The Relation Between Leadership Styles And Conflict Management Strategies Of Hospital Managers

Abstract

This article was produced from the doctorate study with the “effects of hospital managers’ leadership styles on conflict management” title, which is carried out in the department of hospital management, institute of health sciences, Marmara University. This research has been done to reveal the leadership styles of hospital managers and their relationships with the conflict management strategies they use. Target population of the study is senior managers who are responsible for the administrative divisions of 159 Private Hospitals in Istanbul and their first subordinates in the organizational chart. According to the organizational chart, the number of personnel who work directly under the manager was found as 853 with the statements of managers. Sample selection was not made and all managers and personnel who were willing to participate in the research were included. According to the results of the research, there is no difference between the perception of leadership according to the hospital managers and their personnel. Statistically, the selections of leadership equally distribute between two groups. It was found that the transformational leadership is thought to be the most used leadership style for two groups. In terms of the conflict management styles, significant difference between managers and personnel was found in the obliging dimension. Accordingly, statistically significant relationship between leadership styles and conflict management strategies was found.

Keywords: Leadershipconflicthospital organizations

Introduction

In the environment of intensive technology and competition, human resource is the main important input for the companies. On the assumption that several organisations in the same sector use similar means of production, qualified work force of the organisation plays an important role in stepping forward. Leading the work force, the human source of organisations are one of the most studied topics researched by social scientists in the last century. The success of organisation can depend on the human, that’s why; leaders are the key factors that are the responsible for the conflict management and decisions regarding organisation with the power and political leadership skills. (Fush & Fush, 2015). There would be time-wasting when the organisational conflicts cannot be managed. In a research that asked leaders to make self-evaluation, they described the conflict management as one of the most worrying and least vulnerable compellers (Trudel & Reio, 2011). It is important to know leadership styles and conflict management strategies of managers with functional effectiveness in hospitals. Knowing which leadership behaviours are compatible with the conflict strategy in case of conflict will contribute the hospital administrators and health administrators. It will guide managers of hospital in a conflict they face and how to produce more effective and efficient solutions.

Literature research regarding the concepts, which constitute our topic, is as below.

Leadership Concept

Leadership theories are classified differently in the literature; however, the most common classifications are Theory of Characteristics, Behavioural Theory and Circumstance/Condition Dependency Theory, and Modern Leadership Theories (Saeed, Almas, Anis-ul-Haq, & Niazi 2014). Until 1900, there were several articles regarding leadership built upon observation, interpretation and moral valuation. However, increase in the usage of scientific procedures and technics to evaluate human behaviour in the twentieth century enabled researchers to change their approaches (Hackman & Johnson, 2009). Transformational and transactional leadership behaviours, which are recently considered among the postmodern approaches, are the leadership styles we analyse in our research. Transactional leader is committed to the past and the traditions, and the transformational leader is open to innovation, development and reform (Eren, 2014).

Transformational Leadership

Mac Gregor Burns used the concept of transformational leadership in his “Leadership” book published in 1978. J. Mac Gregor mentioned that leadership was built on the need to give meaning to human life and creating an organizational aim (as cited in Barutçugil, 2004). Burn described the transformational leader as someone who promotes his/her followers to want to success big aims and motivates them to work (as cited in Can, Azizoğlu, & Aydın, 2015). In the transformational leadership, it is adopted that power and responsibility are shared. This provides workers to help leaders and managers achieve the objectives. This leadership style would be proper for the modern healthcare services (Curtis & O’Connell, 2011).

Transformational leaders are visionary leaders who empower, develop, support, innovate and charismate their employees (Felix, Ahmad, & Arshad, 2016). In centralized and cumbersome enterprises where bureaucracy is more prevalent, it is more difficult for the manager to exhibit transformational leadership behavior, whereas transformational leadership behaviors are assumed to be more comfortable in the structures where the professionalization increases (Jacobsen, 2017). Transformational leadership has four dimensions; idealized effect (charisma), intellectual stimulation, individualized consideration, and inspirational motivation (Erçetin, 2000).

Transactional Leadership

Transactional Leadership, leadership between the leaser and the employee is based on work and acts as operational leadership, task leadership and managerial leadership (Sabuncuoğlu & Tüz, 2008). According to Bass, who is one of the pioneers of this approach, transactional leaders motivate audiances by attracting personal interests. So the leader will see audience’s interest as long as he observes the interests of the working company. Here is the question of reciprocal relationship (Steers, 1991). There are four sub-dimensions of transactional leadership. These are; contingent reward, management by exception active, management by exception passive, laisses faire. Transactional leader values the order and structure. Puts the rules and regulations to bedside (Hoffner, 2018).

Conflict

Conflict does not have one and open description. Many disciplines such as psychology, sociology and behavioural sciences make descriptions in their own ways (Rahim, 1983). For example, March and Simon (1958) described conflict as the trouble that individuals and groups face after the failure of decision-making mechanisms. With a broad description, Pondy (1967) regarded conflict as a dynamic process under the organizational behaviours. Tedeschi, Schlenker, and Bonoma, described conflict as an interactive condition resulting from the inconsistency of objectives and behaviours of an individual or group with another individual and group. With a similar approach, Smith (1966) also described conflict as the inconsistency between participants, who have different values, traditions and objectives (Rahim, 2001).

Conflict Management

The time spent in the workplace by the managers was analiyzed by the researchers. It was found that managers spent a quaerter of their times solving conflict. Therefore, conflict management is one of the important tasks of the leaders. Conflict management can be handled with creative solutions if it is done properly (Cerni, Curtis, & Colmar, 2014). Many studies show that leaders have an important role in the conflict management (as cited in Doucet, Poitras, & Chênevert, 2009). The reasons and types of conflict, conflict management strategies are classified in different ways by several researchers. Conflict management strategies are basically based on the degree of importance given to each other by the parties (Chen, Hou, & Wu, 2016)

In our study, integration, avoidance, domination and compromise, which are the conflict management strategies modelled by Rahim and Bonoma, are focused (Rahim et al., 2000).

Leadership and Conflict Management in the Hospital Organizations

Health sector is different from other sectors in terms of both its structure and type of provided service and it is a special field. Because of the matrix organization structure used for health care organizations, having difficulty in issues like communication, coordination etc. is possible. In this sector, which failure can result in death, health managers should have different features from managers in other sectors. In this sector, which personnel profile is very different, a visionary leader who leads individuals to the same objective, provides internal effective communication and coordination will be effective in avoiding possible faults (Kaptanoğlu, 2010). For the development of leadership skills, it is also important how the behavior of the leader is perceived by the perception of the counterparty (Chavez, Gomez, Valenzuela, & Perera, 2017). It is important that managers who have functional activity in hospitals should know leadership styles and conflict management strategies. Knowing which leadership behaviour conforms with which conflict strategy contributes health managers and sciences that train health manager. This leads way to health managers how they find more effective and productive solutions for the conflict they will face.

Material and Method

Our study is a descriptive study. It was studied that whether there is a difference between how hospital managers perceive leadership styles and conflict management styles and how their subordinates perceive them. Finally, the relationship between leadership styles and conflict management strategies was studied. In this regard, these are the hypothesis we built;

  • Hypothesise H1: There is a significant difference between the leadership styles perceptions of hospital managers think they have and their subordinates perceive.

  • Hypothesise H1: There is a significant difference between the conflict management strategies which hospital managers think they use and conflict management strategies which their subordinates perceive.

  • Hypothesise H1: According to the perception of hospital managers, there is a significant relationship between the leadership style and the conflict management strategies, which they use.

  • Hypothesise H1: According to the perception of subordinates, working under hospital managers, there is a significant relationship between the leadership style and the conflict management strategies, which hospital managers use.

Population and Sample

Our population is hospital senior managers and their first subordinates according to the organizational chart in 159 private hospital in İstanbul. There is not an updated and valid organizational chart in several hospitals. Titles that managers have differentiate from hospital to hospital. To make equal in terms of functionality, manager groups are determined by contacting directly to the hospital and learning senior administrative manager’s name and title; it is seen that top administrative manager has different titles like general manager, coordinator, operating manager. For example, while person who carries authority in all administrative services of hospital is called operating manager in a hospital with 50 beds, person who is responsible for equal administrative services is called general manager in a hospital with 150 beds. The titles of coordinator or director in some hospitals are used for people who are responsible for administrative services. Sample selection was not made for hospital managers; it was aimed to reach senior manager of every hospital. Senior managers of 130 out of 159 private hospitals were reached. 7 out of them did not want to participate in the questionnaire. 123 hospital managers participated in the questionnaire and gave feedback. However, 7 out of them were left out of assessment because they were not filled properly, for example; some of them were partially filled or same options were marked for all questions. By examining the statements of senior managers and organizational chart if available, 853 subordinates, who work directly under senior managers, was found. Also, sample selection was not made; all personnel were reached with the self-exemplificative population method. 720 out of 853 personnel were reached. However, 450 personnel wanted to participate in the study and filled the questionnaires. Some part of questionnaires was left out of assessment because they were not filled or the highest or the lowest scale was selected. 416 questionnaires in total were put into code. Questionnaires used in the study were filled on the ınternet or printed ones were distributed and collected. Especially personnel, who works under the managers, did not want to fill the questionnaire on the Internet (by sending questionnaire via e-mail) due to the concern of being exposed. Questionnaires were distributed and collected between April 2016 and February 2017.

Data Collection and Analysis

Questionnaire forms were prepared for managers and personnel to collect data. “Multifactor Leadership Questionnaire” to understand the leadership styles of managers and “Questionnaire of Conflict Management Strategies” to determine which conflict management strategies managers use, were used. Multifactor Leadership Questionnaire was developed by Avolio and Bass (1995). “Questionnaire of Conflict Management Strategies” was used to measure conflict management strategies. This measure was developed by Rahim (1983). Multifactor Leadership Questionnaire (MLQ) consists of 45 questions. The reliability of manager group of questionnaire was found as 0,91, the reliability of subordinates was found as 0,89 and general reliability was found as 0,90. Multifactor Leadership Questionnaire (MLQ) is a questionnaire that has a high degree of reliability. For the reliability analysis; Kaiser-Mayer-Olkin (KMO) and Bartlett's Test was used regarding the size of sample. It was found 0,93 (p<0,001) for subordinates and 0,89 for managers. Factor analysis resulted as statistically applicable. Questionnaire of Conflict Management Strategies (ROCI-II) consist of 28 questions. The reliability of manager group of questionnaire was found as 0,74 the reliability of subordinates was found as 0,83 and general reliability was found as 0,81. Questionnaire of Conflict Management Strategies (ROCI-II) is a questionnaire that has a high degree of reliability. For the reliability analysis; Kaiser-Mayer-Olkin (KMO) and Bartlett's Test was used regarding the size of sample. It was found 0,93 (p<0,001) for subordinates and 0,89 for managers. Factor analysis resulted as statistically applicable.

Research Limitations

This research is limited to private hospital managers (general manager, coordinator, director, hospital manager, director of business manager) operating between September 2016 February 2017. Employees are limited to hospitals’ organizational charts. It is limited to perceptions of managers and employees involved in this study on leadership styles and conflict management strategies.

Findings

In this chapter, it was analysed that whether there is a significant difference between the perception of leadership of managers, who participated in the study and the conflict management strategy they use and according to the perception of personnel, the leadership styles of managers and the conflict management strategy they use, and the relationship between perceived the leadership styles and the conflict management strategies.

The Analysis of Leadership Styles Perceptions Of Hospital Managers And Personnel

The leadership perceptions of hospital managers and personnel were analysed (Table 1 ). Total of Questionnaire and differences between sub-dimensions groups were not statistically found significant (p>0,05). There is not a significant difference between leadership styles perception of hospital managers and their subordinates.

Table 1 -
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This result is agreement with the result of Casida and Parker’s (2011) research. In that study 278 nurses and 37 executive nurse are asked to evaluate the leadership styles. According to study the most used leadership styles is transformational leadership. Again in Hater and Bass’s (1988) studies titled “Transformation and Interactional Leadership Evaluations and Perceptions of Supervisors and Employees”, according to two groups transformational leadership scores were high.

The Analysis of the Conflict Management Strategy Perceptions of Hospital Managers and Personnel

The conflict management strategy perceptions of hospital managers and personnel were analyzed. In the oblige sub-dimensions, it was found statistically significant (p<0,05) between two groups, in the integration, domination, avoidance, compromise sub-dimensions, it was not found statistically significant (p>0,05) between two group. In Tunç’s (2011) doctorate thesis that is related self esteem and anxiety effects on conflict management styles found that nurses and physicans use mostly integration strategies and the least use avoidance strategy. Also in our study, integratin is the most used and avoidance is the least used strategies in the both groups.

The results of analysis are in the Table 2 .

Table 2 -
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The Analysis Of Relationship Between The Leadership Styles Of Managers And The Conflict Management Strategy According To Hospital Managers Perceptions

A statistically significant positive correlation between the total of MLQ and the total of ROCI II questionnaire (r=0,489), the integrating (r=0,704), obliging (r=0,547), compromising (r=0,623) was found. A statistically negative correlation between the total of MLQ and dominating (r=-0,400) was found. A statistically significant positive correlation between transformational leadership and the total of ROCI II questionnaire (r=0,399), integrating (r=0,751), obliging (r=0,515), compromising (r=0,609) was found. A statistically significant negative correlation between transformational leadership and dominating (r=-0,463) was found. A statistically significant positive correlation between transactional Leadership and the total of ROCI II questionnaire (r=0,331), dominating (r=0,267), avoiding (r=0,443) was found.

Table 3 -
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The Analysis of Relationship between the Leadership Styles of Managers and Conflict Management Strategy According to the Perception of Personnel

A statistically significant positive correlation between the total of MLQ and the total of ROCI II questionnaire (r=0,512), integration (r=0,614), obliging (r=0,491), avoiding (r=0,215), compromising (r=0,517) was found. A statistically significant positive correlation between transformational leadership and the total of ROCI II questionnaire (r=0,457), integrating (r=0,675), obliging (r=0,498), avoiding (r=0,126), compromising (r=0,568) was found. A statistically significant negative correlation between transformational leadership and dominating (r=-0,199) was found. A statistically significant positive correlation between transactional leadership and the total of ROCI II questionnaire (r=0,156), domination (r=0,404), avoiding (r=0,182) was statistically found. A statistically significant negative correlation between transformational leadership and dominating (r=-0,142) and compromising (r=-0,119) was found. A statistically significant positive correlation between results and the total ROCI II questionnaire (r=0,438) and integrating (r=0,650), obliging (r=0,482), avoiding (r=0,174), compromising (r=0,548) was found. A statistically significant negative correlation between results and dominating (r=-0,253) was found.

The results of analysis are in the Table 4 .

Table 4 -
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Discussion and Conclusion

In this chapter, there are interpretations and recommendations based upon the findings of research. Results and interpretations, obtained by analyzing the relationship between the leadership styles and the conflict management styles according to the perceptions of hospital managers and their personnel, are as follows. According to the analysis result of the leadership perceptions of hospital managers and personnel (Table 1 ), there is not a statistically significant difference between the perceptions of managers and personnel. In another words, first hypothesis is denied. By the fact that the idealized effect (behavior) from the sub dimension of transformational leadership, is the most realized dimension for both groups shows that leaders are such people who express the values and principles they care about, give importance to the common objectives, missions, ethical and moral values and try to develop them. Furthermore, by the fact that this dimension has high means in both groups shows that behaviors are perceived in the same way. When sub-dimensions of transactional leadership are analyzed, the contingent reward is evaluated as the most common realized dimension for both group. The laisse faire is the least realized dimension. Actions like taking responsibility, making decisions, and using authority do not exist in this leadership style. In hospital whose object is the human heath, it is essential that managers should act in a harmony and integrity with the effect of matrix organization. Besides, moral support and motivation given by manager is important for the hospital personnel. When the Laisse faire leadership style avoids even carrying out the administrative services, it is far from reality to expect this leadership to understand personnel and support them.

In general, the transformational leadership is more preferred than the transactional leadership according to the perceptions of both managers and personnel. We can say that this is a positive result for hospitals. Hospitals are organizations that have open and dynamic system. That’s why, it is important for them to cope with the change. At this stage, the characteristics of transformational leaders, such as being open to change, reform and transformation, will significantly contribute to the management of hospital.

When the satisfaction, extra effort and effectiveness, results of the leadership, sub-dimensions analyzed, it is found that the mean of managers are higher than the mean of personnel in all sub-dimensions. In other words, leaders are seen as people who fulfill the need of themselves, organization and others, uncover the potential of personnel much more and they seem to be more satisfied with the situation. Getting training on subjects such as the Leadership and conflict management enables them to improve themselves, notice their negative sides and evaluate objectively. When the conflict management strategies that hospital managers think they use and the strategies that their personnel perceive are compared; there is a statistically significant difference in the obliging strategy (see Table 2 ). In other words, the second hypothesis of our study is accepted. The obliging strategy is strategy that involves behaviors to meet the need and expectations of personnel. According to our study, managers think that they use much more obliging strategy but personnel thinks that managers do not use enough obliging strategy. In hospitals, giving service 7/24, in which the subject is human health and intense effort exists, leaders should give up insistence and make concessions for the requests and expectations of personnel from time to time. Both managers and personnel state that the most used strategy is the integration strategy. The integration strategy is a democratic method that listens to the parts of conflict and looks for acceptable solutions for all parts. In hospitals in which true information exchange is important, taking parts’ opinions, trying to offer permanent and democratic solutions would be proper behaviors. Again, we can see that the compromising strategy is the second most used strategy as the common view of both groups. This result also shows that opinions are consistent. Because the compromising strategy is close to the integration strategy in terms of its features.

On the other hand, the third hypothesis of our study is also accepted. According to the perception of managers, the relationship between leadership style they have and the conflict management strategies they use is statistically significant. It was found that there is a highly significant positive correlation between the idealized effect (attributed) dimension and the integration, obliging and compromising. In other words, manager thinks that s/he solves the conflict by taking everyone’s opinion, giving concession when necessary and trying to find a common obliging on a democratic ground when s/he asks personnel to be proud of working with him/her, puts up his/her interest for the sake of groups’ interest, acts in a way that arouse respect and presents feeling power and trust. There is a highly significant positive correlation between the idealized effect (behavior) dimension and the integration and compromise strategies, and there is a moderate significant positive correlation between the idealized effect (behavior) and the oblige. There is a moderate significant negative correlation with the domination and the avoidance. In other words, manager thinks that s/he primarily uses the integration and the compromising strategies when s/he sees himself/herself someone who expresses values and principles, which s/he cares, pays attention to the codes of conduct and puts emphasis on the exchange of common objective and mission. Besides, managers that shows these leadership features state that they keep away from avoidance strategy. Idealized effect attributed and idealized effect behavior dimensions are characterized as charisma. Hence, we can say that people, who show charismatic leadership feature, prefer positive conflict management strategies like integrating, compromising that reveal successful results from the conflict. In addition, we can say that manager keeps away from the avoidance strategy that requires an attitude, hiding disagreements and divergences as his/her charismatic leadership feature increase. There is a highly significant positive correlation between the inspirational motivation sub- dimension and the integration and compromising. While there is a moderate significant positive correlation with the obliging strategy, there is a low-level significant positive correlation with the domination strategy. The divergence between the domination strategy that calls for the use of all management power to win the competition in which opinions are imposed and authority is used, and the manager who can be accepted by everyone, enable to make a co-decision by making accurate and true information flow to find a common solution, is an expected result. There is a highly significant positive correlation between the intellectual stimulation sub-dimensions and the integration, a moderate significant positive correlation between the Intellectual Stimulation sub-dimensions and the compromising and obliging, and a highly significant negative correlation between the intellectual stimulation sub-dimensions and the domination strategy. Intellectual stimulation leadership behaviour requires finding different solutions for the problems and involves offering people new ideas to carry out their duties. That’s why, managers that have this leadership feature, use also the integration strategy that cares about people with different skills and qualifications and they think that they do not use the domination strategy, which is the reverse of integration strategy. There is a highly significant positive correlation between the individualized consideration sub-dimensions and the integration and compromising, and a highly significant negative correlation between the individualized consideration sub-dimensions and the domination strategy. We can see that managers, who see their personnel as a person, know that skills, needs and expectations of personnel can differentiate, spend time and effort to raise them, use the integration and the compromising strategies more, besides; we find out that they do not prefer the domination strategy. Generally, we can say that managers that they think they present the transformational leadership attitude, state that they primarily prefer the integration strategy. After that, they state that they prefer the compromising and obliging strategies. They think that they do not prefer the domination and the avoidance strategies. There is a highly significant positive correlation between the contingent reward, one of the Transactional leadership sub-dimensions and the integration and compromising, a moderate significant positive correlation between the contingent reward, one of the Transactional leadership sub-dimensions and the obliging, and a low-level significant negative correlation between the contingent reward, one of the Transactional leadership sub-dimensions and the domination strategy. For the system operation, managers that use reward and punishment when necessary, expect from his/her personnel to reach performance objectives, express his/her satisfaction when objectives are reached, help his/her personnel in exchange for making effort, use the integration and compromising strategies more. There is a moderate significant positive correlation between the management by exceptions active dimension and the compromising and integration, and there is a low-level significant positive correlation between the obliging. In other words, managers who pay attention to the failures and do not interfere as long as the standards are preserved, think that they primarily use the integration and compromising strategies. There is a moderate significant negative correlation between the management by exceptions passive dimension and the integration, and there is a low-level significant negative correlation between the obliging, and there is a moderate significant positive correlation between the management by exceptions passive dimension and the avoidance and domination. Accordingly, managers that do not take action unless problems grow prefer primarily the avoidance strategy, then the domination strategy. They avoid using the integration strategy. There is a highly significant negative correlation between the laissea faire sub dimension and the integration, there is a moderate significant negative correlation between the compromising, and there is a low-level significant negative correlation with the obliging. In addition, there is a moderate significant positive correlation with the avoidance and domination. Managers, who avoid taking initiative and making decisions, give free rein to their personnel and do not show up when they needed, state that they use primarily the avoidance and the domination strategies and avoid using the integration and compromising strategies. Generally, managers, expressing Transactional leadership features, who participated in our study state that they primarily use the avoidance strategy, then the domination strategy.

On the other hand, when the relationship between the leadership styles of managers and the conflict management strategies that they use according to the perception personnel was analysed, different relationships between the leadership styles and the conflict management strategies occurred. The forth hypothesis of our study is also accepted. It was found out that personnel perceives that managers who present the idealized effect (attributed) leadership features, one of sub-dimensions of transformational leadership, use high level of integration, obliging and compromising strategies and avoid using the domination strategies even a little. It was found out that managers who present the idealized effect (behaviour) leadership features, use mostly the integration, obliging and compromising strategies at medium level. It was found out that managers, who present the inspirational motivation leadership features, are perceived as preferring mostly the integration for the management of conflict, the compromising and obliging strategies at medium level. There is a feeling that the use of domination strategy decreases as the perception of inspirational motivation behaviour increases. While the integration is thought to be the most used strategy in situations like the increase of intellectual sub-dimension behaviour, the compromising and obliging are thought to be used at medium level. When the actions of managers to the intellectual stimulation increase, the use of domination strategy decreases at medium level. According to the perception of personnel, the individualized consideration features of managers increases, the use of integration and compromising strategies considerably increases. These strategies are followed by the obliging and avoidance at medium level. The use of domination strategy decreases as the individualized consideration leadership features increases. Generally, according to the perception of personnel, as the transformational leadership features, presented by managers, increase, the integration and the compromising strategies increases at high level. Following these strategies, there is also a positive relationship between the obliging strategy and the transformational leadership at a medium level. There is a low-level positive relationship with the avoidance. There is a negative relationship with the domination strategy. It was found that there is a positive relationship between the contingent reward, one of the sub-dimensions of transactional leadership, and the integration at a medium level and a relationship with obliging at a low-level. In other words, according to the personnel, as the contingent reward leadership features presented by managers increase, the use of integration, compromising and obliging also increases. According to the perception of personnel, the management by exceptions (active) leadership sub-dimension behaviours of managers do not affect the use of obliging, domination and avoidance strategies. Nonetheless, the management by exceptions (active) leadership features of managers affect the use of integration and compromising even at a low-level. According to the perception of personnel, when the management by exceptions (passive) and the laissea faire leadership features increase, the use of integration and compromising strategies decreases while the use of domination and avoidance strategies increases.

We can say that generally, according to the personnel, when the transactional leadership features increase, the use of domination and avoidance strategies, in contrast; the use of integration, compromising strategies decreases.

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Faikoğlu, R., Ateş, M., & Kamer*, H. (2019). The Relation Between Leadership Styles And Conflict Management Strategies Of Hospital Managers. In & M. Özşahin (Ed.), Strategic Management in an International Environment: The New Challenges for International Business and Logistics in the Age of Industry 4.0, vol 71. European Proceedings of Social and Behavioural Sciences (pp. 30-44). Future Academy. https://doi.org/10.15405/epsbs.2019.10.02.4