Design, implementation, and demographic differences of HEAL: a self-report health care leadership instrument

Figures & data

Figure 1 Duke Healthcare Leadership Model.

Table 1 Survey questions distributed among five core leadership competencies and the core principle of patient centerednessa

Selfless service	Critical thinking	Teamwork	Integrity	Emotional intelligence
I place the needs of the team above my own needs. (q70)	I regularly engage in activities to keep me up-to-date in my field. (q74)	I earn the trust of others. (q65)	I act in a manner that is open, honest, and trustworthy. (q79)	I clearly express thoughts and plans with fellow health care providers. (q59)
I show genuine interest in my patients. (q71)	I integrate information from multiple sources to make decisions. (q75)	I effectively utilize the strengths of team members. (q66)	I accept responsibility after undesirable outcomes. (q80)	I interact with other health care providers in a respectful manner. (q60)
I go above and beyond to ease the workload of the team. (q72)	I think creatively to solve problems. (q76)	I give credit to team members. (q67)	I act decisively when needed. (q81)	I adapt well to change (eg, new policies, new electronic medical record [EMR], new workflows). (q61)
I care for my patients’ well-being. (q73)	I present complex problems in a simple manner. (q77)	I provide effective, actionable feedback. (q68)	I know and apply medical ethical principles to difficult situations. (q82)	I handle emotionally stressful situations appropriately. (q62)
	I integrate evidence-based medicine to guide my practice. (q78)	I inspire others on the team to achieve higher standards. (q69)	I navigate difficult decisions effectively. (q83)	I am aware of my personal limitations. (q63) I communicate effectively with my patients. (q64)

Notes: Italicized texts are questions related to patient centeredness.

a The item number for each question in the instrument is in parentheses.

Figure 2 Instrument interface with example question.

Table 2 Principal component analysis summary

Question #a	Patient centeredness	Selfless service	Critical thinking	Teamwork	Integrity	Emotional intelligence
q79	0.775	0.136	0.234	0.065	0.021	−0.009
q71	0.719	0.123	0.075	0.273	0.123	−0.02
q73	0.693	0.026	0.346	0.063	0.044	0.149
q60	0.68	0.21	−0.075	0.078	0.215	0.112
q67	0.564	−0.183	0.001	0.496	0.161	0.132
q82	0.488	0.184	0.248	0.093	0.488	0.006
q64	0.481	0.186	0.437	0.225	0.066	−0.28
q65	0.435	0.276	0.378	0.277	0.016	0.103
q80	0.321	0.374	0.134	0.218	0.308	0.17
q72	0.298	0.458	0.127	0.281	0.312	0.133
q62	0.188	0.717	0.266	0.314	−0.187	−0.035
q74	0.103	0.582	0.249	−0.078	0.329	0.158
q61	0.035	0.792	−0.047	0.111	0.133	0.056
q75	0.222	0.232	0.6	−0.042	0.153	0.204
q59	0.21	0.031	0.81	0.211	0.146	0.118
q83	0.079	0.36	0.623	0.32	0.287	−0.116
q70	0.285	0.257	−0.047	0.659	0.02	−0.181
q69	0.26	0.244	0.058	0.533	0.203	0.067
q66	0.159	0.024	0.379	0.703	−0.026	0.247
q68	0.015	0.196	0.295	0.656	0.296	0.031
q76	0.051	0.124	0.401	0.397	0.374	0.159
q78	0.162	0.127	0.105	0.136	0.793	0.018
q81	0.114	0.283	0.363	0.201	0.545	−0.283
q63	0.153	0.093	0.166	0.135	−0.003	0.84
q77	0.157	0.607	0.275	0.151	0.222	−0.146

Notes:

a Refer Table 1 for verbal descriptions of each question number. Factor loadings in bold (≥0.4) were considered for interpretive purposes. Factor loading on one category reflects concept independence for that particular question, whereas multiple factor loadings ≥0.4 suggest the question embodies several leadership categories. Concept independence was considered desirable for validity purposes.

Table 3 Mean (standard deviation) of the category scores by patient contact, age, and sex.

		Principal competencies
		Patient centeredness	Selfless service	Critical thinking	Teamwork	Integrity	Emotional intelligence
Specialty	High-patient contact (n=61)	28.58 (8.97)	27.07 (9.80)	20.09 (9.62)	23.16 (10.41)	25.33 (9.35)	24.48 (7.92)
	Low-patient contact (n=36)	26.21 (10.23)	25.66 (11.84)	23.25 (9.75)	22.58 (11.47)	27.39 (9.79)	26.44 (9.07)
	Other (n=29)	32.21 (14.02)	31.89 (11.75)	23.63 (12.01)	23.69 (12.32)	27.78 (12.73)	28.00 (11.99)
Age (years)	25–29 (n=56)	26.58 (10.04)	26.92 (10.88)	18.24* (10.39)	21.38 (11.07)	22.19* (10.86)	23.25* (8.69)
	30–34 (n=37)	30.50 (10.15)	29.48 (11.91)	26.42* (7.71)	25.25 (10.21)	29.09* (8.34)	28.64* (10.10)
	35+ (n=16)	29.65 (15.26)	27.32 (10.77)	22.64* (11.25)	25.98 (9.80)	30.92* (8.04)	27.25* (8.18)
Sex	Male (n=63)	26.44* (12.02)	25.87 (11.83)	22.44 (10.27)	23.14 (11.29)	26.10 (11.23)	25.46 (10.21)
	Female (n=62)	31.08* (9.01)	29.66 (9.99)	21.06 (10.42)	23.66 (10.07)	26.67 (9.34)	26.34 (8.50)

Note:

* P≤0.05.