=27) had experienced 7 or more
57% (n=77) spent up to .25 of their time on emerg prep plan; 6% (n=8) spent from of their time on emerg prep plan
53% (n = 71) participated in all 4 HRSA years
50% male/female

24. Future Study Subsets
Partially completed packets (increases sample population to 77%)
Evacuated Hospitals (fully or partially) (N = 29; n = 20) Leadership associations as predictor and outcome data
HRSA participants for all grant years (n=71)
Teaching institutions / LSU-HSC
Regional characteristics
HRSA grant experience as a moderator of the relationship between leadership and cohesion scores
Association between MLQ leadership style factors (II, IM IC) and outcome factors with cohesion scores

25. Limitations Cross sectional study characteristics
Inherent bias of choosing Raters (MLQ)
Distinctions of leadership in the four phases of disaster management are not clearly delineated (mitigation, preparedness, response, recovery)
Exploratory nature of Emergency Preparedness Indicator Survey
Reliability (not tested over time, but tested within multiple hospital layers of responders)

26. Research Contributions
This research contributes to the growing body of knowledge that leadership styles have an association to performance effectiveness, and specifically relates to hospital disaster preparedness.
The MLQ application offers a standardized means of assessing the relationship of leadership in hospital disaster planning; its specific use in the Louisiana HRSA hospital framework creates a benchmark for other HRSA hospital systems nationwide.
The EPI survey application offers a framework to assess the cohesion of multiple and often times competing priorities; the results of which will provide insight into factors that may ultimately be affecting hospital preparedness levels.

27. Questions / Comments? Erin Downey, MPH, ScD erindowney@bellsouth.net