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Servant Leadership, Employee Satisfaction, and Organizational Performance in Rural Community Hospitals

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Servant leadership in today's healthcare settings provides a unique avenue through which to assess leadership behaviors and the relationship to employee satisfaction and healthcare patient satisfaction measures. This study sought to determine the degree that leaders in community hospitals were perceived as servant leaders and the level of employee satisfaction at these rural community hospitals. Two hundred nineteen surveys were completed from 10 community hospitals. This research revealed that servant leadership and employee satisfaction are strongly correlated. In addition, servant leadership has a significant correlation between intrinsic satisfaction and HCAHPS scores. Further research can be extended to additional categories and geographic areas of the United States to determine how servant leadership, employee satisfaction, and HCAHPS are related. Hospital administrators should examine the findings of this study for possible implications to their leadership style and practice in determining how it may impact the organization they lead.
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International Journal of Business and Management; Vol. 9, No. 10; 2014
ISSN 1833-3850 E-ISSN 1833-8119
Published by Canadian Center of Science and Education
28
Servant Leadership, Employee Satisfaction, and Organizational
Performance in Rural Community Hospitals
Jack Thomas McCann1, Daniel Graves2 & Lieven Cox3
1 Tusculum College, Greeneville, TN, USA
2 Lincoln Memorial University, Harrogate, TN, USA
3 Claiborne County Community Hospital, New Tazewell, TN, USA
Correspondence: Jack Thomas McCann, Tusculum College, Greeneville, TN, USA. E-mail:
jackmccann9@gmail.com
Received: July 22, 2014 Accepted: August 9, 2014 Online Published: September 25, 2014
doi:10.5539/ijbm.v9n10p28 URL: http://dx.doi.org/10.5539/ijbm.v9n10p28
Abstract
Servant leadership in today’s healthcare settings provides a unique avenue through which to assess leadership
behaviors and the relationship to employee satisfaction and healthcare patient satisfaction measures. This study
sought to determine the degree that leaders in community hospitals were perceived as servant leaders and the
level of employee satisfaction at these rural community hospitals. Two hundred nineteen surveys were
completed from 10 community hospitals. This research revealed that servant leadership and employee
satisfaction are strongly correlated. In addition, servant leadership has a significant correlation between intrinsic
satisfaction and HCAHPS scores. Further research can be extended to additional categories and geographic areas
of the United States to determine how servant leadership, employee satisfaction, and HCAHPS are related.
Hospital administrators should examine the findings of this study for possible implications to their leadership
style and practice in determining how it may impact the organization they lead.
Keywords: healthcare leadership, servant leadership, leadership, employee satisfaction, performance leadership
1. Introduction
Leaders responsible for managing today’s healthcare organizations are exposed to the needs of clients, and the
limitations and demands of the organizations that they must serve. These leaders must practice effective servant
leadership to succeed in today’s challenging climate and to balance these competing demands. Greenleaf (1977),
the developer of the modern context of servant leadership, suggests that managing the institutions that care for
others has transitioned from managing through personal involvement to becoming something that is mediated by
an organization and its stakeholders. These organizations are often enormous, complex, powerful, impersonal,
and even incompetent at times.
The current climate in many healthcare organizations does not align with the idea of servant leadership, as
envisioned by Robert Greenleaf, when he originally introduced the concept of servant leadership. He envisioned
a model of leadership rooted in the fundamental human drive to care for others and contribute to the betterment
of society. Greenleaf (1977) argued that true leadership is essentially synonymous with service and great leaders
are identified by the service they perform for individuals and society.
Servant leadership behaviors appears to be what healthcare organizations need to effectively lead their
organizations in today’s challenging times. Bennis and Nanus (1985) stated, “The problem with many
organizations, and especially the ones that are failing, is that they have the tendency to be over managed and
under led” (p. 21). They found that there is a difference in leadership and management, but both are important to
the success of organizations. However, the distinct difference between leadership and management was matter of
perspective. Leaders were vision, judgment, and effectiveness oriented, while managers were more concerned
with efficiency and mastering routines or doing things right.
The purpose of this research is to assess servant leadership behaviors of leaders in today’s rural community
hospital industry and its impact on employee satisfaction and Hospital Consumer Assessment of Healthcare
Providers and Systems (HCAHPS) scores. The population for this study is rural community hospitals in the
United States. The study will address the following research questions:
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Research Question 1: To what degree are leaders in rural community hospitals servant leaders? Research
Question 2: What is the level of employee satisfaction in rural community hospitals?
Research Question 3: What is the relationship between servant leadership, employee satisfaction, and Hospital
Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores?
2. Literature Review
2.1 Servant Leadership
Leadership is an area of research which has been extensively examined over the past 30 years; however, an
emerging leadership focus since 2004 has been servant leadership. Robert Greenleaf defined servant leadership
in the 1970’s as not just a management technique, but as a way of life which begins with “the natural feeling that
one wants to serve, to serve first” (Parris & Peachey, 2013). Since Greenleaf’s foundational essay The Servant as
Leader (1970), research has developed to better understand the tenants of servant leadership. However,
significant research contributing to an increased awareness of servant leadership did not occur until 2004. The
model for servant leadership, where it has been implemented, has significant implications for the individual and
the organization as a whole (Guillaume, Honeycutt, & Cleveland, 2012). According to the Greenleaf Center
(2011), over 20% of the Fortune magazine top 100 companies have sought guidance from the Greenleaf Center
for Servant Leadership, including Starbuck’s, Vanguard Investment Group, and Southwest Airlines, among
many other organizations (Parris & Peachey, 2013).
As organizations move away from the traditional command and control approach to management, a new and
emerging style of leadership has surfaced, namely servant leadership. Yet, because of relatively recent timeline
and amount of research data available, much research has been conducted on the theoretical approach and on
developing measurement tools through which to explore servant leadership within organizations. With regard to
specific research on the extent of servant leadership in the literature, servant literature research (SLR) had its
origin in the medical, health care, and policy fields used primarily to make clinical and policy decisions (Paris,
2013). A practical construct of servant leadership was needed to operationalize a model of servant leadership for
empirical research that would stand apart from other models of leadership (Huckabee, 2008).
Barbuto and Wheeler (2006) developed an instrument through which to operationalize and measure five factors
derived from characteristics deemed to be indicative of servant leadership. The Servant Leadership
Questionnaire measures five factors, including altruistic healing, emotional healing, wisdom, persuasive
mapping, and organizational stewardship. A description of each of the five factors, as explained by Barbuto and
Wheeler, demonstrates how each of the five factors determines the extent to which leaders demonstrate their
skills in each of the five subscales. Servant leaders create serving relationships with their followers, unlike
transformational leaders who focus on transcending followers’ self-interest toward organizational goals.
Altruistic healing (AH) measures the level to which a leader seeks to make a positive impact in the lives’ of
others. From the perspective of servant leadership, the goal is to serve others, therefore leaders who are high in
this attribute will focus on the interests of others before their own interests and in the process work towards
meeting the needs of others. Another significant component of this factor has been described as a generosity of
the spirit consistent with a philanthropic purpose in life (Barbuto & Wheeler, 2006).
Emotional healing (EH) assesses the leader’s commitment to and the skill in developing spiritual recovery from
either hardship or trauma. Those leaders who score high in this category display such traits as empathy and
strong listening skills. Both of these traits serve to facilitate the healing process by creating an environment
which provides a space through which employees feel safe to share personal and professional concerns.
Wisdom (W) includes a combination of awareness of one’s workplace surroundings and the ability to anticipate
consequences within the dynamic of the workplace. A factor in this intuitive based skill is the ability to
understand organizational dynamics and connect reasonable outcomes based upon the environmental cues that
they read.
Persuasive mapping (PM) describes the leaders who can influence others. Specifically, this factor encompasses
the leader who can use reasoning processes and conceptual frameworks in influencing others. Considered high in
the ability to earn buy-in for organizational visionary aspirations, these leaders can communicate the reasons that
others should support the organizational goals.
Organizational stewardship (OS) addresses the interconnectedness that an organization has to making a positive
contribution to society. Founded on the premise of ethics and value-orientation, this factor is evidenced by the
extent that a leader prepares an organization to be involved in community development, programs and
community outreach (Melchar, 2010). Although focused in the works performed in society, this factor
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recognizes the importance of developing an internal community spirit workplace through which to engage in
societal organizations outside the organization.
2.2 Job Satisfaction
The term “job satisfaction” reflects a person’s attitude towards their job and the organization and can be defined
as an employee’s emotional reaction towards their work environment based on the evaluation of the actual
results against their expectations (Phillips & Gully, 2012). Saari and Judge (2004) found evidence that job
satisfaction is a predictor of employee performance and the relationship is stronger for professional jobs.
Effectively managing the variables that influence employee behavior and job satisfaction affects their
discretionary efforts and performance levels (Phillips & Gully, 2012). Stringer (2006) found empirical support
for the proposition that high-quality supervisor-employee relationships are positively related to levels of both
intrinsic and extrinsic job satisfaction. Mohammad, Al-Zeaud, & Batayneney (2011) also found that a significant
link exists between leadership behavior and job satisfaction.
The intrinsic component of job satisfaction is dependent on the individual’s personal perception and emotional
state regarding the work environment and includes factors such as recognition, advancement, and responsibility.
The extrinsic components are comprised of external job related variables that would include salary, supervision,
and working conditions, (Negussie & Demissie, 2013).
Randolph (2005), in a survey of Physical Therapists, Occupational Therapists, and Speech Language
Pathologists, revealed that intrinsic factors, rather than extrinsic factors such as pay, tend to be predictive of
career satisfaction and desire to stay on the job. Mohammad et al. (2011) explored the relationship between
transformational leadership and job satisfaction of Jordanian registered nurses at private hospitals. The results of
the study indicated the statistically strongest significant positive relationship to exist between intrinsic job
satisfaction and the variables of intellectual stimulation and inspirational motivation. Intellectual stimulation was
described as the employee’s empowerment to solve problems and challenges whereas inspirational motivation
refers to the leaders’ commitment and ability to build relationships with their staff to achieve a common vision
and set of goals. Both intellectual stimulation and inspirational motivation are considered main staples of
Greenleaf’s servant leadership style.
2.3 Servant Leadership and Job Satisfaction
Servant leadership is centered on the core values of “caring” and “serving others,” and focuses on the values of
trust, appreciation of others, and empowerment (Hoveida, Salari, & Asemi, 2011).The servant leader leads by
example and, as such, enables and empowers the follower with all the tools necessary to succeed. This modus
operandi of genuine caring and authenticity for the needs of others has led to improved organizational
effectiveness. The same characteristics lend the servant leadership model to be considered the most appropriate
leadership style for increased organizational performance and enhanced employee satisfaction through improved
focus on the customer (Jones, 2012b).
Various studies support the thesis that servant leadership positively affects employee behavior. Netemeyer,
Maxham, and Pullig (2005) found servant leadership to motivate the employee to go above and beyond the basic
requirements of the job responsibilities in their interaction with customers. Walumbwa, Hartnell, and Oke (2010)
point out that servant leadership is conducive to molding positive employee attitudes as well as creating work
environments that promote benefits for both individuals and the work group. Studies by Johns (2006) and
Ehrhart (2004) further indicate a strong relationship to exist between leaders and followers with the significant
benefit of increased organizational effectiveness. In addition, servant leadership possesses a significant positive
correlation with employee satisfaction (85%) and with employee loyalty (79%) (Donghong, Lu, & Lu, 2012).
Employee satisfaction and organizational commitment are key elements in determining organizational
performance and effectiveness (Rehman, 2012).
2.4 Servant Leadership, Job Satisfaction and Customer Satisfaction
The federal government expressed their vision or health care in a “triple aim” format: improving the individual
experience of care; improving the health of the populations; and reducing the per capita cost of care (Berwick,
2008). The main driving force of any business is the quality of the product or service rendered. In the health care
sector, the creation of value is measured by the outcomes achieved, not the volume of services delivered. Shifting
focus to the quality in the healthcare delivery system therefore, remains the central challenge (Porter, 2010). Hence,
the most fundamentally basic and critical responsibility for health care leaders is to understand their customers
and provide the best care possible (Capoccia & Abeles, 2006; Porter, 2010).
Harold McDowell, CEO of TD Industries, an ardent supporter of servant leadership practices, makes a very valid
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point with his statement, “People go to work for a great company but quit for a bad supervisor no matter how
great the company is” (as cited in Faloon, 2011, p. 32). The World Health Report lists unmotivated healthcare
workers as one of the top ten leading causes of inefficiencies of health care system (World Health Organization,
2006).
Research data support the hypothesis that the level of commitment correlates positively with organizational
performance, and employee commitment mediates the relationship between leadership style and organizational
performance (Khan, et al., 2012). Schneider and George (2011) support these findings as it pertains to the
correlation between leadership patterns and influence on organizational workings, employee satisfaction, or lack
thereof, and its impact on employee turnover. This relationship is exemplified in the quality of the organizational
performance, job performance, organizational citizenship, absenteeism, turnovers, and tardiness (Kool &
Dierendonck, 2012). Consequently, leadership should be considered a determinant variable in organizational
behavior. Research further found that servant leadership impacted the employer-employee relationship to the
extent that it reduced levels of job stress, elevated levels of job satisfaction, and solicited greater organizational
commitment from the employee base (Franke & Park, 2006; Hoveida, et al., 2011).
According to Waterman (2011) servant leadership is characterized by the mantra of putting other people first.
Adopting this caring, empathic attitude should not only be displayed towards patients and customers but also
should be applied in the work place and surrounding community (Waterman, 2011). There is ample evidence for
the need to respect and develop the frontline workers (Abeles, 2006). Bodur (2002) discovered in his analysis of
job satisfaction that a close correlation exists between job satisfaction and quality of health care. The nature of
servant leadership, putting other people first, and displaying concern and empathy for others, lends itself to be
the preferred vehicle to engage healthcare employees into caring for their customers or patients. Servant
leadership not only is designed to create a trusting, fair, collaborative, helping culture resulting in greater
individual and or organizational effectiveness, but also supports and promotes the followers well-being, whether
staff members or patients (Parris & Peachey, 2013).
Practicing servant leadership encompasses three dimensions: motives, means, ends or outcomes. Servant
leadership further embraces the “triple bottom line” (sustaining people, profit and the planet) and does practice
moral symmetry to balance the needs of all affected (SanFacon & Spears, 2010). Servant leadership affects are
closely linked to employee satisfaction and organizational profits as various studies have alluded to a direct
causal relationship between leadership and customer satisfaction, employee satisfaction, and financial
performance (Khan, et al., 2012; Jones, 2012b; Obiwuru, Okwu, Akpa, & Nwankere, 2011).
3. Research Methodology
This section presents the research methodology utilized by this study. We describe the sample used, and then
discuss how each of the variables included in the study are operationalized and presented for statistical analysis.
3.1 Target Population and Sample
The participants in this study were employees from ten community hospitals located in the southeastern region
of the United States. Survey data was collected in December 2013 and January 2014. While a copy of the final
research paper and research data were made available to the hospitals, no identifiable information was made
available about the participants to ensure privacy of participants.
There were 3,942 surveys mailed to hospitals and then delivered to all employees with their payroll stubs
inviting hospital employees to an online survey. One reminder invitation note was sent to employees at about the
mid-point of the survey. Two hundred and nineteen usable surveys were completed online returning a response
rate of 5.6%, during the two month time the survey remained open. The summary of the demographic results are
found in Table 1.
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Table 1. Summary of the sample demographic characteristics (n=219)
N % N %
Age Gender
Below 35 56 25.60% male 49 24.40%
Over 35 163 74.40% female 170 76.60%
Education Work experience
high school graduate or below 25 11.40% 10 years or less 65 29.70%
some college to master's degree 183 83.60% >10 years and < 30 years 108 49.30%
greater than master's degree 11 5.00% > 30 years 46 21.00%
Income
< $50,000 per year 85 38.80%
> $50,000 per year 134 61.20%
Of the total usable responses (219), there were 56 (25.6%) respondents who identified themselves as below age
35 and 163 (74.4%) respondents who identified themselves as over 35 years of age. Of the 219 responses, 25
(11.4%) reported earning a high school degree or below, 183 (83.6%) indicated taking some college to a
master’s degree, and 11 (5%) had earned greater than a master’s degree. Forty-nine (24.4%) of respondents
identified themselves as male and 170 (76.6%) as female. Sixty-five (29.7%) of respondents identified
themselves with 10 years or less work experience, 108 (49.3%) identified that they had more than ten years and
less than thirty years work experience. Eighty-five (38.8%) respondents indicated that they made less than
$50,000 per year, and 134 (61.2%) make more than $50,000 per year.
3.2 Instrumentation
The survey consisted of three parts. Part one of the survey was developed to obtain demographic information
that included age, education, gender, work experience, and income. Part two of the survey utilized the Servant
Leadership Questionnaire (SLQ) created by Barbuto and Wheeler (2006) and adapted to measure the degree of
servant leadership categorized by five factors: altruistic healing, emotional healing, wisdom, persuasive mapping,
and organizational stewardship. This research utilized the self-rater version of the SLQ reliabilities ranging
from .68 to .87. Self-rated subscale means ranging from 2.48 to 2.98, with fairly consistent standard deviations
ranging from 0.49 to 0.58. In the self-rater form wisdom and organizational stewardship were the highest reported
characteristics for Barbuto and Wheeler (2006). There were 23 questions that measured the five factors of servant
leadership using a five-point Likert scales as a way for participants to record their responses. The possible
responses included 1 = not at all, 2 = means once in a while, 3 = sometimes, 4 = fairly often, 5 = frequently.
Part three of the survey employed the Minnesota Satisfaction Questionnaire (MSQ) (short-form) developed by
(Weiss, Dawis, England, and Lofquist, 1967). The MSQ measures two subscales of job satisfaction: intrinsic and
extrinsic, and also measures general satisfaction, which is a summary of both scale questions. There were 20
questions that measured the two sub-factors of job satisfaction and total general satisfaction using a five-point
Likert scale as a means for participants to report their responses. The possible responses were: 1 = very dissatisfied,
2 = dissatisfied, 3 = neutral, 4 = satisfied, and 5 = very satisfied.
3.3 HCAHPS
In addition to the survey components of demographics, servant leadership, and the employee satisfaction concept
it was important to consider customer and patient satisfaction. Khan, Hafeez, Rizvi, Hasnain, and Marian (2012),
argued that customer or patient satisfaction is widely known and accepted to be one of the most significant
factors of any business success. Patients represent the customer base for the hospital industry, and the perception
of their experience of care drives organizational performance. Lutz & Root (2007)confirm that the perception of
the quality of care directly impacts patient satisfaction and the probability of repeat business.
In response to the care discrepancies noted among hospitals, federal policy makers implemented the HCAHPS
program designed to provide a national portrait of patient care experiences and improve accountability in US
hospitals (Ashish, 2008). The Hospital Consumer Assessment of Healthcare Providers and Systems Survey
(HCAHPS) was developed by the Agency for Healthcare Research and Quality (AHRQ) for the Centers of
Medicare and Medicaid Services (CMS) with the intent to provide a standardized data collection tool to measure
a patient’s perspective of their hospital care (HCAHPS: Patients' perspectives of care survey., 2013). The goal of
the public reporting instrument is to provide patients with quarterly data and information that might be helpful in
selecting an appropriate hospital. The HCAHPS survey is composed of 27 items, 18 of which entail critical
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aspects of their hospital care (communication with physicians and nurses, responsiveness of staff, cleanliness,
quietness, pain management, medication management, discharge planning, overall rating, and recommendation
of hospital), four items direct patients to appropriate questions, three items to adjust for the patient mix across
hospitals, and two to support congressional mandated reports. Eligibility criteria for patient participation include
at least one overnight stay as an inpatient, over the age of 18 at time of admission, non-psychiatric
MS-DRG/principal diagnosis at discharge, and being alive at time of discharge. Even though reporting is on a
voluntary basis, the program links a portion of the hospital performance on a set of quality measures to the
Inpatient Prospective Payment System (IPPS) (HCAHPS Fact Sheet, 2012). Therefore healthcare organizations
do have a financial stake in reporting and maintaining high quality HCAPHS data. The significance of achieving
high scores on the HCAHPS surveys and its related impact on the success of the hospital is further underscored
by the percentage of time administrators spent on servant leadership behaviors (Artrip, 2013).
HCAHPS scores were gathered by the authors from the Medicare website for comparison purposes in this study
and inclusion as a continuous variable. According to HCAHPS Fact Sheet (2012), the CAHPS® Hospital Survey
is the first national, standardized, publicly reported survey of patients' perspectives of hospital care. HCAHPS is
a 27-item survey instrument and data collection methodology for measuring patients’ perceptions of their
hospital experience. Even though many hospitals collect information on patient satisfaction for internal use, until
the development of HCAHPS there were no common metrics or national standards for collecting and publicly
reporting information about patient experience of care. HCAHPS has allowed valid comparisons to be made
across hospitals locally, regionally and nationally, since 2008.
The researchers utilized results from one critical question on the HCAHPS survey, Question 22, “Would you
recommend this hospital to your friends and family?” The question offers four answers: 1. Definitely No, 2.
Probably No, 3. Probably Yes, and 4. Definitely Yes. For the purpose of this research the focus was placed on
option number 4. Definitely Yes, and the percentage of those patients who would recommend the hospital based
on their recent visit and perceptions of satisfaction with the experience (HCAHPS Survey, 2014).
4. Data Analysis
The data were entered and analyzed by the Statistical Package for the Social Science (SPSS) for Windows,
version 19.0. Prior to statistical analyses, data cleaning and handling of missing values were performed.
Frequency distributions of all the variables were checked for outliers, missing data, and errors. Normal
distributions of the dependent and independent variables were reviewed.
Analyses of the summary statistics were performed that computed the means, standard deviations, frequency
counts, and percentage of demographic data. Mean scores and standard deviations were computed for the three
factors of satisfaction and five factors of servant leadership to answer research questions one, two, and three.
Pearson r correlation was used to answer research question three in this study. It was used to examine significant
relationships between the continuous variables of the five subscales of servant leadership and hospital employee
satisfaction levels. Pearson r is the linear correlation between two variables X and Y, providing a value between
+1 and 1. One is total positive correlation, 0 is no correlation, and negative one is total negative correlation. An
alpha level of .05 level of confidence for statistical tests was set in SPSS 19.0 for Windows software.
The Multivariate Analysis of Variance (MANOVA) was utilized for a direct test of “no relationship” versus “there
is a relationship” with respect to the dependent variables in the analysis. In MANOVA, a linear function (y) of the
dependent variables (servant leadership subscales, three satisfaction scales, and the HCAHP score) in the analysis
is constructed, so that “inter-group differences” on y are maximized. The composite variable y is then considered
in a manner similar to the dependent variable in a univariate ANOVA, in which the null hypotheses is accepted or
rejected. Alpha was set at .05 level of confidence.
The study addressed the following questions: 1). To what degree are leaders in rural community hospitals servant
leaders? 2). What is the level of employee satisfaction in rural community hospitals? 3. What is the relationship
between servant leadership, employee satisfaction, and Hospital Consumer Assessment of Healthcare Providers
and Systems (HCAHPS) scores?
4.1 Analysis of Research Questions and Discussion
1). To what degree are leaders in rural community hospitals servant leaders?
Descriptive statistics were used to determine the degree to which leaders in rural community hospitals are
servant leaders. Table 2 presents the summary statistics from the SLQ. The mean score of all item subscales was
3.28 (SD=1.48) with the item mean ranging from 2.91 (SD=1.52) and 3.59 (SD=1.35). These results indicate that
supervisor behavior ranges between sometimes behaving as a servant leader role to behaving this way often.
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Results indicated that hospital workers perceived higher mean scores in the subscales of organizational
stewardship 3.59 (SD=1.35) and wisdom 3.51 (SD=1.35).
Table 2. Summary statistics of the total subscale scores of the SLQ (N=219)
Mean Std. Variance
Subscales Statistic Std. Error Deviation Statistic
Altruistic Healing 3.10 .05 1.42 2.01
Emotional Healing 2.91 .05 1.52 2.30
Wisdom 3.51 .05 1.35 1.81
Persuasive Mapping 3.23 .04 1.39 1.94
Organizational Stewardship 3.59 .04 1.33 1.76
Note. SLQ Key-Describes the behavior of the immediate supervisor as perceived by the employee:
“1” means not at all (supervisor does not behave in this manner);
“2” means once in a while (supervisor behaves in this manner-once in a while);
“3” sometimes (supervisor behaves this way-sometimes);
“4” fairly often (supervisor behaves this way-often);
“5” frequently, if not always (supervisor typically behaves in this manner).
2). What is the level of employee satisfaction in rural community hospitals?
Descriptive statistics were used to determine the employee satisfaction in rural community hospitals. Table (3)
presents the mean scores and standard deviations for each of the three scales of satisfaction as measured by the
MSQ and the five subscales of the SLQ. Hospital workers had a higher mean score on subscale extrinsic
satisfaction 3.52 (SD=1.29) than intrinsic satisfaction 3.30 (SD=1.40). General satisfaction is a summary of all
satisfaction scores from intrinsic and extrinsic, plus additional questions 3.64 (SD=1.18). Results indicate that
rural hospital worker’s general satisfaction is slightly closer to satisfied than neutral-neither satisfied nor
dissatisfied.
Table 3. Summary statistics of the total subscale scores of the MSQ (N=219)
Mean Std. Variance
Subscales Statistic Std. Error Deviation Statistic
Extrinsic Satisfaction 3.52 .04 1.29 1.68
Intrinsic Satisfaction 3.30 .03 1.40 1.95
General Satisfaction 3.64 .02 1.18 1.39
Note. MSQ Key:
“1” very dissatisfied;
“2” dissatisfied;
“3” neutral-neither satisfied or dissatisfied;
“4” satisfied;
“5” very satisfied.
3). What is the relationship between servant leadership, employee satisfaction, and Hospital Consumer
Assessment of Healthcare Providers and Systems (HCAHPS) scores?
The Pearson r correlation was computed to determine significant relationships between the continuous variables
of the five subscales of servant leadership and the three satisfaction scales (see Table 4). The correlation
coefficients were significant for all of the five subscales of servant leadership and hospital workers job
satisfaction levels at the 0.01 level of significance (.two-tailed).
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Table 4. Pearson's r correlation between servant leadership and job satisfaction
Altruistic Healing Emotional Healing Wisdom Persuasive Mapping Organizational Stewardship
Extrinsic Satisfaction **.673 **..640 **.759 **.660 **.691
Intrinsic Satisfaction **.831 **.728 **.724 **.672 **.685
General Satisfaction **.360 **.340 **.409 **.422 **0.522
Note. **. Correlation is significant at 0.01 level (2-tailed).
Testing the Multivariate Analysis of Variance (MANOVA) between Servant Leadership Subscales, job
satisfaction, and HCAHPS scores results in a number significant correlations at 0.05 level (2-tailed) using the
Pillai's trace test for reporting. The servant leadership subscale extrinsic satisfaction and emotional healing at a
value of .61, F (2, 7) =5.485, is significant at *0.037. The relationship between servant leadership subscale
extrinsic satisfaction, wisdom, and HCAHPS score at a value of 0.619, F (2, 7) = 5.685, is significant at *0.034.
The servant leadership subscale extrinsic satisfaction, persuasive mapping, and HCAHPS score at a value of .622,
F (2, 7) = 5.757, is significant at *0.033. The servant leadership subscale extrinsic satisfaction, organizational
stewardship, and HCAHPS score at a value of .614, F (2, 7) = 5.558, is significant at *0.036. The servant
leadership subscale intrinsic satisfaction, persuasive mapping, and HCAHPS, at a value of .39, F (2, 7) = 5.036,
is significant at *0.030.
The servant leadership subscale intrinsic satisfaction, emotional healing, and HCAHPS, at a value of .407, F (2,
7) = 2.401, is significant at 0.061, is notable just outside the P < 0.05 (2-tailed) range of correlation. In addition,
the servant leadership scale persuasive mapping, general satisfaction, and HCAHPS, at a value of .529, F (2, 7) =
3.932, is significant at 0.072, is notable falling just outside the P < 0.05 (2-tailed) range of correlation.
Results indicate that all of the servant leadership subscales except altruistic healing have a significant correlation
with extrinsic satisfaction and HCAHPS. These results indicate support of a hypothesis that there is a
relationship between servant leadership, extrinsic satisfaction, and HCAHPS. Results also indicate a correlation
between two out of the five servant leadership subscales and intrinsic satisfaction. In addition, general
satisfaction, and persuasive mapping, and HCAHPS have a correlation. However, intrinsic satisfaction and
general satisfaction, overall, do not support the hypothesis that there is a significant relationship between servant
leadership, satisfaction, and HCAHPS scores.
5. Conclusions and Recommendations
Scruggs-Garber, Madigan, Click, and Fitzpatrick (2009) consider Greenleaf’s servant leadership to be the most
effective leadership model to address the challenges that face the health-care industry. The healthcare industry
by nature serves and cares for people, and in such capacity, is the ideal platform to adopt and incorporate servant
leadership (Scruggs-Garber, 2009). The “servant leader” model centers around identifying and addressing the
requirements of followers ahead of individual considerations, ultimately, leading to the development and growth
of the follower as opposed to the needs of the manager or the organization (Jones, 2012a). It is further
characterized by the key qualities for being a good listener, self-awareness, empathy and stewardship, which
enable the leader to better understand their constituent’s needs and maximize their potential, while tailoring their
aspirations to the organizational needs and objectives.
Servant leaders should therefore be viewed as trustees of the human capital of an organization (Berendt, 2012).
Jones (2012b) investigated the effects of servant leadership on the leader-follower relationship and the resulting
impact on the customer focus within the framework of employee satisfaction, empowerment, organizational
culture, and performance. The results of his study indicate that employing servant leadership is conducive to
greater organizational productivity and increased fiscal stability. He further concluded that the increased profits
occurred as a net effect of servant leadership as mediated through improved job satisfaction, a reduction in
employee turnover, and a greater focus on the customer. Mayer, Bardes, and Piccolo (2008) echoed the
sentiment that increased employee performance leads to greater customer focus when an employee views their
manager to exhibit servant leadership skills.
This study empirically assesses servant leadership, employee satisfaction, and their relationship to HCAHPS
scores, which is a measure of patient satisfaction. Through this research it has been acknowledged that servant
leadership and employee satisfaction are strongly correlated and findings are consistent with (Jones, 2012b;
Phillips & Gully, 2012; Mohammad, Al Zeaud, & Batayneay, 2011; Stringer, 2006). In addition, servant
leadership has a significant correlation with extrinsic employee satisfaction and HCAHPS. There is also a
significant correlation between intrinsic satisfaction and a number of servant leadership subscales findings
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36
consistent with (Stringer, 2006).
General satisfaction, persuasive mapping (a subscale of servant leadership), and HCAHPS have a significant
positive correlation. However, the employee satisfaction subscales of intrinsic and general satisfaction are not
significantly correlated to servant leadership and HCAHPS scores. Leadership is important in any organization
and this study highlights the important relationships between servant leadership, employee satisfaction, and
HCAHPS. Managers have the opportunity to enhance their relationships with employees through servant
leadership, and improve customer satisfaction HCAHPS scores for the improvement of their organizations.
5.1 Limitations and Future Research
There are a number of limitations to this study, and one is that it cannot be generalized to all rural community
hospitals and hospitals in the United States due to limited geographic sampling and limited sample conducted in
this study. Further research can be extended to additional categories and geographic areas of the United States to
determine how servant leadership, employee satisfaction, and HCAHPS are related. Managers and leaders of
United States hospitals can benefit from this study. According to the Garman & Lemak (2011) and the American
College of Healthcare Executives (2012) the challenges that healthcare managers face are financial, quality, and
compliance issues. Healthcare manager objectives are to achieve high patient satisfaction and maximize
profitability by using the leadership style that best allows them to achieve these objectives.
Further research of this topic should use a mixed methodology that incorporates qualitative and quantitative
methods. A longitudinal study could also provide data as the landscape of healthcare industry and legislations is
in constant flux. A future study should correlate more of the HCAHPS scores along with servant leadership and
employees’ satisfaction scores. Hospital administrators should examine the findings of this study for possible
implications to their leadership style and practice and how it may impact the organization that they lead.
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... Consideration of job satisfaction among registered nurses and its causative factors are essential for any hospital care association to survive and thrive. 3 According to extensive literature review, most researchers emphasize intrinsic motivation, extrinsic motivation, 4,5,6,7,8 servant leadership, 9,10,26 marital status, educational level, 9,11,12 and years of work experience 9,12,13,14 as being connected to registered nurses' job satisfaction. ...
... Several studies have identified that servant leadership has an optimistic connection with job satisfaction. 10,15,26 Worldwide, literature revealed that high marital eminence is directly proportional to high job satisfaction. 13,14,15 On the other hand, marital status hassignificant positive association with job satisfaction among registered nurses. ...
... 27,30 On the other hand, empirical evidence showed that servant leadership factors can strongly predict registered nurses' job satisfaction. 8,9,10 Consequently, the following figure (Figure 1.1) is shown as the conceptual framework of this study Therefore, the aim of the study was identified predictive power of marital status, educational level, years of work experience, intrinsic motivation, extrinsic motivation, and servant leadership of head nurses on job satisfaction among registered nurses in medical college hospitals of Bangladesh. ...
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Job satisfaction among registered nurses has become a burningmatter in the medicalcare sectors, mainly for the public hospitalsin Bangladesh. Literature is evident that little is known regarding the associated reasons that influence registered nurses’ job satisfaction. Objective: Aim of this study was identified the predictive power of intrinsic motivation, extrinsic motivation, servant leadership of head nurses, marital status, educational level, and, years of work experience on job satisfaction among registered nurses at medical college hospitals in Bangladesh. Methods: Cross sectional research design was employed to inspect the job satisfaction and associated factors among registered nurses at medical college hospitals in Bangladesh. Sample size was determined by power analysis using G* Power to recruit 286 registered nurses from 8 divisional medical college hospitals. Data collection was conducted from April 2017 to September 2017, using the English version job satisfaction scale, intrinsic motivation instrument, extrinsic motivation instrument and servant leadership assessment instrument. Multiple classification analysis was used to examine the predictive powers of registered nurses’ marital status, educational level, years of work experience, intrinsic motivation, extrinsic motivation, and servant leadership of head nurses on the levels of job satisfaction among registered nurses. Results: Findings of the study revealed that extrinsic motivation and servant leadership of head nurses significantly affect registered nurses’ job satisfaction. Registered nurses who are highly extrinsically motivated and their head nurses have higher servant leadership practices tend to be highly satisfied with their job. Conclusion: The results in this study suggest that hospital administrators can promptly enhance extrinsic motivation which includes senior management, supervisor effectiveness, co-worker relationships, and satisfaction with salary and benefits. In addition, administrators should promote servant leadership of head nurses in order to enhance nurses’ job satisfaction in medical college hospitals of Bangladesh. Bangladesh Journal of Medical Science Vol. 22 No. 01 January’23 Page : 205-215
... Therefore, this study aims to prove the impact of this mediation and develop a job performance model based on turnover-mitigating servant leadership. This aim fits into the research gap as the impact of servant leadership on employee performance through other factors has only been analysed to a very small extent (de Waal & Sivro, 2012), or analyses were performed in other research contexts (Krog & Govender, 2015;McCann et al., 2014). ...
... Many authors examine the relationship between servant leadership and other factors. Relationships have been found between servant leadership and employee empowerment, commitment, trust, and innovative behaviour (Krog & Govender, 2015), employee satisfaction (McCann, Graves, & Cox, 2014), organisational culture, organisational citizenship behaviour, and customer satisfaction (Setyaningrum, 2017), and organisational performance (de Waal & Sivro, 2012;Choudhary et al., 2013;Liden et al., 2015;Alafeshat & Aboud, 2019). One of the most significant relationships is with job performance (Liden et al., 2015;Schwarz et al., 2016;Mcquade et al., 2020;Awan et al., 2012). ...
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Turnover-mitigating effect of servant leadership on job performance A B S T R A C T Job performance is an extremely complex factor affecting organisational performance. The literature recognises factors impacting job performance positively and negatively. This article aims to verify the turnover-mitigating effect on the relationship between servant leadership and job performance. The developed moderated mediation model is empirically verified based on the data collected from 263 managers working in Poland's for-profit organisations. The results were analysed using Macro for IBM SPSS Statistics. It has been shown that employee turnover is a mediator in the job performance model based on turnover-mitigating servant leadership. Additionally, the influence of employees' dynamic capabilities has been analysed. The study revealed the significance of servant leadership in influencing job performance and the disruptive relationship between employee turnover and the impact of employees' dynamic capabilities in reducing employee turnover. This research provides practical implications for managers and organisations regarding selecting the right leadership style to improve employee job performance. K E Y W O R D S servant leadership, employee job performance, employee turnover, employees' dynamic capabilities, organisational performance
... Riset terdahulu meneliti tentang pengaruh kepemimpinan yang melayani (servant leadership) terhadap kinerja pegawai telah dikerjakan oleh McCann, et. al. (2014), serta Paramita, et. al. (2015) yang membuahkan hasil kepemimpinan yang melayani bereaksi positif dan signifikan terhadap kinerja pegawai. Riset tersebut tidak sejalan dengan penelitian yang dilakukan oleh Kamanjaya, et. al. (2017) yang menghasilkan kepemimpinan yang melayani tidak berpengaruh signifikan terhadap kinerja pegawai. ...
... Dapat disimpulkan hipotesis ketiga (H3): kinerja pegawai di lingkungan KPP Madya Semarang dipengaruhi positif oleh kepemimpinan yang melayani, diterima. Perolehan dari penelitian ini konsisten dengan riset terdahulu yang telah diteliti oleh McCann et al. (2014), Paramita, Suharnomo dan Perdhana (2015) serta Aprilliansyah, Astuti dan Sulityo (2018) yang memperoleh hasil kepemimpinan yang melayani berpengaruh positif dan signifikan terhadap kinerja pegawai. ...
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... Researchers in several fields have found that the higher an employee's perception of servant leadership in an organization, the higher their job satisfaction (Mccann et al., 2014). Ndoria (2004) uses LMX theory to explain the influence of servant leadership on job satisfaction-success is found to arise from the formation of high-quality relationships and interactions between leaders and followers. ...
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... This provides new insights, highlighting the significance of wisdom leadership (the ability of hotel supervisors/managers to relate to others, be inspirational, helpful, confident, and prepared for many situations) in damping employee intentions to resign as a result of experiencing dysfunctional behavior from hotel guests. This outcome is consistent with that previously stated by Elbaz and Haddoud (2017) and McCann et al. (2014), where the latter states that employees who work under a wise leader can expect some dysfunctional behavior from customers but at the same time are able to deal with it as a result of the wisdom leadership implemented. ...
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The study highlights how dysfunctional customer behavior affects the hotel’s guest-contact employee turnover intention by performing the role of wisdom leadership and job embeddedness. The model was tested using data collected from 325 guest-contact employees in Omani 4 and 5-star hotels. The results suggest that dysfunctional customer behavior increases the likelihood of employee turnover. Wisdom leadership plays a mitigating role in the relationship between dysfunctional customer behavior and employee turnover. Female respondents supported the notion that employees’ cognitive rumination is positively related to employee turnover intention and that customer dysfunctional behavior has a positive relationship with employee turnover. Emotional exhaustion partially mediates the relationship between dysfunctional customer behavior and employee turnover. However, cognitive rumination and employee stress do not mediate the relationship between dysfunctional customer behavior and employee turnover. On the other hand, males showed better support on the basis that wisdom leadership moderates the association between dysfunctional customer behavior and employee turnover. The paper concludes by contributing various implications and directions for future research.
... Research on the effect of servant leadership on organizational performance revealed relations with different factors, including high-performance organization [15] organizational learning [21], employee satisfaction [22] [17] employee engagement and retention [17]. It may be observed that the majority of mediating factors are employee related. ...
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The paper is devoted to the analysis of the role of IT dynamic capabilities on leadership influence on organizational performance. In particular, the analysis concentrates on servant leadership. It is assumed that the dynamic capabilities of IT strengthen the relation between servant leadership and organizational performance, allowing for quicker adaptation of IT solutions to the needs of employees. Empirical research was conducted to verify formulated hypotheses based on results obtained from 263 organizations operating in Poland. Statistical reasoning based on linear regression analysis with moderator was made using SPSS Macro Process. The role of IT dynamic capabilities for enhancing the development of leadership skills, specifically are presented. The findings show that IT dynamic capabilities indeed strengthen the positive influence of servant leadership on organizational performance, boosting the positive role of servant leadership in contemporary organizations.
... The survival of any organization is majorly based on the management of its employees as they play a vital role in attaining organizational desired goals. For this, it has been explored that human resource management practices significantly impact employee and corporate performances (Mccann, Graves, & Cox, 2016). Therefore to sustain the competitive advantage, the organizations should increase their performance by exploring innovative ideas for designing and executing organizational objectives. ...
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Purpose: This paper aims to overview Bahrain’s various H.R. and organisational behavior elements. It will help participants develop effective strategies to improve their organization’s competitive position. Due to the continuous changes in the economy and society, the importance of Human Resource Management has become more significant. It is widely believed that effective H.R. practices can improve an organization’s competitive advantage. Therefore, this paper aims to identify the various factors that affect the human resource management practices of an oil sector company in Bahrain. Method: Due to the Covid 19 situation, the study collected data from around 300 (271 valid cases) employees through a random sampling method. The data were analyzed using Excel and SPSS software. Results: The study revealed that the recruitment process and other factors greatly affected its competitive advantage. Analysis showed recruitment and selection are positively and significantly related to organizational competitiveness. Also, Job design is positively and significantly related to organizational competitiveness. The overall model was highly significant with a coefficient of determination over 0.76. Conclusion: The objective of this study was to identify the various strategies and programs that H.R. leaders can implement to help their firms gain long-term competitive advantages. The study focused on the H.R. strategies of Bahrain’s oil and gas industry. It revealed that employees should be encouraged to behave more intelligent. The researchers noted that the H.R. professionals of large companies could gain this benefit by performing their duties effectively.
... Servant leadership is described as based on caring for others, the common good and ethical behavior. 31 Previous research confirms that applications of a servant leadership style in hospital settings are correlated to nurses' job satisfaction 32,33 as well as organizational trust and intentions to leave. 34 Macro factors are interesting to include as they interact with and may shape factors at other system levels. ...
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... Similarly, researchers from several domains have discovered that such leadership in a school has an impact on the internal atmosphere, student achievement, persistence, and job fulfilment. These are all mandatory factors of the education system (Al-Mahdy et al., 2016;Black, 2010;Cerit, 2009;Stewart, 2017;McCann et al., 2014). The practical study found that SL had a favourable and substantial impact on the job satisfaction of teachers. ...
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Servant leadership is a type of leadership that encourages people to work together. A leader intends to help the institution’s personnel favorably. The school leader interacts with teachers and administrative staff as a collegial friend rather than a boss and tries to make things as easy as possible for them. The major goal of this study was to see if there was a correlation between servant leadership and job satisfaction among secondary school teachers in Pakistani settings. The study’s participants were male and female public sector secondary school teachers from the districts of Lahore and Kasur, of Punjab province, Pakistan. The sample was chosen using a stratified random sampling technique. A total of 510 teachers participated in the study as a sample. In this study, adapted questionnaires with responses measured on a five-point Likert type scale was used. Both variables, perceived servant leadership style of principals and work satisfaction of teachers showed a strong association. Further sub-factors correlations showed significant results. It is proposed that school principals adopt servant leadership style as it would be more beneficial for them to ease and comfort the school employees that might improve the institutional performance.
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Hoveida, Reza; Salari, Somayeh; & Asemi, Asefeh (2011). A Study on the Relationship among Servant Leadership (SL) and the Organizational Commitment (OC): A Case Study. Interdisciplinary Journal of Contemporary Research in Business (IJCRB). 3 (3). 499-504. http://connection.ebscohost.com/c/case-studies/66172699/study-relationship-among-servant-leadership-sl-organizational-commitment-oc-case-study
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