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Behavioural Indicators of Managerial and Leadership Effectiveness within Romanian and

British Public Sector Hospitals: An empirical study and cross-nation comparative analysis. Refereed Paper

Bob Hamlin

University of Wolverhampton, UK

Taran Patel

Grenoble Ecole de Management, France

Diane Iurac

Groupe ESC Rennes, France

This paper reports the results of a study of managerial and leadership effectiveness

within a Romanian public sector hospital. Concrete examples of effective and

ineffective managerial behaviour were collected using Flanagan’s (1954) Critical

Incident Technique (CIT). The obtained critical incidents were subjected to content

and thematic analysis. From a total of 252 critical incidents, 57 discrete behavioural

themes and analytic categories were identified of which 30 were examples of

“effective” managerial behaviour, and 27 of “least effective/ineffective” managerial

behaviour. A subsequent cross-case/cross-nation comparison against equivalent

findings from previous replica studies in two British NHS Trust hospitals has

revealed high degrees of overlap, commonality, and relative generalization across all

three organizations. The results lend strong empirical support for generic and

universalistic explanations of the nature of managerial and leadership effectiveness.

Keywords: Managerial effectiveness, behavioural indicators, cross-nation research.

Searching for evidence to support empirically-grounded management practice within medicine

and the healthcare sector, Braithwaite (2004) found that although the amount written on

management is voluminous a great deal of its corpus is anecdotal and opinion-based, and that “in

a sea of relative ignorance” there are just a few “scattered empirical islands” (p.240). One such

“island” cited by Braithwaite is Hamlin’s (2002a) study of managerial and leadership

effectiveness within a British NHS Trust hospital. Since that time, Hamlin, in conjunction with

various co-researchers, has conducted several replica studies in various other public sector

hospitals in the UK (Hamlin and Cooper, 2005, 2007), Egypt (Hamlin, Nassar and Wahba, 2010)

and Mexico (Hamlin, Ruiz and Wang, 2010). The present study in a Romanian public sector

hospital builds upon and extends the findings of these earlier and contemporaneous studies.

Many managerial behaviour studies were carried out from the1950s through to the mid1980s.

However, few researchers attempted to differentiate between what Hales (1986) refers to as

“good” and “bad” management. Instead, most explored the frequencies and duration of

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managerial activities (Martinko & Gardner, 1985), and used different types of definitions,

predictors and measurement criteria of managerial effectiveness (Goodman, Atkins &

Schoorman, 1983). Stewart (1989) complained about the lack of comparability between these

studies caused by the ‘haphazard’ and ‘arbitrary’ coding of managerial behaviours, and the use

of unclear and confusing ‘mixes’ of coding categories. Consequently, she argued researchers

should “free the mind of existing categories” and adopt other approaches. (Ibid, p.7). However,

since she made that call the issue of managerial effectiveness has been substantially neglected

(Flanagan & Spurgeon, 1996; Nordegraaf & Stewart, 2000; Willcocks, 1992). And there

continues to be little agreement about what constitutes and is meant by managerial or leadership

effectiveness (See Barker, 2000; Cammock, Nilakant & Dakin, 1995; Kim & Yukl, 1995). The

present study is a further attempt to address this significant gap in the management and HRD

knowledge base

Theoretical Framework and Research Questions

The theoretical framework used for our study is an analogue of the ‘multiple-constituency

model’ of effectiveness (Tsui, 1990). Using this approach in the context of managerial

behaviour studies, managers are perceived as operating within a social structure consisting of

multiple constituencies or stakeholders (e.g. superiors, peers, subordinates), each of whom has

his or her own expectations of and reactions to the manager (Tsui, 1984). How managers are

perceived to behave cause peers, superiors and other key stakeholders to give or withhold

important resources, such as information and co-operation; and cause subordinates either to

follow or ignore their leadership (Tsui & Ashford, 1994). Such perceptions and judgments of

effective and ineffective managerial behaviour contribute to what Tsui (1984) conceptualizes as

reputational effectiveness. The significance of Tsui’s conceptualization is reinforced by

Luthans, Rosenkrantz and Hennessey’s (1985) argument that managerial effectiveness is

comprised of two criteria for getting the job done: (1) through high quantity and quality

standards of performance, and (2) through people, which requires their satisfaction and

commitment. If this holds true, we suggest that least effective or ineffective managerial

behaviours, which cause dissatisfaction and lack of commitment on the part of key stakeholders,

are likely to result in severe damage to a manager’s reputational effectiveness.

According to a proposition put forward by Tsui (1984, p.36), the “specific managerial behavior

instrumental for gaining [or losing] reputational effectiveness will vary by constituencies”, and

that such behaviours, therefore, are idiosyncratic and contingent. However, the aforementioned

‘hospital’ studies of Hamlin and his various co-researchers suggest that such managerial

behaviours are far more ‘universalistic’ or ‘generic’ than ‘contingent’. Because of these

differences of view and findings, and the sparseness of managerial and leadership effectiveness

studies in general, the research reported here makes an important contribution to HRD and MD

research and practice. Based on the above discussion our study addresses two questions as

follows:

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(1) How are the behavioural indications and contra-indications of reputational

managerial and leadership effectiveness manifested within the selected Romanian

case study hospital ?

(2) To what extent are these behavioural indicators similar or different from those

applying within two British NHS Trust hospitals?

Research Methodology

Assuming a post-positivist ontology and adopting a realist epistemology (Madill, Jordon &

Shirley, 2000; Ponterotto, 2005) the research design was comprised of three stages:-

Stage 1: This stage was carried out by the third author who is a native of Romania and

fluent in French and English. Using Flanagan’s (1954) critical incident technique (CIT) in

accordance with the CIT protocol adopted by Hamlin (2002a/b) and Hamlin and Cooper (2005,

2007), she collected concrete examples (critical incidents) of effective and ineffective managerial

behaviour from a convenience yet purposive sample of 36 organizational leaders, managers and

non-managerial staff employed by the collaborating Romanian public sector hospital. Up to 10

critical incidents (CIs) were collected at each CIT interview which lasted from between 1 to 1.5

hours. Usually the collected CIs included a roughly equal number of examples of effective and

ineffective managerial behaviour. In total 346 CIs were obtained of which 33 were considered

unsuitable for analysis because of insufficient development, unclear meaning, or they focused on

non-behavioural factors. The remaining 313 CIs were translated into English by the third author.

Her translation was checked for accuracy by the second author- a native of India who is also

fluent in French and English.

Stage 2 Of the 313 translated CIs a further 61 were set aside by the first author-who is of

British nationality. This was because of a perceived lack of clarity or ambiguity in the English

translation, or a lack of transparency regarding the causal link between specific managerial

behaviours and the described consequence and outcome. Of the remaining 252 CIs, 127 were

examples of positive (effective) managerial behaviour, and 125 of negative (least

effective/ineffective) managerial behaviour. These were then subjected to inductive thematic

analysis (Braun & Clarke, 2006) using second-level open coding (Flick, 2002; Miles &

Huberman, 1994; Strauss & Corbin, 1990) in search of themes and analytic categories that

contained at least 2 and a maximum of 10 CIs. The meaning held in common to all of the CIs

constituting each category was identified. This was described in essence using wherever

possible one of the respective constituent CIs as a label, or alternatively a derived ‘composite

statement’. The interpreted and labeled categories were subsequently referred to as behavioural

statements (BSs). Fifty seven (57) BSs emerged from this process, of which 30 related to

effective and 27 to least effective/ineffective management.

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Stage 3: The set of Romanian BSs resulting from Stage 2 were compared and contrasted

against the sets of British BSs identified by Hamlin (2002a/b) and Hamlin and Cooper (2005,

2007) respectively. Hamlin’s (2002a/b) study had been carried out in an ‘acute’ NHS Trust

hospital. It resulted in 405 usable critical incidents (CIs) being collected from 57 CIT

informants. From these CIs a total of 67 BSs were identified, of which 30 were examples of

effective (positive) and 37 of least effective/ineffective (negative) managerial behaviour. In

contrast, Hamlin and Cooper’s (2005, 2007) study had taken place within a ‘specialist’ NHS

Trust hospital. It resulted in 467 usable CIs being obtained from 60 CIT informants. From these

CIs a total of 49 BSs were identified, of which 25 were examples of effective (positive) and 24 of

least effective/ineffective (negative) managerial behaviour. The method used for this Stage 3

‘realist qualitative [comparative] analysis’ (Madill et al., 2000, p.9) was a variant of open coding

applied inductively and deductively within a grounded theory mindset (Flick, 2002; Miles and

Huberman, 1994; Strauss & Corbin, 1990).

Ensuring credibility, dependability, confirmability, and transferability. To ensure

internal validity (credibility) of the CIT data collected at Stage 1, the researcher, whenever she

had doubts during a face-to-face or telephone interview, clarified these doubts with the CIT

informant right there. Additionally, when doubts arose whilst doing the transcription or when

interpreting those CIs transmitted by email, she contacted the respective CIT informant to

confirm or clarify as need be the meaning of the recorded CI. For Stage 2 the derived BSs were

scrutinized by the first and second authors through digital exchanges until agreement and

consensus was reached. For the Stage 3 research, internal validity (credibility) and reliability

(dependability) which in this study refers to the ‘consistency of meaning’ (Madill et al., 2000) of

CIs and BSs, was ensured through a form of ‘investigator triangulation’ (Easterby-Smith, Thorpe

& Lowe, 1991).. Initially, the first author independently conducted the cross-case/cross-nation

analysis whereby the BSs of the two British data sets were coded and mapped against the

identified Romanian BSs. This analysis was then scrutinized by the second author for her

verification and agreement. Where she disagreed or detected discrepancies in the mapping based

on her independent interpretation of the similarities and differences, these were resolved through

discussion to reach a consensus. Issues of plausibility (confirmability) and external validity

(transferability) were addressed through the multiple cross-case process. This mutually

validated and demonstrated the relative generalizability of the findings from all three replica

studies.

Findings

The thirty (30) positive (effective) BSs resulting from the Stage 2 research, which can be

regarded as the behavioural indicators of reputational managerial effectiveness applying within

the Romanian hospital, are listed in the left hand column of Table 1. As can be seen, they are

juxtaposed against the equivalent British BSs which, to a greater or lesser extent, are the same in

substance and congruent meaning as revealed by the Stage 3 research. To distinguish between

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the two British studies the ‘specialist’ NHS Trust hospital data has been typed in italics. The

underlined British BSs are those that overlap with more than one Romanian BS.

Table 1 The extent of the three types of commonality existing across the positive (effective)

behavioural statements identified by the Romanian and British studies Romanian Study Public Sector Hospital

British Studies Acute NHS Trust Hospital/Specialist NHS Trust Hospital

High Congruence: BSs with near identical/virtually the same meaning.

1) Reacts quickly and calmly to

changing and/or stressful situations,

and to staff problems, and is quick

to take action and/or provide

answers

High Congruence

Responds quickly and appropriately to staff/work problems. Takes control

of difficult situations and deals with them quickly and appropriately.

Recognizes problems and takes the necessary action.

Responds quickly and appropriately to staff work problems. When

problems occur he/she deals with them quickly and fairly. Moderate Congruence

When staff are in conflict with one another, encourages them to reconcile

their personal differences and work through problems with each other. Low Congruence

When faced with urgent or difficult problems/situations is good at making

decisions and following them through and keeping promises.

Deals with personal and difficult situations with sensitivity

2.) Is open to staff, listens to their

suggestions, and encourages them to

make suggestions

High Congruence

Is approachable and makes him/her self readily available to staff (e.g. adopts

open door policy; always got time to listen). Exhibits willingness to listen to the

ideas of staff, and gives backing and support.

Makes time to talk to staff (e.g. engenders a feeling of value in staff by

showing an interest in their work) Low Congruence

Develops a sense of trust with staff (e.g. ensures staff can talk to him/her on matters of

confidentiality; does not break confidences).

Listens to staff when they are overworked and helps to provide solutions

3) Responds/gives consideration to

and takes into account the

suggestions of their staff;

additionally, implements these

suggestions as appropriate

High Congruence

Exhibits willingness to listen to the ideas of staff and gives backing and

support. Moderate Congruence

Makes time to talk to staff (e.g. engenders a feeling of value in staff by

showing an interest in their work). When making decisions, gathers the

facts and considers the views from other members of staff

4) Anticipates trends and potential

problems, and introduces preventive

measures or innovations as

appropriate

High Congruence

Recognizes and acts appropriately when things are going wrong Moderate Congruence

Thinks ahead and ensures things are done in good time, prepares well for

situations and contingencies (e.g. uses good forward planning, prepares well for

negotiations, is forward thinking).

5) Recognises and finds solutions to

problems, and takes the necessary

action to reduce or eliminate them

High Congruence

Recognizes problems and takes the necessary action.

Recognizes and acts appropriately when things are going wrong

6) Gives help and support to staff

confronted with difficult situations

High Congruence

Gives time to listen to staff with problems or worries relative to work or

personal issues.

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Listens to staff when they are overworked and helps to provide solutions

Assists other staff at busy times (e.g. is prepared to get ‘stuck in’ to

alleviate work overloads). Listens to staff on personal issues and acts to

support the member of staff . Low

Deals with personal and difficult situations with sensitivity

Deals with difficult and personal issues with sensitivity (e.g. disciplinary or

emotive situations).

7) Encourages and supports staff in

their learning, training and self-

development, and takes action to

address their specific needs

High Congruence

Gives support to staff in developing and progressing their careers. (e.g.

facilitates and supports career development and progression of staff;

ensures staff get adequate time to update their knowledge; gives support in

projects and encourages managers to learn and develop).

Supports staff in identifying and finding development opportunities.

Ensures staff have the confidence and ability to perform required tasks (e.g.

supports staff who require additional skills)

8) Sets and agrees

priorities/objectives for/with staff ,

and gives them clear future direction

for their daily work

High Congruence

Develops a long term strategy with his/her team members and

communicates objectives to staff

Develops a long term departmental strategy and plan which provides clarity

regarding the overall purpose, the roles, goals and targets of all individuals

in the department.

9) Encourages staff to achieve high

performance, and congratulates and

gives encouragement when they

deliver good results or their best

efforts

High Congruence

Thanks people and gives praise for a job well done. (e.g. makes the effort to

thank the individual and/or the team).

Values the work of his/her team and acknowledges work completed to a

high standard

10) Shows appreciation and says

‘thank you’ when members of staff

perform well

High Congruence

Thanks people and gives praise for a job well done. (e.g. makes the effort to

thank the individual and/or the team).

Values the work of his/her team and acknowledges work completed to a

high standard

11) Readily delegates to staff

important tasks/projects that require

high degrees of responsibility, and

shows confidence and trust in their

capabilities

High Congruence

He/she delegates; is effective when delegating roles and responsibilities.

Positively delegates work to staff (e.g. is fair in delegating work, not just

the ‘dirty’ work)

12) Empowers staff by giving them

freedom to make their own

decisions, to use their own initiative

and to innovate, and by giving them

more important or challenging tasks

High Congruence

Gives staff the freedom and support to perform their own work in the way

they see fit and to address their own problems in their own area. (e.g. applies

right level of understanding, allows to address issues you feel are important, sow seeds of

ideas involves rather than telling them what to do).

Gives staff freedom and flexibility in performing their duties

13) Keeps staff up-to-date and

informed on new hospital policies,

procedures, rules and objectives,

and any other organizational

changes that might affect them at

work

High Congruence

Keeping staff and colleagues regularly informed and up to date on what is

happening and on matters directly affecting them.

Keeps staff informed of the NHS Trust business (e.g. regularly updates staff

on matters concerning the Trust and how it applies or affects them.

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14) Demonstrates good planning,

organization, and control of

work/projects for self and staff;

establishes work priorities,

deadlines and priority resource

needs, and monitors progress.

High Congruence

Develops a long term departmental strategy and plan which provides

clarity regarding the overall purpose, the roles, goals and targets of all

individuals in the department. Thinks ahead and ensures things are done in

good time, prepares well for situations and contingencies (e.g. uses good

forward planning, prepares well for negotiations, is forward thinking). Plans ahead so that work can be carried out effectively Moderate Congruence

Uses resources well to aid decision making (e.g. drawing in different disciplines and

expertise; hand picks best person for the role; uses research evidence to aid decisions).

Low

Uses resources well (e.g. brings in people to assist in times of pressure;

chooses the best person for the job)

15) When planning a change or

deciding matters that affect staff,

collaborates with them to arrive at

the most effective decision

High Congruence

In the planning of change he/she involves staff in discussions and decision

making. (e.g. ‘All staff were involved and their thoughts taken into account’, ‘involved staff

in discussion over what they need’, ‘was invited to be part of another group and involved in

their group decisions’). In change situations he/she proactively canvasses and

listens to the opinions of his/her staff, seeks their ideas/suggestions and

invites them to voice any concerns or fears they may have.

When making decisions, gathers the facts and considers the views from

other members of staff Moderate Congruence

Consults with relevant staff and actively finds out their opinions before

making or implementing a decision.

16) Convenes and chairs meetings

with staff that are well prepared and

organized; ensures all important

agenda items are discussed in a time

efficient manner, and facilitates very

direct and easy exchanges of view

between those attending.

High Congruence

Prepares and organizes well for meetings. (e.g. sorts out venues, sets, publishes and

sends out agendas before meetings, things what other people will want in advance).. Runs

meetings efficiently and effectively. (e.g. runs efficient meetings with staff; hosts

meetings which are well run; is a strong chair of meetings; delegates duties/responsibilities in

meetings; achieves most in meetings).

Prepares well for meetings so that his/her meting is run effectively and

efficiently

17) Holds periodic meetings with

team and individuals to clarify or

discuss issues needing attention or

solution and to exchange views

High Congruence

Holds regular meetings and/or team briefings with his/her team.

18) Involves staff in decision

making

High Congruence

Involves staff in decision making wherever possible. Adopts a team

approach to problem solving and decision making (e.g. involves all staff

including support staff). In the planning of change he/she involves staff in

discussions and decision making. (e.g. ‘All staff were involved and their thoughts

taken into account’, ‘involved staff in discussion over what they need’, ‘was invited to be part

of another group and involved in their group decisions’) Consults with relevant staff

and actively finds out their opinions before making or implementing a

decision.

Involves staff in decision making where appropriate (e.g. consults staff on

changes to work patterns, etc.). Develops a long term strategy with his/her

team members and communicates objectives to staff

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Moderate Congruence: BSs with quite

similar meaning 19) Organizes induction training for

new starters and/or ensures it takes

place

Moderate Moderate

Gives support to staff in developing or progressing their careers. (e.g.

facilitates and supports career development/progression of staff; ensures staff get adequate

time to update their knowledge; gives support in projects and encourages managers to learn

and develop).

20) Communicates very clearly and

openly with staff

Moderate Moderate

Keeping staff and colleagues regularly informed and up to date on what is

happening and on matters directly affecting them. Low Congruence

Holds regular meetings and/or team briefings with his/her team.

21) Reacts quickly ad gives help

(answers) to staff experiencing

problems

Moderate Congruence

When staff are under particular pressure, or confronted with particularly

difficult situations and/ or decisions, is willing to ‘muck in’ and provide

both practical and emotional support.

Assists other staff at busy times (e.g. is prepared to get ‘stuck in’ to

alleviate work overloads)

22) Adopts a flexible/adaptable

approach to dealing with changing

situations and/or staff with different

motivational drivers

Moderate Congruence

Works with staff to support flexible working practice. (e.g. permits the

rearrangement of workload/pattern in line with staff members’ personal

circumstances)

Low Congruence: BSs containing

elements of congruent meaning

23) Ensures all staff are treated

fairly and equitably

Low Congruence

When problems occur he/she deals with them quickly and fairly.

24) Gives honest and immediate

feedback to staff on their work,

performance, and/or on problematic

issues confronting them, and

exhibits honesty and integrity in all

other dealings with people

Low Congruence

Develops a sense of trust with staff (e.g. ensures staff can talk to him/her on matters

of confidentiality; does not break confidences).

Uses a personal approach to leadership (e.g. develops a sense of trust)

Develops trusting relationships with his/her staff (e.g. does not break

confidences of staff)

No Congruence: BSs with insufficient or no evidence of explicit congruent meaning

Romanian hospital: 6 of 30 BSs (20 %)

British ‘acute’ NHS Trust hospital 3 of 30 BSs (10 %)

British ‘specialist’ NHS Trust hospital: 2 of y BSs ( 8 % )

As can be seen, eighteen (18) of the 30 (60%) positive Romanian BSs are the same as at least

one BS from either one or more BSs resulting from the Hamlin (2002a/b) and/or Hamlin and

Cooper (2005, 2007) studies. This demonstrates evidence of high congruence of meaning. Four

(4) of the 30 (13.5%) are quite similar which indicates moderate congruence. Two (2) of the 30

(6.5 %) contain just a single element of convergence and congruency which suggests low

congruence of meaning. Overall, 24 of the30 (78%) positive Romanian BSs overlap with

equivalent British BSs. Conversely, 27 of 30 (90%) acute NHS Trust hospital BSs, and 23 of 25

(92%) specialist NHS Trust hospital BSs overlap with the Romanian BSs. Although 6 of the 30

positive Romanian BSs were identified as having ‘no congruence’, all could be construed as

having some element of implicit ‘congruence of meaning’ with those British BSs concerned with

managerial behaviours that enable and ensure employees perform to standard, or give employees

necessary technical and personal support. Additionally, it should be noted that nothing in the

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key words and phrases of these 6 ‘non-congruent’ Romanian BSs suggest they are context-

specific or culturally embedded.

Due to limitations of space the Stage 3 cross-case/cross-nation comparison of the negative (least

effective/ineffective) behavioural statements cannot be presented in this paper. However, of the

27 negative Romanian BSs, 17 (62.5%) were the same as and 6 (22.5 %) were similar in content

and meaning with at least one of the BSs from one or both of the British studies. And 4 (15%)

contained no congruence of meaning with any unit of meaning contained within the British

negative BSs. Overall, 23 of 27 (85%) of the Romanian negative BSs are to a greater or lesser

extent held in common with the equivalent British findings. Conversely, 25 of 30 (83.5 %)

‘acute’ NHS Trust hospital BSs, and 32 of 37 (86.5%) ‘specialist’ NHS Trust hospital BSs

overlap with the Romanian BSs.

Discussion

Approximately 83% (47 of 57) of the combined positive and negative BSs identified by the replica

Romanian study appear to be held in common with the findings from the two British hospital

studies. Conversely 88% (107 of 122) of the positive and negative British BSs appear to be held in

common with the Romanian findings. These mutual high degrees of sameness and similarity

between the findings from both countries are both striking and significant. They challenge

predominant current discourse which asserts that particular types and styles of managerial and

leadership behaviour are contingent on the cultural aspects of specific countries. On the contrary,

the evidence of this study strongly suggests that people working within the Romanian public

healthcare sector perceive and judge the behavioural indications and contra-indications of

managerial and leadership effectiveness in much the same way as people within British NHS Trust

hospitals. This finding strongly challenges Tsui’s (1984) assertion that the behaviours which

determine a manager’s reputational effectiveness vary according to his or her respective

constituencies, and consequently are idiosyncratic, context-specific and contingent. Additionally,

it provides empirical support for those who theorize and seek to discover generic managerial

competencies; generic leadership functions; universal leader behaviours; and universal

management/leadership styles (Bass, 1997; Bennis, 1999; House & Aditya, 1997; Woodruffe,

1992). The empirical evidence resulting from this research suggests that the concept of managerial

and leadership effectiveness is far more universal across different cultures than previously claimed

in the literature.

Limitations of the study. The study has two main limitations. Firstly, it is likely the CIT data

collection stage of the Romanian study fell considerably short of reaching the point of data

saturation. Furthermore, although 313 usable CIs were collected only 252 were used for the

Stage 2 analysis. This means the number of CIs underpinning the set of Romanian BSs is

significantly smaller than the 405 and 467 CIs underpinning the two sets of British BSs

respectively. Consequently, there may be other behavioural indicators of managerial and

leadership effectiveness applying within the Romanian hospital that have yet to be identified.

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Should some of these be the same as or similar to the British findings, which is likely, then the

degree of overlap would be even higher than 83%. A second limitation is the considerable

imbalance in empirical data used for the cross-nation comparative analysis whereby 57

Romanian BSs were compared against a total of 122 British BSs.

Implications for HRD research and practice:

Although it has been demonstrated that the Romanian hospital study findings are generalized to

British NHS Trust hospitals, as yet it cannot be assumed they are generalized beyond the

population of managers who were the subject focus of the replica study. Consequently, similar

studies need to be undertaken in one or more other Romanian hospitals to demonstrate whether

or not the findings of this study are translatable and transferable to the wider Romanian public

healthcare sector. In addition, replica studies should also be carried out in more public sector

hospitals in various other countries, in order to discover whether the emergent ‘generic’ and

‘universalistic’ behavioural indicators revealed here are in fact near universal.

The behavioural indicators of effective and least effective/ineffective management identified by

the present practice-grounded research could be used by HRD practitioners to develop a targeted

competency-based management/leadership development programme within the collaborating

Romanian hospital. The commonalities and differences identified through our cross-nation

comparative analysis could also be helpful for international HRD practitioners in their

preparation for expatriates who work across borders. Additionally, the cumulative body of

‘general knowledge’ emerging from this study, and from the earlier studies it replicates, could be

used with some confidence to support ‘evidence-based’ HRD and management practice within

and beyond the Romanian and British hospitals.

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