Key words: management methods, hospitals, leadership styles.

The incompetence of managers in treatment environments, such as hospitals, is an issue commonly faced. In such settings, one could witness well-motivated and devoted personnel who have become discouraged due to improper and uneducated leadership. Such frustration has resulted in personnel inefficiency, which in turn, has a direct effect on the health and lives of patients referred to these centers. Hence, what seems to be of great importance is that managers utilise confirmed theories of leadership styles in order to improve the quality of services offered to patients [1.2].

The terms " leader" and " leadership" have been long through history [3,4]. Many definitions of leadership refers to a member of a group, who possesses outstanding skills not found in other members. He is introduced as a leader, whois obeyed and followed. In fact as Loveridge et al. [5] mentioned , leadership refers to one's ability to influence others in order to achieve a certain objective. So, a leader, is one who can convince others to act in such a way to achieve a certain goal [6]. Jasbi [7] also mentions that a leader is, compared to the other members of a group, a more active person, capable of influencing others and consequently gaining more importance and attention.

Similarly, as related to the field of medical studies, Tappen [8] stated that
acquiring leadership and related sciences, is a crucial part of the requirements of health and treatment services. Since such centers play a critical role in the lives of people, it is necessary for their leaders to be skilled and competent. Ghabeljoo [9] acknowledged that in addition to awareness of the basics of planning and organization, a hospital manager should have information regarding the best and most popular methods of leadership styles, and be able to recognize the responsibility to organize individuals and guide them through the process of the job, leading them all towards the completion of the requirements of the sections.
The importance of the issue of hospital leadership has led the researchers to conduct a study to investigate leadership styles in hospitals affiliated with the Shiraz University of Medical Sciences and suggesting a suitable model of management;recognize a method to improve hospital leadership styles in the country by increasing the managers' ability to direct treatment units; to explore leadership styles through those personnel who have evaluated their managers favorably and have the most job satisfaction; and propose a model that could help to improve the present state of leadership in the Fars province as well as nationwide, so that policy-and decision-makers as well as curriculum planners with the health and treatment organization of the country, could help the centers benefit from more effective and educated managers.

The present study is a cross-sectional descriptive-analytical field study, carried out on all affiliated hospitals with the Shiraz University of Medical Sciences and Health-Care Services of the Fars Province. The participants of this study were all 315 chiefs of units and wards (intermediate manager) who worked under the direct supervision of the hospital manager and had at least one year of working experience in the hospital and one year of experience under the supervision of the particular manager. The 13 managers themselves participated as well. They were all official government employees. The samples were selected from the following educational and clinical hospitals: Ali-Asghar, Ghotboddin, Khalili, Zeynabieh, Hafez, Razi, Shahid Faghihi, Hazrat Fatemeh Heart Center, Ebneh Sina, Shahid Chamran, Nemazi, and Shooshtari hospital.

The instruments used for collection of data for this study were four questionnaires, distributed among managers and personnel of the educational and clinical hospitals. The questionnaire were versions of "The Ohio State Leader Behaviour Questionnaire", and the Job Description Index "by Smith Kendall, Hulin and Minnesota". The questionnaires were all tested and analysed so as to ensure their reliability and validity.

The first questionnaire was used to determine leadership styles as the managers judged themselves, including 6 items regarding the demographic characteristics of the words and 30 items about the managers' own understanding of consideration and structural priority.

The second questionnaire was applied to determine leadership styles by the personnel working under the direct supervision of the hospital manager, and was a copy of the first one, differing in only wording to refer to the personnel themselves. It included two sections: one aiming at collection demography information of the personnel (6 items), and the other given to determine the personnel's understanding of the, managers' leadership style as related to consideration and structural priority (30 items).

The third questionnaire was distributed aiming at determining the job satisfaction of personnel as relate to the leadership style of the manager, with the purpose of discovering the leadership style. This questionnaire included two separate sub questionnaires, one including 20 items, designed to show viewpoints of personnel regarding the hospital managers' performance, and the other, also including 20 items, used to determine the personnel's job satisfaction as relate to their manager's performance.

The results of the first questionnaire shows that 92.5 % of the managers under study (7.7% females and 92.3 % males, all married) believed that they are exercising a democratic leadership style. These managers had all participated in in-services training classes and 15.4 % of the managers of this group held a high school diploma, while 69.2% and 15.4% of the remained held BS and MS/PhD degrees respectively. The management experience of 30.7% of the members of this group were between 3-5 years, 30.7% between 6-9 years, 38.6% between 6-9 years , and the remaining (38.6 %), 10 or more years.

Among the total number of managers in this study, 7.7% utilized the non-interference style, which, not having participated in in-service training classes and held a university diploma or BS degree and had work experience of 1-15 years.

The results obtained by the second questionnaire indicate that the personnel classified their managers as dictators, democratic, or non-interfering leaders. The marital status of these participants was 20.1% as single, and 79.9% as married. As judged by 8.1% of the personnel (6.1% of them were males and 9.7% females), 15.4% of the, managers were dictator leaders. The educational level of these staff members was 3.3% at lower levels than high school, 6.5% at high school level, 9.7% at BS degree or higher, and they had worked under the supervision of the present manager for 1-5.5 years (10.7%), 6-10.5 years (3.4%) and 11 years or more (3.5 %).

Among the personnel, 41.3% of them (53.4% males and 32.2% females), judged 7.7% of their managers as democratic. Their educational level was 8.%, 49.2%, 42.3%, 29.3%, 41.7%, at lower levels than high school, high school diploma, college diploma, BS, and MS or higher degrees respectively. Their working experience under the supervision of the present managers was 1-5.5 years (38.3%), 6-10.5 years (38.3%), and 11 years or more (58.6%).

The remaining personnel judged that 76.9% of the managers to be non-interfering. This group consisted of 40.5% males and 58% females who had the following educational degrees: 16.7%, 44.4%, 47.7%, 61%, 41.6% were lower levels than high school, high school diploma, college diploma, BS, and MS or higher degrees respectively. These staff members had worked under the supervision of the present manager for 1-5.5 years (50.5%), 6-10.5 years(58.3%), and 11 years or more (37.9%).

The results of the third and fourth questionnaires indicated that 15.3% of the personnel who had judged their managers as dictator leaders, 7.7% of the personnel calling their managers, democratic and 46.2% of those who had judged them as non-interfering, had evaluated their managers as "good" and were satisfied with their job, while 30.8% of the latter group had evaluated their managers as " poor", and had low job-satisfaction.

This study suggests that the leadership system of hospitals in this area suffers from the lack of effective methodology causing a stressful working environment, reducing the personnel's efficiency.

The results show that 53.8% of the personnel held a BS degree. Over 48.4% of the personnel participating in this study had a work experience of 16-25 years in the hospital, which indicates their capability of making sounder judgments regarding the inquiries. Among the total number of personnel, 54.7% had worked for 1-4 years under the supervision of a particular manager.

As for the managers, 60.2% of them held a BS degree, 30.7% of which had worked for over 20 years in the hospital, and 60% had worked as hospital managers for 5-10 years. This work experiences their acceptable familiarity and knowledge of hospital environments and management.

The findings also show that the managers' leadership style was significantly related to the personnel's

1. Gender (df=2, x2 =13.97, p= 0.092).
   
2. Age (df=6, x2 =16.69, p=0.01).
   
3. Marital status (df=6, x2 =14.27, p=0.0070).
   
4. Education (df=8, x2 =34.88, p=0.003).
   
5. Work experience (df=6, x2 =10.04, p=0).

The work experience of the personnel under the supervision of the present manager showed no significant relation to the managers' leadership styles (df=4, x2 =7.97, p=0.09).

The findings also indicate that the views of managers and personnel regarding structural and consideration priority were significantly different. Also, there was a significant difference between managers' performance job satisfaction. In other words, the personnel had evaluated their non-interfering managers as good and were satisfied.

Based on the information provided by the above-mentioned findings, and that obtained through a Delphi questionnaire given to managers and university management professors and instructors, a model was devised. The points mentioned below were all considered thoroughly for the development of the model:

1. The required information were gathered through hospital managers and personnel, such an nursing managers, supervision, employment and financial managers, head-nurses, and other intermediate managers supervised by the hospital manager.
2. Based on the findings and model provided by The Ohio Study, the present model was proposed.

In the first stage of development the model, the qualification and other required characteristics of hospital managers were analyzed and necessary points and measures were highlighted. In the second stage, attention was focused on the foundations of effective and scientific management such as programming, leadership and guidance, and interactive control. The third stage, and the most fundamental one, was the recognition and analysis of the conditions and situations, including the characteristics of the manager, personnel, working environment and organization, as related to the two leadership dimensions of structural priority and consideration. The last stage was to introduce a leadership style in accordance with the personnel assessments regarding job satisfaction from the managers' leadership, and the points given to structural priority and consideration. The proposed model eliminates the problem of the Ohio Model, taking into account situational factors and their effects on leadership efficacy, so that one leadership style might shift to another depending on the above-mentioned factors. It is suggested that researchers use the model to investigate leadership styles in all medical universities, hospitals, and health-treatment centers of the country.