The Development of Conceptual Framework for the Leadership

of Sub-district Health Promoting Hospital Directors

Tarawadee Iasakul

, Wallapa Choeibuakaew



Graduate Student in Public Health, Faculty of Health and Sport Science, Thaksin University, Thailand

Lecturer, Faculty of Health and Sport Science Thaksin University, Thailand

Keywords: Leadership, Director, Sub-district Health Promoting Hospital (SHPH)

Abstract: SHPH works closely with community and under close supervision of District Public Health Office. SHPH

leadership is significant for SHPH effectiveness. However, the framework for SHPH leadership was never

developed in Thailand context. The purpose of this research was to develop the conceptual framework for the

leadership of SHPH directors by integrating the information from systematic review and data collected from

related stakeholders. Open-ended questions on “the required leadership of SHPH Directors” were asked to

8 SHPH directors, 2 local leaders, 4 public health district officers, 10 SHPH staff and 10 SHPH customers in

a selected district. The concept analysis (Walker and Avant, 1995) was used to frame the concept. The result

showed as follows: (1) Antecedents of the SHPH directors’ leadership were deep knowledge, intrinsic

motivation, organization culture, open environment, self-efficacy, and corporate social responsibility. (2)

Attributes of the SHPH directors’ leadership were individual competency to lead, intellectual skill,

management skill and connection to others. (3) The consequences were goal achievement, organization

growth, staff happiness and satisfaction, and sustainability. This conceptual framework will fit for SHPH

services in Thailand context. The suggestion for further investigation is to refine the conceptual framework

and develop the questionnaire for SHPH directors’ leadership (SHPH-D Lead).

1 INTRODUCTION

In Thailand, there are 4 levels of government

hospitals responding for 3 types of care. The four

levels consist of regional, province, district and sub-

district health promoting hospital (SHPH). The three

types of care are tertiary, secondary and primary care,

as summarized in figure 1. Primary care is the

services provided by SHPH, district, provincial, and

regional hospitals consisting of health promotion,

disease prevention, health rehabilitation, and

treatment. All services end at out-patient department

or day care services with or without physician

provider. Secondary care focuses on curing diseases

which provides by district, provincial and regional

hospitals. This level includes in-patient services and

requires physicians in a health care team. Tertiary

care concerns on the complication treatment or an

excellent center which provides by regional and

university hospitals. Sub specialty and specialty are

required. (Thai Health Coding Center: 2019).



Figure 1: Scope of three types of care in Thailand

SHPH is the smallest health care unit provided by

Ministry of Public Health. SHPH is categorized into

3 sizes (Ministry of Public Health: 2016) regarding to

the number of responded citizen: small (≤3,000

citizen), medium (3,001-8,000 citizen) and large

(>8,000 citizen). The major responsibility of the

SHPH is primary care consisting of health promotion,

basic treatment, disease prevention, health

rehabilitation and consumer protection (Public Health

Administration Office: 2016). SHPH service ends at

outpatient care. Health promotion is a major role

among all. SHPH plays a pivotal role in nationwide

primary healthcare. SHPH provides the service by

Iasakul, T. and Choeibuakaew, W.

The Development of Conceptual Framework for the Leadership of Sub-district Health Promoting Hospital Directors.

DOI: 10.5220/0009910407930797

In Proceedings of the 3rd Yogyakarta International Seminar on Health, Physical Education, and Sport Science in conjunction with the 2nd Conference on Interdisciplinary Approach in Sports

(YISHPESS and CoIS 2019), pages 793-797

ISBN: 978-989-758-457-2

793

public health officers and registered nurses led

directors. Some SHPH has more staff i.e. physicians,

public health technical officers, Thai traditional

medical doctors and hygiene dentists (Human

Resources Management Division Office of

Permanent Secretary: 2017). A director of SHPH is a

person who has been put into service and appointed

to serve by considering the knowledge and ability for

the benefits of government (Civil Service Act: 2008)

and been appointed by the provincial governor (State

Administration Act: 1992).

The disruptions caused by the rapid growth of

digital around the world, including changes in

Thailand itself affect the management and services of

SHPH (Office of the Civil Service Commission:

2015; College of Public Health Administration:

2561). Therefore, the leadership of SHPH's directors

is important to the growth and development of SHPH

in this era. However, there is no report on the

conceptual framework of the SHPH directors’

leadership. From the conducted observations, it is

found that all studies used one or more leadership

styles to assess SHPH directors’ leadership. Existing

leadership styles originate from Europe or the United

States. The purpose of this research, thus, was to

develop the conceptual framework of the SHPH

directors’ leadership by integrating data from

systematic review with information gathered from

SHPH staff and stakeholders.

‘True leadership is not a bullet which one uses to

kill and harm others. Rather, it is an instrument one

uses to serve others’ (Amera: 2008). Well known

leadership models were reviewed to guide this study.

Kurt Lewin’s concept is still influential over 60 years

after his death. In 1939, Lewin conducted a classic

study of leadership, involving three styles of

leadership: autocratic, democratic, and laissez-faire.

The three types are widely applied in management

environment and research (Lewin, Lippitt, and White:

1939 cited in Chou: 2012). Hersey and Blanchard

(1996) proposed a situational leadership model

explaining the balance of leadership style and the

readiness of the group members. There are 4

leadership styles: (1) telling- high task and low

relationship, (2) selling-high task and high

relationship, (3) participating- high relationship and

low task, (4) delegating- low relationship and low

task. Moreover, this model states that most effective

leadership style depends on the readiness of group

members. Readiness is divided for 4 levels: low

readiness, moderate, moderate to high, and high

readiness.

Fiedler’s contingency model was proposed by

Fiedler in 1967 concerning on the effectiveness of a

leader in an organization coming from leadership

style and situational favourableness. That matching of

leadership style and situational favourableness is

called “situational contingency”. There are 2 types of

leaders: relationship-oriented (aim to utilize the

emotional connection to maximize staff performance)

and task-oriented leader (aim to use the full potential

of staff to maximize performance). Servant leadership

is grounded in religious teaching; (Greenleaf, 1970)

consisting of empathy, listening, awareness, healing,

conceptualization, persuasion, stewardship, foresight,

community building and commitment to growth of

others. The servant leadership is value to be applied

for a director’s work. (Samut Chamnan, 2011).

The concept of transformational leadership is

widely applied. It was initially introduced by James

V. Downton. Then, a concept was further developed

by James MacGregor Burns. Later, Bernard M. Bass

expanded upon Burns' original ideas to develop what

is today referred to as ‘Bass Transformational

Leadership Theory’ (Wikipedia: 2019).

Transformational leadership enhances the

motivation, morale, and job performance of followers

through a variety of mechanisms. The mechanisms

sometimes referred to as the 4 I's: (1) idealized

Influence (II) – the leader serves as an ideal role

model for followers, (2) inspirational Motivation

(IM) –leader has the ability to inspire and motivate

followers through having a vision and presenting that

vision, and (3) individualized Consideration (IC) –

leader demonstrates genuine concern for the needs

and feelings of followers and help them self-

actualize, and (4) intellectual Stimulation (IS) – the

leader challenges followers to be innovative and

creative, they encourage their followers to challenge

the status quo.

The antecedents of leadership from diversity of

sources were collected. Thanakorn Eiempan (2013)

studied in the Thai air force and found the following

factors related to leadership: organization culture,

conscientiousness, procedures, operation and

openness. Kitikan Patibhan (2019) summarized

factors relating to creative leadership which were (1)

intrinsic motivation (goal setting, intensity,

persistence), open environment (independence,

challenge, trust and sincerity, and new paradigm),

deep knowledge (expert, experience and skill).

Jantana sansuk (2014) found self-efficacy, adaptive

capacity and corporate social responsibility affecting

leadership. She also reported the consequence of

leadership which was organizational effectiveness.

YISHPESS and CoIS 2019 - The 3rd Yogyakarta International Seminar on Health, Physical Education, and Sport Science (YISHPESS

2019) in conjunction with The 2nd Conference on Interdisciplinary Approach in Sports (CoIS 2019)

794

2 CONCEPTUAL FRAMEWORK

The conceptual framework of this study was framed

based on literature review with the integration of

information from stakeholder’s opinion (figure 2).

Leadership in several professions were carefully

reviewed. In SHPH context, the roles and

responsibilities of SHPH directors were drawn from

notification of Ministry of Public Health (Ministry of

Public Health Issue Order No. 897/2559.2016). The

leadership of SHPH from the perspective of the

directors and staff of SHPH, sub-district leaders, and

SHPH customers were explored.

Figure 2: Conceptual framework for developing SHPH

directors’ leadership.

3 OBJECTIVES

The objective of this study was to develop a

conceptual framework for the sub-district health

promoting hospital (SHPH) directors’ leadership.

4 RESEARCH METHODOLOGY

This descriptive study aimed at developing the

conceptual framework for SHPH directors’

leadership. A review of the literature was conducted

using several databases, including CINAHL, Google

Scholar, ScienceDirect, ThaiJo, and Emerald

management. The mentioned resources were

searched using the terms: 'leadership', 'director of

sub-district health promoting hospital', ‘director of

sub-district health promoting hospital & 'leadership',

and 'health care staff & 'leadership', and for studies

published from January 2000 to March 2019. Books,

articles; rules, regulation, policy and protocol enacted

by the Ministry of Public Health of Thailand relating

to SHPH director were reviewed.

(1) Systematic review on 2 major aspects: 1)

outstanding leadership models and related

research/article, on leadership and 2) roles and

responsibilities of SHPH directors.

(2) Data collection was conducted by answering

open-ended question “the required leadership of

SHPH directors” done by 8 SHPH directors, 2 local

leaders, 4 district public health officers, 10 SHPH

staff and 10 SHPH customers. The data was

thematically analyzed.

(3) Information from (1) and (2) were integrated

to conceptualize SHPH directors’ leadership by

applying the concept analysis suggested by Walker

and Avant (1995). There were 5 steps from 8 steps:

selecting a concept, determining the aim of analysis,

identify all uses of the concept, define attributes and

construct the case.

5 FINDINGS

The research findings were presented in figure 3 and

the details below:

(1) There were 4 antecedents of SHPH directors’

leadership, namely deep knowledge, intrinsic

motivation, organization culture, open environment,

self-efficacy, and corporate social responsibility.

(2) The attributes of SHPH director leadership

includes individual competency to lead, intellectual

skill, management skill and connection to others. The

sub-attributes were presented in table 1.

(3) The consequences were goal achievement,

organization growth, staff happiness, staff

satisfaction, and sustainability.

Figure 3: Antecedents, attributes and consequences of the

SHPH directors’ leadership.

The Development of Conceptual Framework for the Leadership of Sub-district Health Promoting Hospital Directors

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Table 4: Attributes and sub-attributes of SHPH the

directors’ leadership

6 CONCLUSION AND

RECOMMENDATION

The model case of the SHPH directors’ leadership

consisted of 5 antecedents, 4 attributes and 5

consequences. This is the first model developed for

the SHPH directors’ leadership. Thus, the refinement

of the model should be further examined. The

questionnaire measuring the SHPH directors’

leadership should be determined for psychometric

property which is an intellectual property of Thailand.

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Attribute Sub attributes

Individual competency

to leadership

- visionary

- charisma

- EQ and social maturity

- recognition

- information technology skill

- social skill

- public mind

- service mind

- health care practice mastery

Intellectual skill - ability to learn and grow consisting

- individual consideration

- self- awareness

- adapting to change

- achievement drive

- problem solving skills

- decision making skill

Management skill

- good governance

- motivating and encouraging others

- risk management

- conflict management

- team building

- financial management

- role modelling

connecting to others -applying the King philosophy

of sufficiency

- understanding

-community engagement

-communication

- collaboration skill

YISHPESS and CoIS 2019 - The 3rd Yogyakarta International Seminar on Health, Physical Education, and Sport Science (YISHPESS

2019) in conjunction with The 2nd Conference on Interdisciplinary Approach in Sports (CoIS 2019)

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Shih Yung Chou (2012) Millennials in the Workplace: A

Conceptual Analysis of Millennials’ Leadership and

Followership Styles. International Journal of Human

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pp 71-83.

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ship#Origins

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