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Dissertation Abstract

The Bases for Executive Action: A Multiple Case Study of Leadership in the Highly Regulated Long-Term Health Care Industry

Douglas B. Crawford
Regent University

Leader contribution in regulated industries is often dismissed because of the perception that opportunities for discretion are limited by the dictates of the government. The long-term health care industry, one of the most government-regulated industries in the United States, has produced many failed business and few successes. Assuming limited leader discretion, since all of these businesses are regulated, why are there stories of both success and failure? This study explores how leaders can influence their environments despite regulatory constraints and market uncertainties. This was a mixed-method, multicase study incorporating a quantitative measure, the Multifactor Leadership Questionnaire (MLQ 5X), into a qualitative study. Three cases examined the leadership of successful executives from three separate nursing home corporations through in-depth interviews, questionnaires, researcher observation, and the examination of field notes and participant feedback. As a result, analytical generalizations, as opposed to statistical generalizations, produced themes, patterns, and insights of extraordinary leadership in the context of this industry. Cross-case analysis yielded similarities among these executives. Leaders scored high on both transformational and transactional leadership, suggesting that managing in both arenas is essential in their regulatory environment. Further, these leaders do not allow regulations to drive decisions; rather, they transcend the environment by setting higher expectations and operating standards. Finally, these executives exhibited the constructs of hope, optimism, and resilience that are emerging from the positive psychology movement. Additional observations were noted to delineate how leaders construct psychological pathways to goals.